痛风与高尿酸血症患者膳食方式新理念

doi:10.16138/j.1673-6087.2024.02.11

摘要/Abstract

摘要：

痛风和高尿酸血症患病率逐年升高，疾病负担随之加重。对患者或高危人群的膳食进行合理干预有利于降低患病率，并提高患者慢病自我管理的质量。本文通过对痛风和高尿酸血症患者膳食方式的研究进展进行分析，推荐遵循目前较为公认的健康饮食模式来进行长期的膳食管理，而并非单一的区别“好”或“坏”的食物，或过度的低嘌呤饮食方式，以期更好地指导痛风和高尿酸血症患者的自我管理。

关键词: 痛风, 高尿酸血症, 低嘌呤饮食, 地中海饮食, 终止高血压膳食疗法

Abstract:

The prevalence of gout and hyperuricemia is increasing year by year, leading to a rise in the disease burden. Reasonable dietary interventions for patients or high-risk groups are beneficial in reducing the incidence of these diseases and improving the quality of chronic disease self-management for patients. The research progress on dietary patterns for patients with gout and hyperuricemia was analyzed in this article, which recommended adherence to generally recognized healthy eating patterns for the long-term dietary management, rather than simply distinguishing between “good” or “bad” foods or excessively following a low-purine diet. The aim of the study is to provide better guidance for the self-management of gout and hyperuricemia patients.

Key words: Gout, Hyperuricemia, Low-purine diet, Mediterranean diet, Dietary approaches to stop hypertension

中图分类号:

R593

吴菊蕾, 毛莉华, 余婷婷, 林丛, 缪语, 朱小霞, 曹灵. 痛风与高尿酸血症患者膳食方式新理念[J]. 内科理论与实践, 2024, 19(02): 144-148.

WU Julei, MAO Lihua, YU Tingting, LIN Cong, MIAO Yu, ZHU Xiaoxia, CAO Ling. New dietary concepts for patients with gout and hyperuricemia[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 144-148.

图/表 1

表1

饮食干预与血尿酸关系

人数	时间	干预组	对照组	结论
30名健康受试者（>18岁）^[36]	3周	低碳水化合物（≤20 g/d）和高脂肪饮食	正常饮食（碳水化合物≤20 g/d）	血清尿酸在干预组中明显升高，亚组分析中提示干预组中血脂明显升高
90名具有相似饮食习惯的受试者（18~65岁）^[37]	17 d	低盐饮食后高盐饮食		低盐组中血尿酸较高盐组降低，低盐组24 h尿尿酸较高盐组及基线减少
40名健康且轻度高胆固醇血症的志愿者（29~65岁）^[38]	20周	每天2个苹果，持续8周；4周的洗脱期，后8周内每天摄入500 mL对照饮料（第1组），或按相反顺序接受干预食品（第2组）		干预组血尿酸较对照组升高，亚组分析提示干预组血脂较对照组降低
44例代谢综合征患者（20~65岁）^[39]	8周	含有300 g/d益生菌的酸奶	正常酸奶	干预组血尿酸较对照组显著降低
459例（血压<160 mmHg，80~95 mmHg）受试者（≥30岁）^[40]	8周	富含水果和蔬菜的饮食；DASH饮食	经典美式饮食	干预组血尿酸较对照组显著降低
26名健康且每天3餐饮食的成年人（20~30岁）^[41]	2周	100%橙汁；不含咖啡因的可乐		与基线相比，干预后血尿酸降低，尿尿酸显著增加
75例早期2糖尿病肾病患者（年龄18~80岁）^[42]	12周	高蛋白饮食	蛋白质限制性饮食	干预组血尿酸较对照组显著降低
30例超重或肥胖受试者（男性，13~18岁）^[43]	未涉及	含糖苏打水或低脂牛奶		摄入牛奶后尿酸显著降低
43 例未启动降尿酸药物治疗的患者（≥18岁）^[44]	8周	DASH饮食，然后自主购买饮食（ self-directed grocery shopping ，SDG）或预定饮食[营养师指导饮食（dietitian-directed groceries，DDG）]		DDG组血尿酸显著降低
20名健康超重女性（25~40岁）^[45]	2周	每天3份100%天然加糖橙汁	每天3份含蔗糖饮料	血尿酸在对照组中显著升高
14例习惯性低钙摄入的2型糖尿病受试者（20~59岁）^[46]	32周	先高钙脱脂牛奶再低钙（HC组）	先低钙脱脂牛奶再高钙（LC组）	高钙脱脂（high-Ca fat-free milk, HC）组血尿酸显著降低，低钙（low-Ca control, LC）组血尿酸显著升高
235例中度肥胖受试者（40~65岁）^[47]	24个月	低脂限热量饮食；低碳水化合物和非限制热量饮食；地中海和限制热量		6个月和24个月观察期所有受试者血尿酸均下降
5 168名受试者（≥40岁）^[48]	6周	每隔1 d在早餐前至少1 h饮用过滤汤（250 g新鲜菜豆+1 000 mL水）		干预组血尿酸显著降低
25名男性，9名女性受试者（>60岁）^[49]	30 d	温水冲莲藕和黄瓜粉		血尿酸显著降低

表1

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