DOI: https://doi.org/10.30841/2307-5112.5-6.2019.193365

Менеджмент пациентов с бессимптомной гиперурикемией – лечить или не лечить?

І. Ю. Головач, Є. Д. Єгудіна

Аннотация


В статье рассмотрены причины возникновения гиперурикемии, в том числе влияние таких факторов, как ожирение, метаболический синдром, снижение функции почек.

Гиперурикемией называется повышение уровня мочевой кислоты сыворотки крови более 360 мкмоль/л у женщин и более 420 мкмоль/л у мужчин. Наиболее обоснованным считается уровень мочевой кислоты не более 6,8 мг/дл (400 мкмоль/л), при котором в физиологических условиях происходит кристаллизация. Распространенность сопутствующих заболеваний, ассоциированных с гиперурикемией, увеличилась в течение последних двух десятилетий.

Гиперурикемия (и/или подагра) может быть причиной или следствием сопутствующей патологии. В то время как эпидемиологические исследования предполагают, что гиперурикемия может быть связана с сердечно-сосудистыми, метаболическими и почечными сопутствующими заболеваниями, исследования менделевской рандомизации не предоставили доказательства того, что эти связи являются причинно-следственными. Расхождения между результатами обсервационных и клинических исследований не позволяют выработать рекомендации о потенциальных преимуществах уратснижающей терапии (УСТ) у отдельных пациентов с бессимптомной гиперурикемией. Соотношение риска и пользы УСТ остается неясным неясно. Риск развития подагры в результате бессимптомной гиперурикемии, оцениваемый в 50%, должен быть сопоставлен с риском кожных и сердечно-сосудистых побочных эффектов ингибиторов ксантиноксидазы. Напротив, необходимость в оптимальном менеджменте сопутствующих заболеваний общепризнана. Среди лекарственных препаратов, принимаемых пациентами для лечения сопутствующих заболеваний, следует отменить агенты, обладающие гиперурикемическим действием и заменить на препараты, которые оказывают противоположное действие. Изменения в образе жизни, снижение массы тела и достаточная физическая активность полезны для улучшения общего состояния здоровья. О том, оказывает ли УСТ благоприятное влияние на сопутствующие заболевания, станет известно только при наличии мощных интервенционных испытаний с соответствующими первичными конечными точками.

Ключевые слова


бессимптомная гиперурикемия; подагра; метаболический синдром; сердечно-сосудистые заболевания; хроническая болезнь почек; уратснижающая терапия; диета; модификация образа жизни

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Литература


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