3.小结
近年来,随着人们生活水平的提高和生活方式的改变,痛风性关节炎发病率逐年提高,发病年龄也逐渐提前。痛风及高尿酸血症的发病机制与尿酸代谢的生理生化息息相关,也与免疫学有密切联系。尿酸代谢与两方面相关,生成过多由嘌呤代谢酶的缺乏所造成,排泄减少主要是由于肾小管和肾小球上存在参与尿酸排泄的重要转运体,其异常影响尿酸排泄。目前大多数对痛风的研究都局限于尿酸代谢异常,而尿酸盐触发痛风炎症反应的具体发病机制尚未完全明确。随着医学知识的不断深入发展,免疫与炎症在痛风发病机制中的作用也逐渐受到医学科研工作者的关注,其具体机制有待于进一步研究。
主要参考文献:
[1] 胨灏珠.实用内科学[M]. 第十三版.北京:人民卫生出版社.2005 :2602.
[2] Anzai N,Enomoto A,Endou H.Renal urate handling clinical relevance of recent advances[J].Cu
-rr Rheumatol Ren,2005,7(3):227-234.
[3] Hediger MA,Johnson RJ,Miyazaki H,et al.Molecular physiology of urate transport[J].Physiol
-ogy(Bethesda),2005,20:125-133.
[4]Yamada Y.Complete and partial deficiencies of hypoxanthine guanine phosphoribosyltrans
-ferase (HPRT) [J].Nippon Rinsho, 2003,61:288-293.
[5] Jinnah HA, De Gregorio L, Harris JC,et al. The spectrum of inherited mutations causing HPRT deficiency:75 new cases and a review of 196previously reported cases[J]. Mutat Res, 2000,463:
309-326.
[6] Kawasugi K, Takeuchi F. Phosphoribosylpyrophosphate(PRPP) synthetase[J]. Nippon Rinsho, 2003,61:20-23.
[7] Garcia- Pavia P, Torres RJ, Rivero M, et al. Phosphoribosylpy-rophosphate synthetase over activity as a cause of uric acid over-production in a young woman[J]. Arthritis Rheum, 2003, 48(7):2036- 2041.
[8] 薛耀明,李晨钟.痛风的诊断与治疗[M].北京:人民军医出版社,2004.34.
[9] Enomoto A, NiwaT, KanaiY,etal. Urate transporter and renal hyperuricemia[J].Rinsho Byori, 2003, 51(9): 892-897.
[10] Ichida K, HosoyamadaM, Hisatome I,et al. Clinical and molecular analysis of patients with renal hyperuricemia in Japan: in-fluence ofURAT1 gene on urinary urate excretion[J].J Am Soc Nephrol, 2004, 15(1): 164-173.
[11] Iwai N, Mino Y, Hosoyamada M, et al. A high prevalence of renal hypouricemia caused by inactive SLC22A12 in Japanese[J]. KidneyInt, 2004, 66(3): 935- 944.
[12] Leal-Pinto E, Cohen BE, Lipkowitz MS,et al. Functional analysis and molecular model of the human urate transporter/channel, hUAT[J]. Am J Physiol Renal Physiol, 2002,283:150-163.
[13] Lipkowitz MS, Leal-Pinto E, Rappoport JZ,et al. Functional reconstitution, membrane targeting, genomic structure, and chromosomal localization of a human urate transporter[J]. J Clin Invest, 2001,107:1103-1115.
[14] Bleasby K,Hall LA,Jennifer L,et al.Functional consequences of single nucleotide polymorphisms in the human organic anion trasporterh OAT(SLC22A6)[J].J Pharmacol Exp Ther,2005,314(2):923-931.
[15] Erdman AR,Mangravte LM,Urban TJ,et al.The human organic anion transporter 3 (OAT3; SLC22A8): genetic variation and functional genomics[J].Am J Physiol Renal Physiol,2006,290(4):F905-F912.
[16] Van Aubel RA,Smeets PH,van den Heuvel JJ,et al.Human organic anion transporterMRP4 (ABCC4) is an efflux pump for the purine end metabolite urate with multiple allosteric substrate binding sites[J].Am J Physiol Renal Physiol,2004,288(2):F327-F333.
[17] Van Aubel RA,Smeets PH,Peters JG,et al.The MRP4/ABCC4 gene encodes a novel apical organic anion transporter in human kidney proximal tubules:putative efflux pump for urinary cAMP and cGMP[J].J Am Soc Nephrol,2002,13(3):595-603.
[18] Rampoldi L, Caridi G, Santon D, et al. Allelism of MCKD, FJHN and GCKD caused by impairment of uromodulin export dynamics[J].Hum Mol Genet, 2003, 12(24): 3369-3384.
[19] Martinon F,Pétrilli V,Mayor A,et al.Gout-associated uric acid crystals activate the NALP3 inflammasome[J].Nature,2006,440:237-241.
[20] Church LD,Cook GP,McDermott MF.Primer:inflammasomes and interleukin 1 beta in inflammatory disorders[J].Nat Clin Pract Rheumatol,2008,4:34-42.
[21] Kawai T, Akira S. The role of pattern-recognition receptors in innate immunity: update on Ton-like receptors[J]. Nat Immunol, 2010, 11: 373-384.
[22] Chapman PT .Yarwood H , Harrison AA, et a1.Endothelial activation in monosodium urate monohydrate crystal-induced inflammation: in vitro and in vivo studies on the roles of tumor necrosis factor alpha and interleukin—1[J].Arthritis Rheum, 1997. 40: 955-965.
[23]Di Giovine FS, Malawista SE, Nuki G, et a1. Interleukin-I(IL-1) as amediator of crystal arthritis: stimulation of T cell and synovial fihroblast mitogenesis by urate crystal-induced IL-1[J]. J Immunol, 1987,138:3213-3218.
[24] 蒋莉,周京国,青玉凤,等.Toll样受体2和Toll样受体4及其信号通路在原发性痛风性关节炎发病机制中作用的研究[J].中华风湿病学杂志,2011,15:300-304.
[25] 杨其彬,周京国,青玉凤,等.痛风性关节炎患者外周血单个核细胞NLRP3炎性体mRNA表达的研究[J].中华风湿病学杂志,2010,14:686-689.