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July 2013, Volume 16, No.20 Abstracts

 The Harms and Management Models of Hyperuricemia

LI Ting,JIN Qin-hua,FAN Jing.Longhua Community Health Center,Xuhui District,Shanghai 200232,China

Abstract As a chronic non-infectious disease,hyperuricemia is bringing more chronic health threats to the population with its increasing prevalence.This paper elaborates the harms of hyperuricemia and reviews the international chronic disease management models,concluding that the combination of management by general practitioner team and self-management is a good approach to the management of hyperuricemia.

Key words Hyperuricemia;Chronic disease; Disease management; Community health services

Relationship of Serum Uric Acid to ba-PWV of Healthy Subjects:Report of 3127 Cases

TANG Zhong-min,WEI Chun-ling,TAN Shi-cheng,et al.The Fifth Affiliated Hospital of Guangxi Medical University,Liuzhou Peoples Hospital,Liuzhou 545006,China

Abstract Objective To explore the relationship between serum uric acid(SUA) and brachial ankle pulse wave velocity(ba-PWV) in subjects having health examinations.

Methods A total 3 127 healthy subjects,2 095 males and 1 032 females,aged between 35 and 64 years old,were enrolled in this study. Height,weight,blood pressure were measured and fasting SUA,fasting plasma glucose(FPG),blood fat and ba-PWV were detected.The subjects were divided into groups A(ba-PWV1 400 cm/s,normal),B(ba-PWV=1 400~1 599 cm/s,slightly faster),C(ba-PWV=1 600~1 799 cm/s,moderately faster),D(ba-PWV1 800 cm/s,severely faster).SUA levels were compared among 4 groups.Males with SUA420 μmol/L and females with SUA350 μmol/L were defined as hyperuricemia(HUA).HUA detection rates were compared in 4 groups.SUA levels and ba-PWV were analyzed correlatively and multivariate regression analysis used to evaluate the influencing factors of ba-PWV.

Results The SUA levels of groups A,B,C,D were 360.7±100.1)μmol/L,394.0±97.5)μmol/L,390.4±100.1)μmol/L,414.0±118.9)μmol/L,respectively,the difference was significant(F=30.514,P=0.000).SUA of males was 412.6±91.7)μmol/L,significantly higher than that of females〔(294.6±70.0)μmol/L,P=0.000.HUA detection rates of groups A,B,C,D were 30.6%, 40.9%, 41.0%, 53.1%, respectively, the difference was significant(P=0.000),those of males(43.7%) higher than those of females(17.2%,P=0.000).SUA was not correlated linearly with ba-PWV in males(r=0.043, P0.05),but positively with ba-PWV in females(r=0.248, P0.05).Taking ba-PWV as independent variables, age, height, weight, systolic blood pressure(SBP),diastolic blood pressure(DBP), FPG, uric acid, TC,TG,HDL-C,LDL-C,Cr as dependent variables,multivariate stepwise regression analysis showed that there was significant difference in effects of SBP,age,FPG,uric acid,body mass, TG, Cr on ba-PWV(P0.05).

Conclusion Increased SUA level in adults especially in females is correlated with faster ba-PWV. Attention should be paid to SUA and ba-PWV determinations in adults having cardiovascular disease or its risk factors.

Key words Hyperuricemia;Pulse wave velocity;Cardiovascular diseases;Risk factors

Relationship of Serum Uric Acid to Arteriosclerosis Diseases in Elder Males

LI Shan-shan,WU Zheng-yu, HUANG Yan-yan.The GP Training Base of Huashan Hospital, Fudan University, Shanghai 200040, China

Abstract Objective To investigate the relationship between serum uric acid (SUA) and arteriosclerosis diseases.Methods A total of 1, 002 males (aged at 60~89 years old) screened out from 1, 258 subjects were divided,according to age,into groups A (aged at 60~69,n=187),B (aged at 70~79,n=472),C (aged at 80~89,n=243),and divided,according to SUA level,into groups normal SUA group (420 μmol/L, n=721),high SUA (420 μmol/L, n=281).The relationship of SUA to age,total cholesterol (TC),triacylglycerol (TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),fasting blood glucose (FBG),glycosylated hemoglobin (HbA1c ),serum creatinine (Scr),blood urea nitrogen (BUN),systolic blood pressure (SBP),diastolic blood pressure (DBP) were analyzed.Results There was no linear correlation between SUA and age (r=0.027, P0.05),no significant difference was noted in SUA between groups A,B,C (P0.05).SUA was positively correlated with TG,Scr,BUN (r=0.268,0.206,0.188,respectively,P0.05),negatively with HDL-C,FBG (r=-0.286,-0.064,P0.05),not linearly with TC, LDL-C,HbA1c ,SBP,DBP (r=0.044,0.050,-0.012, 0.055, 0.043, respectively, P0.05).The levels of TG, Scr, BUN were higher in high SUA group〔(1.84±1.16mmol/L,95.38±24.80)μmol/L,6.85±2.03mmol/L, respectively than in normal SUA group 〔(1.37±0.67mmol/L,83.71±29.53)μmol/L,6.71±1.61mmol/L, respectively,and HDL-C lower in high SUA group 〔(1.12±0.25mmol/L than in normal SUA group 〔(1.27±0.30mmol/L,the difference was significant (P0.05).SUA was correlated with hyperlipidemia, hypertension, coronary heart disease(CHD),chronic renal insufficiency (CRI)(β=2.108,1.688,1.720,1.738,2.108,respectively,P0.05).The incidences of hyperlipidemia, hypertension, CHD, CRI were higher in high SUA group than in normal SUA group 43.4% vs 26.1%,76.5% vs 61.0%,31.0% vs 27.3%, 9.6% vs 2.5%,respectively,but there was not difference in incidence of diabetes between two groups (22.8% vs 23.0%).Conclusion The incidences of hyperlipidemia,hypertension,CHD,CRI are higher in high UA elderly males than in normal UA ones.

Key words Aged; Men; Uric acid; Arteriosclerosis

Relationship between Serum Uric Acid Level and Non-alcoholic Fatty Liver Disease in Uygur

CAI Wen,SONG Jiang-mei,WANG Shu-xia,et al.Xinjiang Medical University,Urumqi 830000,China

Abstract Objective To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and the relationship between serum uric acid (SUA) level and NAFLD in Uygur.

Methods We conducted a questionnaire survey among 2 241 Uygurs (1 214 males and 1 027 females) who had physical checkups in the First Affiliated Hospital of Xinjiang Medical University between July 2011 and July 2012.Body mass index (BMI),abdominal circumference, blood pressure, fasting plasma glucose,fasting plasma glucose,and SUA level were measured.

Results The prevalence rates of NAFLD and hyperuricemia were 43.90% (984/2 241) and 8.38% (188/2 241), respectively. NAFLD patients had significantly higher SUA level than those without NAFLD(320±88)μmol/L vs.254±80)μmol/L,P0.05.The prevalence rate of NAFLD was significantly higher in subjects with hyperuricemia than in those without (78.19% vs.40.83%,P0.05).The increase of SUA level was associated with increased fasting plasma glucose, and higher prevalence of metabolic syndrome, blood pressure elevation, hypertriglyceridemia, low high-density lipoprotein cholesterol, and central obesity (P0.05).Multiple regression analysis showed that hyperuricemia was associated with an increased risk of NAFLDodds ratio=2.086,95% confidence interval(1.344,3.237).Conclusion SUA level is significantly associated with NAFLD, and elevated SUA level is an independent risk factor for NAFLD in Uygur ethnic group of China.

Key words Fatty liver,non-alcoholic; Uric acid; Uygur nationality

Treatment with 1, 25(OH) 2D3 Combined with Irbesartan on IgA Nephropathy and Its Effect on T Cell SubsetRandomized Controlled Trial

YE Kun, PENG Xiao-mei, WEI Qiao-yu, et al.Department of Nephrology, Peoples Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China

Abstract Objective To prospectively observe the clinic efficacy and safety of 1, 25(OH)2D3 combined with irbesartan for IgA nephropathy, and discuss its effect on T cell subset.

Methods Forty-five IgA nephropathy inpatients in our department between 2009 and 2010 were randomly divided into irbesartan group(irbesartan 150 mg/d), 1, 25(OH)2D3 group1, 25(OH)2D3 0.25 μg/d, and combined treatment groupirbesartan 150 mg/d+1, 25(OH)2D3 0.25 μg/d.Proteinuria, blood creatinine(Cr), blood calcium(Ca), and T cell subset of three groups were detected before and after the treatment.

Results No significant differences were observed in proteinuria, blood Cr, blood Ca, CD+4, CD+8, and CD+4/CD+8 among the three groups before the treatment(P0.05).After treatment for 12 weeks, level of proteinuria in irbesartan group and combined treatment group significantly decreased compared to that before the treatment(570±66)mg/24 h vs.977±116mg/24h, 286±72mg/24 h vs.931±140mg/24 h; P0.05.The level of proteinuria in combined treatment group was significantly lower than that in irbesartan group and 1, 25(OH)2D3 group〔(607±143mg/24 h, P0.05.No significant differences were observed in levels of blood Cr and blood Ca among the three groups after treatment for 12 weeks(P0.05).The level of blood Ca in combined treatment group was higher after the treatment than before〔(2.30±0.06mmol/L vs.2.28±0.12mmol/L; P0.05.All patients had no side effects or hypercalcemia. After treatment for 12 weeks, level of CD+4 and CD+4/CD+8 significantly descended in combined treatment group(P0.05).

Conclusion 1, 25(OH) 2D3 combined with irbesartan can reduce proteinuria in patients with IgA nephropathy effectively and safely, in which down-regulation of CD+4 and CD+4/CD+8 may be one of the mechanisms.

Key words Glomerulonephritis, IgA; Calcitriol; Irbesartan; Proteinuria; T-lymphocytes

Relationship of Personality Types to hs-CRP and P-Selectin in CHD PatientsA Follow-up Research

ZHOU Jian-zhi, SU Yong-chen, BO Hai-mei, et al.Hospital of Hebei United University, Tangshan 063000, China

Abstract Objective To analyze relationship of personality types to high sensitivity C reactive proteinhs-CRPand P-selectin in patients with coronary heart diseaseCHDand to observe patients major adverse cardiac eventsMACEin 1-year follow-up.

Methods A total of 336 patients were divided into groups control, angina pectorisAP, myocardial infarctionMI.Type A behavior pattern scale was used to judge personality types, and hs-CRP and P-selectin levels were detected.The followed up lasted 1 year to observe the occurrence of MACE.

Results By personality type analysis, there was significant difference in hs-CRP and P-selectin in 3 groupsP0.05, and group AP higher than control group, MI group higher than groups AP and controlP0.05; There were 14 cases of A-type personality in control group25.5%, 80 in AP group52.3%, 82 in MI group64.1%, the difference was significantP0.05, cases of A-type were more in AP group than in control groupP0.05, more in MI group than in groups AP, controlP0.05; hs-CRP and P-selectin higher in A-type cases than in B-type casesP0.05.By analysis of follow-up results, 263 patients had stable conditions78.3%, 73 had MACE21.7%, including 54 cases of UAP16.1%, 9 AMI2.7%, 3 deaths0.9%.Forty-nine A-type patients had MACE27.8%, higher than B-type25 cases, 15.0%, the difference was significantP=0.05.

Conclusion Severe CHD patients have high levels of hs-CRP and P-selectin, people with A-type personality have a higher incidence.In addition, hs-CRP and P-selectin levels are higher in A-type patients than in B-type, and so is 1-year MACE incidence.

Key words Coronary disease; Personality type; C-reactive protein; P-selectin; Follow-up study

Changes of Serum Levels of Homocysteine and Cystatin C in Patients with Diabetes and Its Complications before and after Treatment with Lipoic Acid

ZHANG Li,LV Xiao-feng,WU Jin-xiao,et al.Department of Endocrinology,the Military General Hospital of Beijing PLA,Beijing 100700,China

Abstract Objective To observe the changes of serum levels of homocysteine (Hcy) and cystatin C (Cys C) before and after lipoic acid treatment in patients with diabetes,often combined with diabetic neuropathy and lower extremity vascular disease.

Methods A total of 84 patients with type 2 diabetes mellitus (T2DM) admitted to our hospital between August 2011 and August 2012 were assigned to the simple diabetic group (SDM, n=28),diabetic peripheral neuropathy group (DPN, n=27),and low extremity vascular disease group (VDF, n=29).Another 30 non-diabetic/healthy controls were recruited from health check-up population (NC,n=30).Serum Hcy and Cys C levels, body mass index (BMI),blood pressure, hemoglobin A1c (HbA1c ),fasting blood glucose (FBG),levels of lipids and lipoprotein aLP(a) of all subjects were measured before the treatment. Levels of Hcy and Cys C of patients in SDM, DPN, and VDF groups were measured again after lipoic acid treatment for two weeks.

Results Before treatment,serum levels of Hcy and Cys C of VDF group(20.86±3.07)μmol/L and (3.28±1.01)mg/L were higher than those of DPN group(14.78±2.29)μmol/L and (2.00±0.37)mg/L,which were higher than those of SDM group(11.42±2.84)μmol/L and (1.49±0.44)mg/L,P0.05.After lipoic acid treatment, serum levels of Hcy and Cys C of the three groups (SDM,DPN,VDF) all decreased Hcy:(8.73±1.91),(10.81±1.88),(16.43±3.11) μmol/L;Cys C:(1.25±0.40),(1.50±0.36),(2.72±0.72) mg/L, P0.05.Pearson correlation analysis showed that serum Hcy level was positively correlated with the course of disease, and the levels of HbA1c ,LP (a),and Cys C (r=0.553, 0.511, 0.499, 0.650; P0.05),but did not have correlation with age, FBG, triglyceride (TG),total cholesterol (TC),low-density lipoprotein-cholesterol (LDL-C),high-density lipoprotein-cholesterol (HDL-C),systolic blood pressure (SBP),or diastolic blood pressure (DBP) (P0.05).Serum Cys C level was positively correlated with the course of disease, SBP, LP(a), and Hcy (r=0.354, 0.409, 0.493, 0.650; P0.05),but did not have correlation with age, BMI, HbA1c, FBG, TG, TC, LDL-C,HDL-C, or DBP (P0.05).Multivariate Logistic stepwise regression analysis showed that Hcy and Cys C were influencing factors of DPNOR=1.284, 2.523; 95%CI1.032, 1.492,1.143, 13.192)

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