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。(輔仁醫學期刊2005；3 (1) ：25-32 ) 關鍵詞：痛風，高尿酸血症，尿酸鹽，飲食習慣
黃麗玲 林川雄 黃建財
26 Fu Jen Journal of Medicine Vol.3 No.1 2005
顯示，95%的人其血清尿酸鹽低於 7.0 mg/dl。人 (acute gouty arthritis)、發 作 間 期(intercritical period)及 慢 性 痛 風 關 節 炎(chronic tophaceous gout)[18]。腎結石可發生在第一期以外的任何一
痛風與高尿酸血症
黃麗玲 林川雄 黃建財
28 Fu Jen Journal of Medicine Vol.3 No.1 2005
素、三酸甘油脂等而言是有較多的幫助[24]。而 triphosphate, ATP)，而增加尿酸的生成[27]。此 外，某些酒精性飲料，例如啤酒，也含有較高的 (cytotoxic drug)、維生素 B12 (治療惡性貧血)；
其機轉為減少腎臟排泄尿酸鹽的藥物有環孢靈 (cyclosporine)、呲胺(pyrazinamide)、ethambutol、
levodopa、thiazides、furosemide 和其它的 loop diuretics、菸鹼酸(nicotinic acid)與低劑量的阿斯 匹靈(aspirin)。降血壓藥物 thiazides 系的利尿劑 導致血中尿酸升高的原因是約有原本一半的尿酸 無法自組織中分泌到腎小管所造成的；亦即利尿 劑會阻礙腎小管的分泌作用，進而減少尿液尿酸 的排泄。
痛風與高尿酸血症
七、遺傳因素
兩種特異酵素的異常會引起高尿酸血症，即 hypoxanthine- guanine phosphoribosyl transferase 的缺乏[33]與 phosphoribosyl pyrophosphate 合成
的活性過高[34]。此與性聯遺傳有關。 醇抗發炎的藥物(nonsteroidal anti-inflammatory agents, NSAIDs)、秋水仙素 (colchicines)、皮質
類固醇 (corticosteroids) 或鎮痛劑。無併發症的 病人則以非類固醇抗發炎藥物為最優先的選擇
[18]。使用非類固醇抗發炎藥物有indomethacin、
naproxen 和 ketoprofen 等的選擇。
對急性尿酸腎臟病與尿酸結石的治療應該增 物 有 probenecid 和 sulfinpyrazone 等；而 allopurinol 則是一種可抑制黃嘌呤氧化酵素而減 擇性細胞激素抑制劑(cytokine inhibitor)，和訊
黃麗玲 林川雄 黃建財
30 Fu Jen Journal of Medicine Vol.3 No.1 2005
息 傳 遞(signal transduction)與 基 因 轉 錄(gene transcription)因子抑制劑，也可能對痛風關節炎 與進行性關節破壞提供新的管理與治療方法
[39]。
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