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动物实验结果 别嘌醇治疗 “左”派意见 Oxonic acid (OA): 尿酸酶抑制剂 Marilda Mazzali et al Hypertension. 2001;38:1101-1106 动物实验结果 Benziodarone（苯碘达隆）治疗 “左”派意见 Oxonic acid (OA): 尿酸酶抑制剂 Marilda Mazzali et al Hypertension. 2001;38:1101-1106 只有10%高尿酸血症患者转变为痛风 “全民降尿酸”给社会带来沉重的经济负担 因为服药者增多可能引起的药物不良反应危 害更大 “右”派意见 HUA治疗目标值：血尿酸357umol/l(6mg/dl) 常规检测血尿酸，尽早发现无症状HUA 所有无症状HUA患者均需进行治疗性生活方式改变；尽可能避免应用使血尿酸升高的药物 无症状HUA合并心血管危险因素或心血管疾病时（包括高血压，糖耐量异常或糖尿病，高脂血症，冠心病，脑卒中，心力衰竭或肾功能异常），血尿酸值8mg/dl给予药物治疗；无心血管危险因素或心血管疾病的HUA，血尿酸值9mg/dl给予药物治疗 积极控制无症状HUA患者并存的心血管危险因素 中国专家共识 在类风湿关节炎治疗中，首先提出达标治疗（treat－to－target）的理念 高尿酸血症治疗中，2010年首次提出达标治疗的概念 相关研究有待深入 动物研究：探寻高尿酸的危害 流行病学分析；基于队列的前瞻性研究 机制上：遗传易感性研究 “达标治疗”理念 孟济明，邹和建. 风湿病学发展的点滴思考. 内科理论与实践，2011，6（5）：329－330 上海市风湿病学会 中华风湿网 复旦风湿网 InSCAR网站 相关网站 * * * febuxostat is molecularly different from allopurinol and is the first new drug in 40 years for the treatment of hyperuricemia in gout patients Uric acid is the end product of purine metabolism and is generated in the cascade of hypoxanthine→xanthine→uric acid Xanthine oxidase catalyzes the metabolism of hypoxanthine to xanthine, resulting in the end product, uric acid ULORIC , a xanthine oxidase inhibitor, achieves its therapeutic effect by decreasing serum uric acid. ULORIC is not expected to inhibit other enzymes involved in purine and pyrimidine synthesis and metabolism at therapeutic concentrations The diagram shows the purine molecule and the allopurinol molecule compared with the ULORIC molecule Stryer L. Biochemistry. 4th ed. W.H. Freeman; 1995:76, 756. ULORIC? (febuxostat) [package insert]. Takeda Pharmaceuticals America, Inc.; 2009. ZYLOPRIM? (allopurinol) [package insert]. San Diego, CA.: Prometheus Laboratories Inc.; 2003. Lowering uric acid levels prevents the development of hypertension (experiments II and III). A and B, Rats placed on OA-2% diet that were also administered allopurinol did not show the increase in BP (A) and had a normalization of serum uric acid levels (B). C and D, A similar effect on B