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Научно-практическая ревматология

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Подагра, гиперурикемия и кардиоваскулярный риск

https://doi.org/10.14412/1995-4484-2009-143

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Аннотация

Подагра – системное тофусное заболевание, характеризующееся отложением кристаллов моноурата натрия в различных тканях и развивающимся в связи с этим воспалением, у лиц с гиперурикемией (ГУ), обусловленной внешнесредовыми и/ или генетическими факторами [1]. Заболеваемость подагрой увеличилась в несколько раз за последние десятилетия и продолжает неуклонно расти [2, 3]. Не менее 1% мужчин в западных странах страдают подагрой [4-7], которая является одной из самых частых причин воспаления суставов у мужчин среднего возраста [8, 4, 9].Установлено, что подавляющее большинство больных подагрой (около 2/3) погибают от сердечно-сосудистых заболеваний, связанных с атеросклерозом, и только менее четверти – от хронической почечной недостаточности [10, 11]. Большинство пациентов с подагрой (около 70%) имеют более двух факторов риска развития сердечно-сосудистых заболеваний. По данным эпидемиологических исследований, сочетание двух, трех или более факторов у одного больного существенно повышает риск кардиоваскулярных катастроф. При этом сочетание нескольких, даже умеренно выраженных, кардиоваскулярных факторов риска прогностически более неблагоприятно, чем существенное нарастание одного кардиоваскулярного фактора [12]. По данным литературы, частота артериальной гипертензии (АГ) у больных подагрой колеблется от36% до 41%, а в сочетании с метаболическим синдромом увеличивается до 72% [13]. Хорошо известна ассоциация подагры с ожирением и дислипидемией [14]. Во многом дислипидемию при подагре связывают с инсулинорезистентностью и гиперинсулинемией [15]. Нарушения липидного обмена заключаются в развитии гипертриглицеридемии, снижении сывороточной концентрации холестерина липопротеидов высокой плотности (ХС-ЛВП) и увеличении апо-ß, а также липопротеида (а) [16], которые ассоциируются с риском развития атеросклероза и ИБС. Результаты недавнего исследования свидетельствуют о повышенном риске развития инфаркта миокарда у пациентов с подагрой после исключения классических факторов риска (ФР) [17].

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Для цитирования:


Iljina A.E., Барскова В.Г., Насонов Е.Л. Подагра, гиперурикемия и кардиоваскулярный риск. Научно-практическая ревматология. 2009;47(1):56-62. https://doi.org/10.14412/1995-4484-2009-143

For citation:


Iljina A.E., Barskova V.G., Nasonov E.L. Gout, hyperuricemia and cardiovascular risk. Rheumatology Science and Practice. 2009;47(1):56-62. (In Russ.) https://doi.org/10.14412/1995-4484-2009-143

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