肌酸酐(英语:Creatinine)又称肌酐,是肌酸和磷酸肌酸代谢的终产物,它主要由肌肉中磷酸肌酸的非酶促反应生成。对正常成人来说,每日产生肌酸酐的量是恒定的,而且肌酸酐的产生量与肌肉量成正比,因此一般男性的数值比女性高一点。经常锻炼肌肉者和非素食者[1]的数值也较高。肌酸酐的产生量一定,且仅有微量的肌酸酐会被肾小管再吸收。它的排泄量反映血液中的肌酸酐含量和肾小球的过滤速率,也就是肾脏的机能。当肾发生严重病变时,肌酸酐排泄受阻,血液中肌酸酐含量升高。血液中肌酸酐的测定,可以知道肾功能是否有严重障碍,肌酸酐的值越高,肾脏的障碍越大;但是血液肌酸酐只有在肾脏有严重障碍时才会大幅提高,不能作为早期肾脏病的指标。一般正常值为:男性 0.7~1.2 mg/dL(60~110 μmol/L),女性 0.5~1.0 mg/dL(45~90 μmol/L)
Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acidefficiently. A uric acid blood test, also known as a serum uric acid measurement, determines how much uric acid is present in your blood. The test can help determine how well your body produces and removes uric acid. Uric acid is a chemical produced when your body breaks down foods that contain organic compounds called purines.
一个人如果以下任一现象:腹部有肥胖、胰岛素抵抗(糖尿病或糖尿病前期)、高血压、高血脂(Hyperlipidemia)、经常饮水过少、经常进行无氧运动而不事后按摩舒缓、先天体质特殊,则很容易在新陈代谢过程中,无法将摄取的嘌呤进一步代谢成为可以从肾脏中经尿液排出的排泄物。而这些物质最终形成过多尿酸,再经血液流向(软)结缔组织,以结晶体积存于其中,如果有诱因引起沉积在软组织如关节膜里的尿酸结晶释出,那便导致身体免疫系统过度反应(敏感)而造成炎症(痛风症)。
高尿酸血症是引起痛风的主因。痛风是一种因嘌呤代谢障碍而尿酸累积而引起的疾病。
药物治疗帮助排泄尿酸,常用的有秋水仙碱、别嘌醇、洛芬待因。在饮食上,低脂低钠、低果糖、避免高升糖指数,少用强烈刺激的调味品或香料,禁食内脏、骨髓、海鲜、啤酒,限酒[2] ,还要大量喝水,每日应该喝2000c.c以上的水,促进尿酸排除。
血尿酸高的人在饮食上应减少动物性高嘌呤食物、果糖、饱和脂肪及酒(尤其啤酒)的摄入,尤其是带壳海鲜、动物内脏、肉类(红肉影响更大)的摄取也要有限制。
Low-fat diary
Purine-rich foods include some types of meat, seafood, and vegetables. All of these foods give off uric acid when they’re digested.
Avoid or reduce your intake of foods such as:
- organ meats
- pork
- turkey
- fish and shellfish
- scallops
- mutton
- veal
- cauliflower
- green peas
- dried beans
- mushrooms
事实上,超过80%的高尿酸血症患者没有临床表现。“无论有无症状,二者对人体的器官损害程度是一样的,相对来说,‘无症状的高尿酸血症’更危险,就像是‘沉默杀手’,许多患者直到体检抽血报告出来后,才发现自己血液中的尿酸值超标了。” 高尿酸血症所带来的冠心病死亡风险甚至可以增加50%以上。
傅君舟说:“尿酸盐结晶沉积在关节会引起痛风,沉积在肾小管、肾间质,容易导致肾脏的炎症性损伤。非结晶尿酸导致肾脏小血管收缩、肾脏缺血,最终同样导致肾功能的损害。”此外研究表明,高尿酸血症还与糖尿病、高甘油三脂血症、代谢综合征有密切关系。
如果患者除了血尿酸超标之外并无其他症状,例如痛风等,而尿酸虽然超过了正常值,但小于480μmol/L时,在无冠心病危险因素的基础上,可以先从改善生活方式做起,暂时不用药
应避免吃海鲜、动物内脏、浓肉汁汤等高嘌呤食物;切忌“啤酒或白酒+海鲜”的搭配,啤酒、白酒本身不产生尿酸,但有抑制尿酸排泄的作用,红酒可以适当少量喝。
对于一般非内脏的肉类、豆类、菇类等“次危险类”食物,患者可以适量摄入,但不能为追求低嘌呤而完全不吃,否则易导致营养不良。
Foods that are high in purine include:
- All organ meats (such as liver), meat extracts and gravy
- Yeasts, and yeast extracts (such as beer, and alcoholic beverages)
- Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms
Foods that are low in purine include:
- Refined cereals – breads, pasta, flour, tapioca, cakes
- Milk and milk products, eggs
- Lettuce, tomatoes, green vegetables
- Cream soups without meat stock
- Water, fruit juice, carbonated drinks
- Peanut butter, fruits and nuts
- Keep well hydrated, drinking 2 to 3 liters of water per day, unless you were told otherwise.
- Take all of your medications for hyperuricemia as directed
- Avoid caffeine and alcohol, as these can contribute to problems with uric acid and hyperuricemia.
- Avoid medications, such as thiazide diuretics (hydrochlortiazide), and loop diuretics (such as furosemide or Lasix®). Also, drugs such as niacin, and low doses of aspirin (less than 3 grams per day) can aggravate uric acid levels. Do not take these medications, or aspirin unless a healthcare provider who knows your condition told you.
表100g食物中嘌呤的含量
甲类(0~15mg) | 除乙类以外的各种谷类、除乙类以外的各种蔬菜、糖类、果汁类、乳类、蛋类、乳酪、茶、咖啡、巧克力、干果、红酒 |
乙类(50~150mg) | 肉类、熏火腿、肉汁、鱼类、麦片、面包、粗粮、贝壳类、麦片、面包、青豆、豌豆、菜豆、黄豆类、豆腐 |
丙类(150~1000mg) | 动物内脏、浓肉汁、凤尾鱼、沙丁鱼、啤酒。 |
限制高嘌呤(内脏,海鲜)、软饮料和果糖;并非所有海产品均为高嘌呤饮食:海参、海蜇皮和海藻为低嘌呤;并非所有蔬菜均属低嘌呤饮食:黄豆、扁豆、香菇及紫菜为高嘌呤,但不增加患痛风风险。3.禁酒,尤其是啤酒和白酒,可适当喝红酒。