痛風與高尿酸血症的認知與管理

Recognition and Management of Gout and Hyperuricemia

黃麗玲(Li-Ling Huang) ； 林川雄(Chuan-Hsiung Lin) ； 黃建財(Chien-Tsai Huang)

《輔仁醫學期刊》 3卷1期 (2005/06) Pp. 25-32

摘要

本文的目的在回顧最近流行病學上痛風與高尿酸血症的文章，以對痛風與高尿酸血症的認知與管理有新的見解，同時也回顧有關痛風與高尿酸血症臨床上關注的文章。結果發現痛風的自然發展史中，可分作四期：無症狀的高尿酸血症、急性痛風性關節炎、發作間期及慢性痛風性關節炎。痛風是40 歲以上成年男子最常見的關節炎疾病。此外，痛風的發生率正在增加中，且發生的年齡愈來愈早；此很可能與飲食習慣的改變，導致高尿酸血症的發展，進而形成痛風有關。病人在無症狀的高尿酸血症期間，並不需要治療，但需要鼓勵他們藉由改變飲食或生活型態來降低體內的尿酸鹽濃度。使用非類固醇抗發炎藥物、秋水仙素、皮質類固醇或鎮痛劑可終止急性痛風關節炎的發作。而預防急性痛風症狀的復發則可以使用增加腎臟排泄尿酸的藥物及減少尿酸製造的藥物。此外，肥胖、喝酒和某些特定的食物或藥物可促成高尿酸血症的形成。建議這些潛在加重疾病的因子也應該被確認和改變。

關鍵字

痛風 ； 高尿酸血症 ； 尿酸鹽 ； 飲食習慣

並列摘要

The purpose of the article was to review the latest publications on the epidemiology of gout and hyperuricemia, as there have been new insights into the recognition and management of these 2 disease entities. We also review different publications of clinical interest. The results show that the 4 phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. Gout is the common form of inflammatory joint disease in men aged 40 and older. The recent finding is that the incidence of gout seems to be increasing, and the onset of disease apparently occurs at an earlier age; this is likely related to changes in dietary habits that have led to the development of hyperuricemia, and thus gout. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in their diet and/or lifestyle. Acute attacks may be terminated with the use of nonsteroidal anti-inflammatory agents, colchicines, corticosteroids, or analgesics. Probenecid, sulfinpyrazone, and allopurinol can be used to prevent recurrent attacks. Obesity, alcohol consumption, and certain foods and medications can contribute to hyperuricemia. We suggest these potentially exacerbating factors should be identified and modified.

並列關鍵字

gout ； hyperuricemia ； urate ； dietary habits