Tang acid uric mau và nguy cơ bệnh nội khoa TS BS Cao Thanh Ngọc Khoa Nội cơ xương khớp, BV ĐHYD TPHCM (ALTHE FOUR INDUSTRIAL REVOLUTIONS178018001850 1900 1950 2000 FIRST (1784) SECOND (1870) THIRD (1969) FOURTH (NOW) Mechanical production, Mass production, electri- Automated production, Artificial intelligence, big railroads, and steam cal power, andthe advent electronics, and data, robotics, and more computers power of the assembly line tocome All contents and images used on this slide deck is for educational purposes only Overproduction (10%) Risk factors Underexcretion (90%) Dietary purine lamb) * Male Urinary excreti,on * Meat (beef, pork, tuna) * Seafood (shrimps, * Age Diuretics * Beer * Obesity * Renal failure Endogenous purine synthesis Urinary reabsorption * Malignancy * Alcohol * Tumor lysis syndrome * Genetic defects Purine salvage ccc * HGPRT deficiency * PRPS deficiency URIC ACID CRYSTALS Purine breakdown Hyperuriceamia * Glycogen storage disease | | GiT excretion Renal excretion Gaafar Ragab J Adv Res 2017 Sep; 8(5): 495-511 Tang acid uric mau ¢ Tang acid uric mau: > 7mg/dl (420umol/L) (Ngưỡng hòa tan của urate: > 6,8 mg/dl (408umol/L) °Ö Nguyên nhân tang acid uric mau: — Tang tao acid uric — Giảm đào thải acid uric (nhiều) ¢ Tăng acid uric máu là nguy cơ của nhiều bệnh nội khoa: — Bénh tim mach: THA, BMV, RLLP, rung nhi — Nội tiết: hội cheng chuyén hda, béo phi, DTD, khang insulin — Bénh than man — Cac bénh khac: viém gan C, vay nén Xanthine Purine Factors that cause hyperuricemia: oxidoreductase + Decreased kidney function Hypoxanthine, + Diuretic use Intracellular + Increased renal vascular resistance adverse action + Insulin resistance of uric acid Xanthine |: Others Stimulation of RAAS “ Uricacid Stimulation of chemokines Hyperuricemia Untoward Endothelial rae clinical effects of uric acid dysfunction Coronary artery disease Chronic kidney disease Activation of NADPH oxidase aa Reduction in NO bioavailability Heart failure Activation of vasoconstrictive mediators Stroke Gout Tang acid uric và gout > 8 2 8 —@— Men 50 Gout Prevalence(per 1000 patiens) —@— Women 40 N © — _© NOTE: Weights are from random effects analysis 1 T 8.2 T .122 Current Medical Research and Opinion, (2017) 33:sup3, 21-25 Tăng acid uric và hội chứng chuyên hóa ° 23% dân số Mỹ mắc HCCHÍ Các yếu tô của hôi chứng chuyên hóa - Tăng nồng độ insulin lưu - RLCH lipid hanh/tang dé khang insulin - Tăng huyết áp - ĐTĐ2/ELDNĐ - Tang acid uric máu - Beo phi vung bung - Tăng xơ vữa ĐM ° 86% bệnh nhân gout mắc HCCH2 "| Ford et al Jama 2002;287:356-359 2 Vazquez-Mellado et al J Clin Rneu 2004;10(3): 105-109 Tăng acid uric và hội chứng chuyên hóa 100 - Revised NCEP/ATP Oo Women Original NCEP/ATP n90 - | O Men | || | | 80 - | Prevalence, % T 60 + - | 50 ¬ o H 40 4 T H 30 - p f H H 20 + c h 10 - ¬ = 0 F R T T T T T T T T 1