原标题：
约20%的高尿酸血症会出现痛风的症状，其余80%没有症状，但却同样会对心脏、肾脏等人体重要器官产生危害。
Roughly 20 per cent of high urinate hemorrhagic disorders show symptoms of gout, while the remaining 80 per cent have no symptoms, but they also cause harm to vital human organs such as the heart, kidneys, etc.
医学指导／广州市第一人民医院肾内科主任医师、广东省医学会肾脏病分会副主任委员傅君舟教授
Medical guidance/Head of Nephrology at Guangzhou City Hospital No. 1 and Deputy Director of the Society of Renal Diseases, Guangdong Province
春节长假刚结束，陈先生的痛风又犯了，“都怪我假期没有严格遵照医生的嘱咐，回老家和朋友喝了好几回啤酒，还吃了不少海鲜。”事实上，像陈先生这种因为“管不住嘴”而导致痛风发作的患者不少，“每次长假结束门诊就有不少这样的病人。”广州市第一人民医院肾内科主任医师傅君舟教授告诉记者，近年来，高尿酸血症发病率日益走高，“10%～13%的发病率其实已和人们所熟知的糖尿病相当，但大家对高尿酸血症的认知却还存在着许多缺失。”傅君舟指出，高尿酸血症对心脏、血管和肾脏等人体重要组织和器官的危害不亚于高血压、糖尿病，“但很多人以为高尿酸血症只要不引发痛风就无需理会，这种认识亟待纠正。”
& & & & & & & & & quo; & & & & & & & & & & & & ; & & & & & & & & & & ; & & & & & & ; & & & & & & & ; & & & & & & ; & & & & ; & & & & & & ; & & ; & & & & & & ; ; & & & & & ; ; & ; & ; ; & & & & ; ; ; ; ; & ; ; ; ; & ; ; ; ; ; & ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;
文／广州日报记者黎蘅、李津 通讯员黄月星、魏星
Wen/Kongzhou daily reporters Le Chiu, Li Xin, correspondent Wong Moonxing, Wei Xing
发病：
Morbidity:
每10人中就有1人患病
近年来，高尿酸血症越来越多地出现在公众视野中，在正常嘌呤饮食状态下，非同日两次空腹血尿酸水平男性高于420μmol/L，女性高于360μmol/L，即可诊断为高尿酸血症。
In recent years, hemorrhagic hypertension has become increasingly visible in the public domain, and under normal dietary conditions it is more than 420 permu for males, more than 360 perm for females, and more than 36 perm for males, more than twice on the same day.
这是一种由嘌呤代谢紊乱、尿酸排泄障碍所引起的疾病，易对人体多器官组织产生损害。
It is a disease caused by metabolic disorders and urinary acid discharge disorders, which can cause damage to human multi-organic tissues.
傅君舟介绍，我国高尿酸血症的发病率不断升高，根据近两年的统计，我国的高尿酸血症患者超过1亿，约占总人口的10%～13%，其中多食海鲜的沿海地区、多食肉食的内陆牧民聚集地区发病率要高于13%。
According to Fu Junchang, the incidence of high urea haemorrhagic disease is on the rise in our country, where, according to statistics for the last two years, there are more than 100 million people suffering from high urea haemorrhagic disease, about 10 to 13 per cent of the total population, of which the prevalence rate is higher than 13 per cent in coastal areas where seafood is high, and in areas where there is a high concentration of inland herdsmen.
高尿酸血症的高发与多种因素有关，包括遗传、生活方式、饮食习惯、药物治疗和经济发展程度等。
The high incidence of hypertension is associated with a variety of factors, including genetics, lifestyle, dietary habits, drug treatment and economic development.
症状：
Symptoms:
高尿酸不一定会痛风
说起高尿酸血症，人们通常首先联想到痛风。久而久之，不少人会把痛风与高尿酸血症画上等号，认为只有出现了痛风症状才意味着患了高尿酸血症。傅君舟对这种片面理解进行了纠正。
When it comes to haemorrhage, people tend to think of gout first. For a long time, a lot of people have equated it with haemorrhage, which means haemorrhage only if there is a haemorrhage. This one-sided understanding has been corrected.
“一般只有当尿酸盐在机体组织中沉积下来造成了损害，患者才出现痛风。临床上将高尿酸血症分为‘有症状的高尿酸血症’和‘无症状的高尿酸血症’。前者尿酸水平检测超过正常值，并且高尿酸血症对患者器官产生了一定损害，其中最常见的就是人们熟悉的痛风。而无症状的高尿酸血症患者的尿酸水平也超过正常值，但没有尿酸盐沉积在关节或软组织里，因此没有痛风关节炎、痛风石、尿酸结石等表现。”
& & ldquo; patients have a gout only when damage is caused by the deposition of urinate in the tissue of the organism. Clinically, &lsquo is divided into ‘ & rsquo; and ‘ & non-symptomatic ureaemia & & rsquo; & & & & & & & & & & & & & & & & & & & Qu; & urinary acid levels are detected above normal values and high urinate blood conditions cause certain damage to the patient's organs, the most common of which is the familiar bad wind. & & & & & rdquo;
傅君舟补充说，事实上，超过80%的高尿酸血症患者没有临床表现。“无论有无症状，二者对人体的器官损害程度是一样的，相对来说，‘无症状的高尿酸血症’更危险，就像是‘沉默杀手’，许多患者直到体检抽血报告出来后，才发现自己血液中的尿酸值超标了。”
Fu Junchang added that, in fact, more than 80% of the patients with high urinary acid have no clinical performance. & ldquo; both have the same degree of organ damage to the human body, irrespective of the symptoms, relative, &lsquao; non-symptomatic ’ more dangerous, like ‘ silent killer & rsquo; many patients find urinary acid in their blood to be overvalued only after a medical examination of the blood. & & rdquao;
危害：
Hazard:
损伤心脏、肾脏 与多种疾病有关
Heart, kidney damage related to multiple diseases
“痛风仅仅是高尿酸血症患者的一种临床表现，它的危害远不止如此。”傅君舟指出，根据国内外近年来对高尿酸血症与心血管系统关系的大规模临床调查显示，可以肯定高尿酸血症是心血管系统疾病的独立危险因素。例如许多原发性高血压病人伴有高尿酸血症。
& ldquo; gout is merely a clinical expression for people with high urinary acid hemorrhagic disease, and the harm is far more than that. & & rdquo; Fu Junchang pointed out that, according to large-scale clinical investigations into the relationship between high urea hemorrhagic disease and cardiovascular system in recent years, both at home and abroad, it can be ascertained that high urea is an independent risk factor for cardiovascular system diseases. For example, many patients with primary hypertensive hypertension are accompanied by high urinary acid haemorrhosis.
此外，高尿酸血症对冠心病的影响也十分显著。“高尿酸会损害人体血管的内皮细胞，导致血管的收缩状态，产生高血压、心脏缺血、动脉硬化等一系列问题。因此目前医学界已经达成共识，高尿酸是冠心病独立高发或已有冠心病容易导致死亡的危险因素，国外有研究数据表明，高尿酸血症所带来的冠心病死亡风险甚至可以增加50%以上。”傅君舟谈道。
In addition, the effects of leukemia on coronary heart disease are also significant. & ldquo; hyperurinary acid damages the inner skin cells of human blood vessels, leading to a series of problems such as constriction of blood vessels, high blood pressure, heart ailment, arterial sclerosis, etc. There is now a consensus in the medical community that puretic acid is a risk factor for the high incidence of independent coronary disease or for the death of existing coronary heart disease, and studies from abroad show that the risk of coronary blood disease can increase even by more than 50%. & rdquao;
不容忽视的是，高尿酸血症还能引起肾脏损伤。傅君舟说：“尿酸盐结晶沉积在关节会引起痛风，沉积在肾小管、肾间质，容易导致肾脏的炎症性损伤。非结晶尿酸导致肾脏小血管收缩、肾脏缺血，最终同样导致肾功能的损害。”此外研究表明，高尿酸血症还与糖尿病、高甘油三脂血症、代谢综合征有密切关系。
What cannot be ignored is that high urinary acid hemorrhage can also cause kidney damage. The canon says: “ urinate crystalline deposition in joints can cause agonizing strokes, which can be deposited in kidney tubes, between kidneys, and can easily cause inflammation damage in the kidneys. Non-crystal urinary acid leads to a contraction of the kidney vasculars, a lack of blood in the kidneys, and ultimately also to damage kidney function. And & rdquo; research also shows that high urinate hemorrhosis is closely linked to diabetes, high glycerin triglycerin, metabolic syndrome.
诊治：
Treatment:
分型用药效果显著
Disaggregated Drug Use Visible
既然高尿酸血症对人体健康有这么多的风险，那么我们该如何面对呢？
How are we supposed to deal with the risks to human health posed by leukaemia?
首先，高尿酸血症的诊断并不难，“前面已经提到过，只要非同日两次空腹血尿酸水平超标就能诊断。”
First, & ldquo is not difficult to diagnose; as already mentioned, it can be diagnosed if the levels of haemorrhage are not exceeded twice on the same day. & rdquao;
那诊断出高尿酸血症就要马上治疗吗？
So you're gonna have to treat him right away when you're diagnosed with high urinary acid?
“肯定是应该积极治疗的，但治疗不意味着就是吃药。”傅君舟指出，如果患者除了血尿酸超标之外并无其他症状，例如痛风等，而尿酸虽然超过了正常值，但小于480μmol/L时，在无冠心病危险因素的基础上，可以先从改善生活方式做起，暂时不用药；但如果患者年龄已经超过60岁，又有冠心病、糖尿病、抽烟史等，则应该药物治疗和改善生活方式同时进行。
& & ldquo; definitely positive treatment, but treatment does not mean taking drugs. & & & & & & & & ; & & & & ; & & & ; & & ; & & ; & & ; & & & & & & & & ; & & & & ; & & & & & & & & & ; & & & & ; & & ; & & ; & & & & & & & ; & & & & & & & & & & & & & ; & & & & & ; & & & & ; & & & & & & ; & & & & ; & & & & ; & & & & & ; & & & & & & & & & & ; & ; & & &, & & & & & &, & & &, &,,, & & & &,,,,,, & &,, & &, & & & &,,, &,, & &, &,, &,,, &,,,,, & &,,,,,,, &,, & &,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
事实上药物治疗也并不复杂，“常用的也就三种药物，而且疗效明确。”傅君舟指出，需要注意的是，选对药物对于高尿酸血症治疗至关重要。这是因为，高尿酸血症的发病机制分为两种：尿酸排泄障碍型（占总发病人数80%~90%）和尿酸生成过多型（占总发病人数10%~20%）两种。“通俗地说，前者是身体的排泄机制出了问题，尿酸排不出去；后者则是体内产生的尿酸太多，身体来不及排泄。”
In fact, medications are not complicated, “ there are only three kinds of medications that are commonly used and have a clear effect. & & & & & & & & & & & & & & & & & & & & & & ; & & & & & & & & & & & ; & & & & & & & & & ; & & & & & & & & & ; & & & & & & & & & ; & & & & & ; & & & & ; & & & & ; & & ; & & ; & & & ; & ; & & ; & & & & ; & & & & ; & & & & ; & & ; ; & & & & ; ; ; ; & & & ; ; ; & ; ; ; ; ; ; & ; ; & & ; ; ;
而目前临床上常用的两大类药物，一种是针对血尿酸排泄障碍的，另一种则是针对血尿酸生成过多的。因此，理想的治疗方式是先明确患者是属于“排泄障碍型”还是“生成过多型”（或两者都有），再进行针对性用药。
The two types of medication that are currently commonly used in clinical settings, one for urinary acid excretion disorders and the other for excess urinary acid production. Thus, the preferred treatment is to identify the patient as & ldquo; excretion type & & rdquo; & & & & & ldquo; to produce too many & rdquo; or both) and then to apply the specific drug.
傅君舟说，若药物有效，通常在用药7~10天左右即能看到明显效果，因此医生一般会要求患者在用药两周后复查；若患者服药后尿酸值没有明显改善，就需要调整用药。
Fukuo said that, if the drug was effective, it would normally be visible within 7 to 10 days of use, so doctors would usually ask the patient to review the drug after two weeks; if there was no significant improvement in the urinary acid value of the patient after taking the drug, the drug would need to be adjusted.
那么临床上治疗高尿酸血症，哪些药物疗效显著？傅君舟介绍，尿酸生成过多型患者多使用别嘌呤醇和非布司他两种药物。“有一点要注意，少数患者对别嘌呤醇过敏，亚裔人群过敏率相对较高，这种过敏会导致严重的剥脱性皮炎，甚至有致死风险，因此在使用别嘌呤醇之前要求患者进行基因检测。非布司他极少发生过敏，作用明显，但心血管病人用药需谨慎，且价格较贵。”
And & ldquo; one thing to note is that a few patients are allergic to beryllium and that the Asian population has a relatively high rate of allergies, which can lead to severe decoupling skin inflammation and even a risk of death, and therefore require a genetic test of the patient prior to the use of beryllium. He rarely has an allergy in the non-buzz, which is obvious, but the cardiovascular patient needs to be cautious and expensive. & rdquao;
尿酸排泄障碍型患者则多用苯溴马隆，此外，对于同时有高尿酸血症和高血压的患者，还可服用氯沙坦进行辅助治疗。傅君舟提醒，高尿酸血症患者应对尿液酸碱值进行自检，保证尿液酸碱值控制在pH6.2~6.8之间，酸碱值小于pH6.2的患者，必要时可遵医嘱服用小苏打片碱化尿液。
In the case of patients with urinary acid excretion disorders, phenyl-bromomalone is used more frequently, and in the case of patients with high urea hemorrhage and hypertension, chlorsatine is also used for supplementary treatment.
至于很多患者担心的药物副作用，傅君舟指出，除了极少数人群对别嘌呤醇过敏之外，其他药物对副作用并不明显，和常用的高血压、糖尿病药物的副作用差不多。事实上，对于大多数高尿酸血症患者来说是要做好长期治疗准备的，“部分患者经过一段时间的药物治疗后如果血尿酸水平回归正常值，可以考虑减药甚至停药，但这期间一定要做好定期检测，如果尿酸水平出现反复，那就需要重新进行药物治疗。”
As for the side effects that many patients are concerned about, Fu Juntao points out that, apart from a very small number of people who are allergic to pyreol, the side effects of other drugs are not obvious, and are similar to those of commonly used high blood pressure, diabetes drugs. In fact, for most patients with high urea hemorrhagic disease, “ some patients who, after a period of drug treatment, return to normal levels of blood urinary acid may be considered for decomposition or even decomposition, but this must be done on a regular basis, and if the urinary acid level is repeated, the medication will need to be re-treated. & & rdquo;
预防：
Prevention:
养成健康生活方式 控制嘌呤摄入量
To develop a healthy lifestyle and control
普通人如何在日常生活中预防高尿酸血症？傅君舟指出，第一，要重视常规体检，这对于无症状高尿酸血症患者非常重要，普通的常规抽血即可反映血尿酸值是否超标，及早发现，及早治疗。一般可以选择到医院的风湿科、骨科、肾内科甚至风湿免疫科和内分泌科寻求诊断治疗。 How do ordinary people prevent haemorrhagic acid in their daily lives? First, according to Fu Junchang, it is important to focus on routine medical examinations, which are important for patients with non-synchronous hyperurbic acid, which is reflected in regular blood withdrawals, early detection, and early treatment. 第二，养成良好的健康方式，多运动（但避免剧烈运动），控制体重，尽可能戒烟，少喝酒。已确诊的高尿酸血症患者，由于其嘌呤代谢紊乱，应避免吃海鲜、动物内脏、浓肉汁汤等高嘌呤食物；切忌“啤酒或白酒+海鲜”的搭配，啤酒、白酒本身不产生尿酸，但有抑制尿酸排泄的作用，红酒可以适当少量喝。 Second, to be healthy, to exercise well (but to avoid intense physical activity), to control weight, to stop smoking as much as possible, and to drink less. Persons with confirmed high urinate hemorrhage, due to their metabolic disorders, should avoid eating high urinary foods such as seafood, animal internal organs, gravy soup; toxy &ldquao; beer or white wine + seafood & rdquao; and to mix beer, white wine, which does not produce urinate in itself, but which has the effect of discouraging urinate from excretion, red wine can be used in appropriate quantities. 对于一般非内脏的肉类、豆类、菇类等“次危险类”食物，患者可以适量摄入，但不能为追求低嘌呤而完全不吃，否则易导致营养不良。傅君舟表示，尚未服药的患者应严格控制嘌呤摄入量；而由于个体的代谢、基因差异，正在使用药物的患者可根据尿酸检测结果，遵医嘱适当放宽嘌呤摄入。 For meat, pulses, mushrooms, etc. that are generally not in vitro & ldquo; sub-hazard & rdquo; food, patients can take an appropriate amount of food, but they cannot simply not eat it for the purpose of pursuing it. 第三，每天多饮水。普通人每天应摄入150~2000ml的水分（包括从食物中摄取的水分），而患者在服药期间更需要增加饮水量，每天应饮用2000ml以上的纯水（不包括从食物中摄取的水分）。 Third, there are more drinking water per day. The average person should take 150 ~ 2,000 ml per day (including water taken from food), while patients need to increase the amount of drinking water during their medications and drink pure water above 2000 ml per day (excluding water taken from food). 第四，慎用可能引起尿酸排泄的药物和使尿酸升高的药物。 Fourthly, care should be taken in the use of drugs that may cause urinary acid discharge and those that increase urinary acid.
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