Prevention Measures Of Two Types Of Acute Hyperuricemia

Objectives:Hyperuricemia(HUA)is an important manifestation of metabolic syndrome,and is closely related to gout,hypertension,diabetes,cardiocerebrovascular disease,renal disease and so on.However,it was suggested that acute HUA can also cause serious situations.Because acute HUA mainly occurs in some specific circumstances,the prevention and treatment of acute HUA does not attract sufficient attention like that of sustained HUA,but it is easily neglected.And it was reported that vitamin C and benzbromarone played important roles in the prevention and treatment of HUA in the general population,respectively.Therefore,we selected two typical kinds of acute HUA named acute high-altitude hyperuricemia(HAHU)and pyrazinamide-induced hyperuricemia(PIHU)which is closely related to my profession to explore preventive measures against different acute HUA.Methods:The first part of my study was a prospective controlled study for HAHU.It was divided into two sub-studies.The study enrolled the young male recruits who entered the Tibet Plateau for the first time.The first study(Study I)was completed in 2015.The subjects were assigned to the vitamin C group and the blank control group.The vitamin C group was administered by vitamin C with a dose of 500 mg/d for one month.The blank control group has no intervention.Serum uric acid(SUA),serum creatinine(SCr),and blood urea nitrogen(BUN)levels were monitored at baseline(MO)and one month of observation(Ml).The difference between the two groups of SUA levels and the incidence of HAHU were compared.The second study(Study Ⅱ)was completed in 2016.The subjects were assigned to the vitamin C group(500 mg/d)and the vitamin E group(75 mg/d)for a period of one month.The levels of SUA,SCr,and BUN were also monitored at the baseline(M0)and one month of observation(M1),and the differences in SUA levels and HAHU incidence between the two groups were compared.The second part was the retrospective investigation of PIHU.We gathered the information of hospitalized tuberculosis patients(2014～2016)in Department of Infectious Disease,Kunming General Hospital of Chengdu Military Command.The level of SUA in the course of anti-tuberculotic treatment in all tuberculosis patients of inclusion was investigated.logistic regression analysis was used to determine factors affecting PIHU.And the comparisons were conducted with or without intervention(application of uric acid lowering drugs such as benzbromarone,allopurinol and sodium bicarbonate)for PIHU.Results:For the first part study:1.in study I,the level of SUA at one month was significantly higher than at baseline(436.1±79.3 vs.358.0±79.8 μmol/L,p<0.001)and the incidence of hyperuricemia was also significantly higher(63.6%[95%CI:52.0%-75.2%]vs.19.7%[95%CI:10.1%-29.3%],p<0.001).Both the level of SUA(411.5±74.2 vs.460.8±54.8 μmol/L,p=0.003)and the incidence of hyperuricemia(48.5%[95%CI:31.4%-65.6%]vs.78.8%[95%CI:64.9%-92.7%],p=0.020)were significantly lower in the vitamin C group than in the blank control group.2.In study Ⅱ,the levels of SUA and the incidence of hyperuricemia also increased over one month in the vitamin C and the vitamin E group(p>0.05).3.The change of SUA was positively correlated with both the changes of SCr(r=0.599,p<0.001)and BUN(r=0.207,p=0.005).For the second part of the study:1.In the course of anti-tuberculosis treatment with the HRZE standard protocol,the mean SUA level at one week of PZA treatment in patients with normal SUA at baseline who had not been treated with uric acid lowering drugs was increased significantly(496.3±126.9 vs.293.2±69.5 μml/L,p<0.001);and its incidence of PIHU was 76.2%(211/277).The incidence of PIHU in young patients(15～34 yrs.)was 2.56 times that of patients in other age groups(p=0.005),and 0.31 times that of diabetic patients than non-diabetics(p=0.019);2.With one week of PZA application,the average SUA level of PIHU in the prevention group(n=44)was significantly lower than that in the non-prevention group(n=331)(454.2±140.9 vs.520.0±143.1 μmol/L,p=0.004).The incidence of baseline HUA in the former was higher than that of the latter(29.5%[95%CI:15.6%-43.4%]vs.16.3%[95%CI:12.3%-20.3%],p=0.031),but there was no statistically significant difference at one week(65.9%[95%CI:51.9%-79.9%]vs.78.5%[95%CI:74.1%-82.9%],p=0.061);3.With 2 weeks of PZA application,SUA levels in the initial-prevention group(n=12)were significantly lower than those in the early-intervention group(n=23)(p=0.006);4.The comparisons of vitamin C and non-prevention group in mean SUA levels at baseline(297.4±47.3 vs.323.6±98.3 μmol/L,p=0.552)and one week(519.2±62.2 vs.521.2±143.7 μmol/L,p=0.977)were no statistically significant difference.Conclusions:1.The incidence of acute HAHU in young men entering the plateau was high,and the high-dose vitamin C supplement can reduce the incidence of HAHU and the mean level of SUA and is relatively safe and economic.2.TB patients treated with PZA had a high incidence of PIHU,the traditional uric acid lowering drugs such as benzbromarone can reduce the incidence of HUA and SUA level,and the high-dose vitamin C supplement could not significantly reduce the SUA in PZA population.3.Because of different kinds of acute HUA have different mechanisms,the prevention measures are different.