ROLE OF URIC ACID IN CLINICAL MANIFESTATIONS OF ANKYLOSING SPONDYLITIS

Vrach Pub Date : 2024-03-01 DOI:10.29296/25877305-2024-03-07

I. Bazina, D. Krechikova, O. Kozyrev, M. Pavlova, D. Rostkova, M. Konevskikh, A. Mukhina

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Abstract

Prevalence of ankylosing spondylitis (AS) is about 0.2–0.8% and increasing during last decades in Russia. Coronary Heart Disease (CHD) plays an important role in mortality in patients with rheumatic diseases. AS mainly affects able-bodied age persons thus having a significant social and economic impact. There plenty of biomarkers of AS, including those for early diagnosis. Purpose. To study the level of uric acid (UA) in patients with AS and its role in development of AS. Materials and methods. A total of 72 medical charts of patients hospitalized at Smolensk Regional Rheumatological Center were evaluated, among them 73.6% were men and 26.4% – women. AS was diagnosed according to classification criteria. Lab tests were done in a central lab using standard methodology. All data collected for each patient was entered into an Excel spreadsheet and analyzed. Results. Average patients age was 49.6±12.4 years. BMI was 28.1±5.4 kg/m2. Arterial Hypertension (AH) and CHD was diagnosed in 44.4% of patients. Glomerular Filtration Rate (GFR) was 95.1±21.9 mL/min. UA concentration were equal to 301.3±94.3 mmol/L, total cholesterol (TC) – 5.0±1.0 mmol/L, CRP – 60.5±35.1 IU/L. A direct correlation between CRP and BMI was revealed (p<0.005). UA concentration in patients with AS and CHD was 347.3±73.9 mmol/L, while in patients with AS without CHD it was significantly lower: 261.8±77.4 mmol/L (p<0,001). UA concentration in patients with AS and HLA-B27(+) was 345.1±90.8 mmol/L, in patients with AS and HLA-B27(-) – 259.1±75.1 mmol/L (p<0,001). BASDAI in patients with AS was equal to 5.7±2.1. UA concentration in patients with mild to moderate AS was 255.4±77.7 mmol/L; severe AS – 343.4±75.3 mmol/L (p<0.001). Correlations between TC level and BASDAI (p<0.05) as well as between UA level and BASDAI (p<0.05) were revealed. Conclusion. In patients with AS increased level of UA supports inflammation activity, forces subjective symptoms of the disease (pain), correlates with disease activity and BASDAI. Hyperuricemia increases risk of CHD, worsens prognosis of AS. UA may be considered as a biomarker of disease activity and prognosis of AS, atherosclerosis and cardiovascular diseases

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尿酸在强直性脊柱炎临床表现中的作用

在俄罗斯，强直性脊柱炎（AS）的发病率约为 0.2%-0.8%，并且在过去几十年中不断上升。冠心病（CHD）在风湿病患者的死亡率中占有重要地位。强直性脊柱炎主要影响身体健康的老年人，因此对社会和经济有重大影响。强直性脊柱炎的生物标志物很多，包括用于早期诊断的生物标志物。研究目的研究强直性脊柱炎患者的尿酸（UA）水平及其在强直性脊柱炎发病中的作用。对斯摩棱斯克地区风湿病中心住院患者的 72 份病历进行了评估，其中 73.6% 为男性，26.4% 为女性。强直性脊柱炎根据分类标准进行诊断。实验室检查由中心实验室采用标准方法进行。每位患者的所有数据均输入 Excel 电子表格并进行分析。患者平均年龄为 49.6±12.4 岁。体重指数（BMI）为 28.1±5.4 kg/m2。44.4%的患者被诊断为动脉高血压（AH）和冠心病。肾小球滤过率（GFR）为 95.1±21.9 mL/min。尿酸浓度为 301.3±94.3 mmol/L，总胆固醇 (TC) - 5.0±1.0 mmol/L，CRP - 60.5±35.1 IU/L。CRP与体重指数之间存在直接相关性（P<0.005）。强直性脊柱炎和心脏病患者的尿酸浓度为（347.3±73.9）毫摩尔/升，而无心脏病的强直性脊柱炎患者的尿酸浓度明显较低：（261.8±77.4）毫摩尔/升（P<0.001）。强直性脊柱炎和 HLA-B27（+）患者的尿酸浓度为 345.1±90.8 mmol/L，强直性脊柱炎和 HLA-B27（-）患者的尿酸浓度为 259.1±75.1 mmol/L（p<0，001）。强直性脊柱炎患者的 BASDAI 为 5.7±2.1。轻中度强直性脊柱炎患者的尿酸浓度为（255.4±77.7）毫摩尔/升；重度强直性脊柱炎患者的尿酸浓度为（343.4±75.3）毫摩尔/升（P<0.001）。TC水平与BASDAI（P<0.05）以及UA水平与BASDAI（P<0.05）之间存在相关性。在强直性脊柱炎患者中，尿酸水平升高支持炎症活动，加重疾病的主观症状（疼痛），并与疾病活动和 BASDAI 相关。高尿酸血症会增加患冠心病的风险，恶化强直性脊柱炎的预后。尿酸可被视为强直性脊柱炎、动脉粥样硬化和心血管疾病的疾病活动和预后的生物标志物。

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