Objective To systematically review the effects of fenofibrate on kidney function in various populations, so as to provide references for selecting the methods of treating hyperuricemia. Methods Such databases as PubMed (1966-2013), EMbase (1984-2013), The Cochrane Library (Issue 1, 2012), CBM (1978-2013), and CNKI (1989-2013) were electronically searched for relevant randomized controlled trials or non-randomized controlled trials on fenofibrate for treating hyperuricemia. According to the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 16 studies involving 346 patients were included in total. The results of meta-analysis showed that: a) compared with the control group, the fenofibrate group had the lower serum uric acid level (WMD=48.68, 95%CI 10.02 to 87.34, Plt;0.000 01), lower Ccr (endogenous creatinine clearance) level (WMD=8.88, 95%CI 1.29 to 16.47, P=0.002), and similar serum creatinine level (WMD=1.78, 95%CI –2.86 to 6.42, P=0.45); and b) adverse reaction included gastrointestinal discomforts, skin rashes and transient increase of GPT and transaminase, most of which were mild. Conclusion Fenofibrate has good effects. Due to the low quality of the included studies, the exact effectiveness and adverse reaction need to be rigorously verified based on more multi-center, double-blind, randomized controlled trials with large sample size.
Objective To study the relationship between the levels of plasma fibrinogen, serum bilirubin, uric acid and mild stenosis of coronary artery. Methods Patients with suspected myocardial ischemia who underwent coronary angiography in our hospital were divided into the coronary artery mild stenosis group and the normal control group according to the result of coronary arteriongraphy between April 2007 to May 2009. Logistic regression was used to identify the risk factor of mild stenosis of coronary artery. Results Two-hundred and seventy-nine patients involving 191 patients with mild stenosis of coronary artery and 88 patients with normal coronary artery were included. The factors of gender, age, history of hypertension or diabetes mellitus, smoking history, systolic blood pressure, levels of plasma fibrinogen and serum creatinin were significantly different between the two groups. Multivariate logistic regression models found that the factors of age (OR=1.084, 95%CI 1.040 to 1.129, Plt;0.001), hypertension (OR=3.025, 95%CI 1.462 to 6.261, P=0.003), diabetes mellitus (OR=2.519, 95%CI 1.066 to 5.951, P=0.035), smoking history (OR=5.412, 95%CI 2.186 to 13.401, Plt;0.001), plasma fibrinogen (OR=1.748, 95%CI 1.059 to 2.885, P=0.029), serum bilirubin (OR=0.599, 95%CI 0.418 to 0.858, P=0.005), and high-density lipoprotein (HDL) cholesterol (OR=0.219, 95%CI 0.049 to 0.985, P=0.048) were independently associated with mild stenosis of coronary artery. By contrast, the level of serum uric acid was not associated with mild stenosis of coronary artery. Conclusion Except for traditional risk factors, levels of fibrinogen and bilirubin are independent risk factors of mild stenosis of coronary artery.
【摘要】 目的 探讨血尿酸水平、颈动脉斑块与冠心病之间的关系。 方法 收集2006年1月-2009年12月拟诊为冠心病的住院患者280例,冠状动脉造影检查冠状动脉狭窄程度gt;50%的194例为冠心病组,冠状动脉无狭窄或狭窄程度lt;50%的86例为对照组;冠心病组又分为单支、双支、多支病变亚组。分别测定冠心病组与对照组颈总动脉与颈动脉分叉处内膜中层厚度(IMT)、等级评分、Crouse积分、血尿酸浓度。结果 与对照组相比,冠心病组颈总动脉与颈动脉分叉处IMT、等级评分、Crouse积分、血尿酸浓度均高于对照组,差异有统计学意义。在冠心病组,随病变分支的增多,颈动脉超声检查指标与血尿酸随之升高(Plt;0.05或0.01)。 结论 颈动脉IMT、等级评分、Crouse积分、血尿酸浓度与冠心病相关,是冠心病的独立危险因素。【Abstract】 Objective To investigate the relationships between serum uric acid levels, carotid artery plaque and coronary heart disease (CHD). Methods 194 patients with CHD and 86 nonCHD patients were selected through coronary angiography in patients with essential hypertension. CHD group was divided into three subgroups including a single branch, doublebranch and multivessel disease. Intimamedia thickness (IMT) of carotid artery and carotid bifurcation, grade score, Crouse score, serum uric acid concentrations were detected in patients with coronary heart disease and control group. Results IMT of carotid artery and carotid bifurcation, grade score,crouse score, serum uric acid concentrations were higher in CHD group than that in control group, and the difference was statistically significant. In the CHD group, ultrasound parameters of carotid artery and serum uric acid increased with the increase in branch lesions (Plt;005 or 001). Conclusions Carotid IMT, grade score, Crouse score, serum uric acid concentration relate to coronary heart disease, which is an independent risk factor for coronary heart disease, respectively.
ObjectiveTo evaluate the association between extent and severity of acute coronary syndrome and uric acid, leukocytes. MethodsA retrospective analysis of leukocytes, platelets, lipids and uric acid levels were performed on 23 patients with acute myocardial infarction (AMI group), 17 patients with unstable angina (UA group), and 17 healthy subjects (controls) between January and December 2010. ResultsIn the three groups (AMI, UA, and Control), the leukocyte count was respectively (10.4±3.2)×109/L, (6.9±2.4)×109/L and (5.4±1.1)×109/L (P<0.05); neutrophil was (7.4±3.2)×109/L, (4.8±2.3)×109/L, and (3.4±0.8)×109/L (P<0.001); and uric acid was (401.4±94.3), (384.1±74.1) and (285.5±76.8) μmol/L, respectively (P<0.001). Multinomial Logistic regression showed leukocyte was a predictor for AMI (OR=1.712, P=0.003), while uric acid was not (OR=1.006, P=0.255), regarding the UA group as the reference. When the control group was using as reference, leukocyte was an independently significant factor for AMI (OR=2.942, P=0.004) and was not a significant factor for UA (OR=1.718, P=0.125); uric acid was a significant factor for AMI and UA (OR=1.027, P=0.016; OR=1.021, P=0.041). ConclusionUric acid may be associated with the chronic development of coronary heart disease, while leukocytes may play a potential role in plaque destabilization and the onset of AMI.
ObjectiveTo investigate the correlation of synovial fluid uric acid, the serum and synovial fluid interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α with knee osteoarthritis (KOA). MethodsThe clinical data of 130 patients with KOA treated between January and December 2013 and 30 patients with gouty arthritis (GA) treated at the same period were collected. The clinical symptoms, Western Ontario and McMaster Universities Osteoarthritis Index score, the serum and synovial fluid IL-1β, IL-6, and TNF-α, uric acid levels, radiographic joint stenosis score, and bone hyperplasia score of the patients were compared using t-test analysis and Spearman correlation analysis. ResultsIn the KOA group, the synovial fluid uric acid and joint stenosis score (r=0.31, P=0.037), bone hyperplasia score (r=0.38, P=0.027) were positively correlated; serum and synovial fluid uric acid gradient and hypnalgia were positively correlated (r=0.34, P=0.031); the synovial fluid IL-6 and joint stenosis score (r=0.33, P=0.029), bone hyperplasia score (r=0.37, P=0.032) were positively correlated; the synovial fluid IL-1β and joint stenosis score (r=0.39, P=0.023), bone hyperplasia score (r=0.34, P=0.034) were positively correlated; and the synovial fluid uric acid and IL-1β (r=0.26, P=0.003), IL-6 (r=0.21, P=0.016) were positively correlated. ConclusionSynovial uric acid, IL-1β and IL-6 play a role in the inflammatory progress of knee osteoarthritis.
Uric acid (UA) is the final product of human purine metabolism. As one of the main antioxidants in the body, it can scavenge oxidative radicals. Under the action of oxidative-antioxidant shuttle mechanism, the antioxidant activity of UA can be reversed, causing inflammation and oxidative stress of vascular endothelial cells. Hyperuricemia (HUA) is considered to be one of the major risk factors for diabetes and diabetic nephropathy. The study of HUA in diabetic retinopathy (DR) is also a hot topic. UA can cause retinal vascular sclerosis, and affect the occurrence and development of DR by promoting oxidative stress and inducing neovascularization.
ObjectiveTo investigate the association of preoperative serum uric acid (UA) levels with postoperative prolonged mechanical ventilation (PMV) in patients undergoing mechanical heart valve replacement.MethodsClinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There were 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into a PMV group (>48 h) and a control group according to whether the duration of PMV was longer than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic (ROC) curve..ResultsAmong 311 patients, 38 (12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group (7.48±2.24 mg/dl vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV (rs=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio (OR)=1.44 and confidence interval (CI) 1.15–1.81 (P=0.002). The area under the ROC curve of UA predicting PMV was 0.72, 95% CI0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63.0% at this time, respectively.ConclusionPreoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.
Objective To investigate the risk factors of high peritoneal transport characteristics in patients with end-stage renal disease undergoing initial continuous ambulatory peritoneal dialysis. Method The clinical data of continuous ambulatory peritoneal dialysis patients who underwent initial peritoneal dialysis and catheterization in the Department of Nephrology, West China Hospital of Sichuan University from January 2011 to December 2017 and completed the peritoneal equilibration test were collected retrospectively. According to the ratio of dialysate to plasma ratio for creatinine at 4 hour [D/Pcr (4h)] in the standard peritoneal equilibration test, the patients were divided into 4 groups (low transport, low average transport, high average transport and high transport). Spearman correlation analysis was used to analyze the related factors of D/Pcr (4h). The risk factors of high peritoneal transport characteristics were analyzed by ordered multi classification logistic regression. Results A total of 647 patients were included. The average age of the patients was (45.85±14.03) years, and the average D/Pcr (4h) was 0.67±0.12. Among them, there were 89 cases (13.76%) in the high transport group, 280 cases (43.28%) in the high average transport group, 234 cases (36.17%) in the low average transport group and 44 cases (6.80%) in the low transport group. Diabetic patients with D/Pcr (4h) were higher than those without diabetes mellitus (0.72±0.12 vs. 0.66±0.12; t=−4.005, P<0.001). Correlation analysis showed that age and 24-h urine volume were positively correlated with D/Pcr (4h); serum albumin, triglyceride, potassium, calcium, magnesium, phosphorus, hemoglobin, serum uric acid and creatinine were negatively correlated with D/Pcr (4h); body surface area (BSA), high sensitivity C-reactive protein, ferritin, cholesterol, sodium, intact parathyroid hormone and estimated giomerular filtration rate had no correlation with D/Pcr (4h). Regression analysis showed that serum albumin [odds ratio (OR)=0.842, 95% confidence interval (CI) (0.809, 0.877), P<0.001], serum uric acid [OR=0.996, 95%CI (0.994, 0.998), P<0.001], magnesium [OR=0.389, 95%CI (0.156, 0.965), P=0.042], BSA [OR=3.916, 95%CI (1.121, 13.680), P=0.032] were correlated with the incidence of peritoneal high transport characteristics. Conclusion Low serum albumin, high BSA, low magnesium and low serum uric acid were independent risk factors for high transport characteristics in initial PD patients.
As the largest ecosystem of human body, intestinal microorganisms participate in the synthesis and metabolism of uric acid. Developing and utilizing intestinal bacteria to degrade uric acid might provide new ideas for the treatment of hyperuricemia. The fecal samples of people with low uric acid were inoculated into uric acid selective medium with the concentration of 1.5 mmol/L for preliminary screening, and the initially screened strains that may have degradation ability were domesticated by concentration gradient method, and the strains with high uric acid degradation rate were identified by 16S rRNA sequencing method. A strain of high-efficiency uric acid degrading bacteria was screened and domesticated from the feces of people with low uric acid. The degradation rate of uric acid could reach 50.2%. It was identified as Escherichia coli. The isolation and domestication of high efficient uric acid degrading strains can not only provide scientific basis for the study of the mechanism of intestinal microbial degradation of uric acid, but also reserve biological strains for the treatment of hyperuricemia and gout in the future.