Бессимптомная гиперурикемия: тайные взаимосвязи, невидимые эффекты и потенциальные осложнения

Гиперурикемия является широко распространенной проблемой во всем мире, встречаемость которой составляет 16—17%. Значение бессимптомной гиперурикемии — гиперурикемии без клинических проявлений подагры — продолжает обсуждаться. Бессимптомная гиперурикемия приводит к отложению кристаллов моноурата натрия в тканях, способствуя развитию хронического воспаления. Внутриклеточно ураты ингибируют протеинкиназу, связанную с основным регулятором аденозинмонофосфата, обусловливая иммунные ответы посредством долговременных эпигенетических модификаций. И если внутриклеточные ураты оказывают прооксидантный эффект, растворимые внеклеточные ураты биологически активны и проявляют антиоксидантные свойства с потенциально противовоспалительным действием. Судя по данным популяционных исследований, бессимптомная гиперурикемия ассоциирована с множеством коморбидностей, включая артериальную гипертензию, хроническое заболевание почек, ишемическую болезнь сердца и сахарный диабет. Однако эти работы имеют широкий круг ограничений, поскольку большинство из них являются ретроспективными, а некоторые не проводят разграничения между пациентами с бессимптомной гиперури-кемией и подагрой. Изучение эффективности фармакотерапии показывает, что снижение уровня уратов может уменьшить риск возникновения или прогрессирования некоторых из этих коморбидностей. Однако необходимы дополнительные проспективные исследования, чтобы точно установить причинно-следственные связи и определить показания для назначения пациентам с бессимптомной гиперурикемией лечения, снижающего уровень уратов. Кроме того, имеющиеся данные подтверждают нейропротективное действие мочевой кислоты, которая улучшает когнитивные функции у пациентов с болезнью Альцгеймера, болезнью Паркинсона и сосудистой деменцией. В то же время гипоурикемия является фактором риска более быстрого прогрессирования нейродегенеративных заболеваний. В настоящем литературном обзоре рассмотрена взаимосвязь между бессимптомной гиперурикемией и коморбидными состояниями.

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