年輕族群高尿酸血症與高血壓關聯性研究之進展

Recent Progress in Studies on the Relationship between Hyperuricemia and Hypertension in the Young

林冠宏(Kuan-Hung Lin) ； 楊振昌(Chen-Chang Yang) ； 胡啟民(Chii-Min Hwu)

《內科學誌》 28卷6期 (2017/12) Pp. 317-324

https://doi.org/10.6314/JIMT.2017.28(6).01

摘要

根據美國全國健康與營養檢查調查(National Health and Nutrition Examination Survey，NHANES)顯示，兒童和青少年的血壓近年來有上升趨勢。兒童與青少年血壓升高與其日後罹患高血壓、微蛋白尿和代謝症候群的風險密切相關。目前已知年輕族群的血壓上升與年齡、性別、種族和身體質量指標有關，但關於生物標記影響彼等血壓值的研究較為缺乏。動物實驗和流行病學研究顯示，較高的血液尿酸值是罹患高血壓的重要因子之一。高尿酸血症造成高血壓的可能機轉包括腎臟血管構造病變、腎小管間質損傷、腎素－血管收縮素系統活化、平滑肌細胞增生、內皮細胞功能阻礙等。本文探討年輕族群高尿酸血症與血壓升高的關聯性和致病機轉，最後評論使用降尿酸藥物作為年輕族群高血壓治療的合理性。

關鍵字

尿酸(Uric acid) ； 高血壓(Hypertension) ； 青少年(Adolescents) ； 異嘌呤醇(Allopurinol) ； 降尿酸藥物(Urate-lowering agents)

並列摘要

Hypertension is the most prevalent disease of the world, and is becoming more common in adolescents. National Health and Nutrition Examination Survey has shown the mean systolic and diastolic blood pressure increased among American children and adolescents. Children hypertension has been associated with an increased risk of developing hypertension, microalbuminuria, and metabolic syndrome. Elevated blood pressure in children and adolescents are known to be correlate to age, gender, ethnicity, and body mass index. It lacks biomarkers to explore which have a more powerful impact on blood pressure levels. Animal experimental studies and epidemiologic studies demonstrated an elevation in serum uric acid is strongly associated with having an elevated blood pressure. Plausible physiologic mechanism that links hyperuricemia and hypertension involves renal arteriolopathy, renal tubulointerstitial injury, activation of renin-angiotensin system, stimulation of smooth muscle cells proliferation and endothelial dysfunction. This article is to investigate the association of serum uric acid and blood pressure in children and adolescents and to study the rationale in urate-lowering therapy as an anti-hypertensive treatment in youths.