Y HOC VIET NAM THANG 5 - SO 2/2015
ROI LOAN LIPID MAU VA CAc YEU TO LIEN QUAN a BENH NHAN GUT NGUYEN P H A T
T O M TAT
Muc tieu' Tim hieu roi loan lipid mau va cac yeu to hen quan 6 benh nhan gut nguyen phat. Doi tu'dng: goml27 nam benh nhan Gut nguyen phat va 127 nam gi6i khoe manh, cung tuoi den kham tai khoa kham chiJa benh theo yeu c3u Benh vien Bach Mai, tCr 3/20012-3/2014. Phu'rfng phap nghien cifu: c§t ngang. Cac doi tu'Ong du'dc hoi benh, kham lam sang, xet nghiem mau (xet nghiem cO ban, lipid mau). Ket qua.-Tuoi trung binh la 49,3 ± 15,6, thdi gian mac benh 2,5 ± 1,6 nam. Tan suat roi loan lipid mau d benh nhan gut cao hdn (p <0,001) nhom chu'ng nhif tang cholesterol toan phan (48,0 so vdi 33,9%), tang LDL-C (51,2 so vdi 37,0%), HDL-C thap (53,5 so vdi 22,8%) va tang triglycerides (56,7 so vdi 32,3%), chi so danh gia xd vCa mach mau (cholesterol toan phan/HDL-C (3,95 ± 1,37 so vdi 3,45 ± 1,83). Cac yeu to lien quan den roi loan lipid mau d benh nhan gut la tuoi, tien SLf gia dinh co benh tim mach, hut thuoc la, uong ru'du, bia, it hoat dgng the due, beo phi, nong dp acid uric mau va xuat hien hat tophi. Ket luan:
T^n suat cac roi loan lipid mau 6 benh nhan gut nguyen phat kha cao, dao dgng tir 48,0 den 56,7%.
Hut thudc la, uong rugu, bia, ft hoat dgng the due, beo phi, tinh trang benh la nhu'ng yeu to lien quan den roi loan lipid mau. Do do, can kiem soat tot tinh trang benh giit, khuyen khich benh nhan thay ddi loi song va sinh hoat hdp ly, de lam giam nguy cd roi loan lipid mau, qua do han che nguy cd tim mach d benh nhan gut.
TWkhoa: roi loan lipid mau, beo phi, nguy cd tim mach, gut
SUMMARY
PLASMA L I P I D DISORDERS AND RELATED FACTORS I N PATIENTS
W I T H PRIMARY GOUT Objectives: To investigate the plasma lipid disorders and related factors in patients with primary
* Klioa kham child benh theo yeu cau, Benh wen Bach Mai Chiu trach nhiem chfnh: Dao Hung Hanh
Email: [email protected] Dt: 0983.111.888 Ngay nhan bai: 5/3/15
Ngay phan bien khoa hgc: 6/4/15 Ngay duyet bai: 20/4/15
Do Trung Quan*, Dao Hung Hanh*
gout. Patients: 127 men with primary gout and 127 healthy age-matched men examined in our department from 3/2012-3/2014 were included.
Methods: cross-sectional study. Patients were underwent clinical examination and blood tests (basic tests, plasma lipid). Results.- Mean age: 49.3 ± 15.6;
disease duration: 2.5 ± 1.6 yrs. Prevalence of plasma lipid disorders were significantly higher (p <0.001) in gout patients for high total cholesterol (49.3 vs 47.8%)low HDL-Cholesterol (50,5% vs 26.1%), high total cholesterol (48.0 vs 33.9%), high LDL-C (51.2 vs 37.0%), low HDL-C (53.5 vs 22.8%) and high t3ng triglycerides (56.7 vs 32.3%), atherosderotic index (total cholesterol/HDL-C (3.95 ± L37 vs 3.45 ± 1.83).
Related factors to plasma lipid disorders were age, family history of cardiovascular diseases, smoking, dnnkmg beer and alcohol, infrequent physical activities, obese, plasma uric acid and tophus nodule.
Conclusions: Prevalence of plasma lipid disorders was rather higher in gout patients, varied from 48.0 to 56.7%; these disorders were significantly related to smoking, drinking beer and alcohol, infrequent physical activities, obese, plasma uric acid and tophus nodule. Therefore, doctors should well control disease's activity and encourage patients to change life style in order to reduce plasma lipid disorders and cardiovascular risk factors in gout patients.
Keywords: plasma lipid disorders, obese, cardiovascular nsk, gout
I. OAT VAN BE
Gut la benh ly viem khdp do roi loan chuyen hda purin, thu'dng gap nhat d nam gidi, chiem 0,5-2% dan so, tudi trung nien vdi dinh cao nhat la 50-60 tuoi. Nguyen nhan sinh benh cd su*
tham gia cua nhieu yeu to nhu' dl truyen, che dp
an udng, sinh hoat nhu' thdi quen uong ru'du bia,
nu'de ngpt cd du'dng fructose, an nhieu chat
dam, ldi sdng tinh tai (1-3). Benh gut thu'dng di
kem vdi nhieu roi loan chuyen hda nhu" beo phi,
roi loan lipid mau, du'dng mau va tang huyet ap
(THA). Cac yeu to nguy cd nay thu'dng ket hdp
vdi nhau tren cung mot ngu'di benh, du'dc goi la
Y HOC VIET NAM THANG 5 - SO 2/2015
hpi chCmg chuyen hda (HCCH). Ngu'di mac HCCH cd nguy cd dai thao du'dng (DTD) va benh ly tim mach cao gap 2-4 lan ngu'di binh thu'dng (3). Da cd mpt so nghien cu'u ghi nhan rang benh nhan gut cd roi loan lipid mau va nguy cd tim mach cao hdn nhu'ng ngu'di khong bj benh (1-3, 5-7).
NhiJng nghien cu'u ve rdi loan lipid mau d benh nhan gut thu'dng tap trung d nhD'ng benh nhan da bi benh lau nam (1,3,7), cdn rat ft cac nghien cifu d nhii'ng benh nhan mdi mac benh. Nu'de ta la nu'de dang phat trien, vdi sir thay doi Idi sdng va thdi quen sinh hoat theo chieu hu'dng Au hda trong nhulig nam gan day da lam gia tang nhanh chdng mot so benh ly man tinh, khdng lay nhiem nhu' gut, roi loan lipid mau, DTD, THA, thieu mau cd tim, dot quy. Tuy nhien, cdn it nhu'ng nghien cifu rdi loan lipid mau, cac yeu to nguy cd tim mach va chuyen hda d benh nhan gut. Do vay, chung toi nghien cu'u de tai nay nham tim hieu rdi loan lipid mau va cac yeu to lien quan d benh nhan gut nguyen phat.
II. OOI TirgwG vA PHITOIMG PHAP NGHIEN C U U
2.1. Dei tu'dng nghien cu'u Doi tu'dng nghien cifu gom 2 nhdm:
-I- Nhdm benh: goml27 nam benh nhan Gut duWc chan doan theo tieu chuan cua ACR 1977 (8).
+ Nhdm chulig: gom 127 nam gidi khde
manh, ci!ing tud'i den kham tai khoa kham chffa benh theo yeu cau Benh vien Bach Mai, thdi gian 3/20012-3/2014.
Loai khdi nghien cifu cac tru'dng hdp gut thff phat: sau suy than, sau sff dung thudc dieu trj lao, sau truyen hda chat dieu tri ung thff.
2.2. Phu'dng phap nghien cu'u - Phffdng phap nghien cffu: cat ngang Cac ddi tffdng nghien cffu dffdc tien hanh hdi benh, kham lam sang va can lam sang
+ Hdi benh: thdi quen tap the due, sff dung thudc, chu y tien sff gia dinh ve cac benh tim mach + Kham lam sang ty my: Iffu y vi trf, sd lu'dng khdp bi dau, sffng
+ Go huyet ap (HA); bang HA ke thuy ngan.
Benh nhan dffdc nghi ngdi 5 phut trffdc do. Benh nhan dffdc do it nhat 2 ian each nhau it nhat 5 phut va lay sd HA trung binh cua 2 lan do.
Phan ioai HA theo JNC VII va hpi Tim mach hoc Viet nam. THA khi tri sd HA >140/90 mmHg.
+Xet nghiem thong thffdng nhff cdng thffc mau, acid uric mau, dffdng mau, lipid mau (cholesterol, LDL-C, HDL-C, triglycerides), chffc nang gan, than.
+ Danh gia nguy cd tim mach bang su*
dung tieu chuan chan doan hoi chu'ng chuyen hoa cua NCEP ATP I I I (2004) cd dieu chinh tieu chuan beo bung ddi vdi ngffdi Chau A (3).
- Beo bung: vdng eo > 90cm doi vdi nam va >
80cm doi vdi nff
Tang huyet ap > 130/85 mmHg Roi loan glucose mau khi ddi > 5,6 mmol/l Tang Triglycerid mau > 1,7 mmol/l HDL-C thap< 1,0 mmol/l d nam va <1,3 mmol/l d nff
Benh nhan dffdc xac djnh cd HCCH khi cd tff 3 yeu td trd len.
2.3. Xuf ly so lieu; theo phffdng phap thong ke y sinh hpc bang phan mem SPSS 16.0.
. KET QUA
3.1. Dac diem lam sang chung cua nhom nghien cu'u Binffl. Pac diem chung cua nhdm nghien cffu
Thong sd Tuoi
Thdi gian mac benh (nam) Tien sis gia dinh benh tim mach, n (%) Hut thuoc ia, n (%)
Uong ru'du, n (%)
Tap the due thu'dng xuyen, n (%) BMI (l<g/m')
Binh thu'dng; BMI 18,5-22,9 (n,%)
Gut (n =127) 49,3 ± 15,6
2,5 ± 1,6 66 (51,9) 85 (66,9) 69 (54,3) 53 (41,7) 26,6 ± 13,5
54 (42,5)
Chu'ng (n =127) 49,7 ±16,7
42 (33,1) 49 (38,6) 39 (30,7) 78 (61,4) 24,2 ± 11,7
71 (55,9) P 0,347
<0,001
<0,001
<0,001
<0,001
<0,001
<0,001
Y HOC VIET NAM THANG 5 • SO 2/2015
Thim can: BMI 23-24,9 (n,%) Beo phi: BMI >25 (n,%) Vdng bunq (cm)
41 (32,3) 32(25,1) 89,7 ± 8,3
37 (29,1) 19 (14,5) 83,5 ± 7,9
<0,001
<0,00l
<0,001 Nhin xet: Tuoi trung binh cua 127 benh nhan
Gut ia 49,3 ± 15,6, thdi gian mac benh 2,5 ± 1,6 nam. So vdi nhdm chu'ng, benh nhan gut co nguy ccJ tim mach cao hdn (p <0,001) nhU tien sir gia dinh benh tim mach (51,9 so vdi 33,1%), hut thuoc la (66,9 so vdi 38,6%), uong rUdu bia (54,3 so vdi 30,7%), it tap the due thudng xuyen (41,7 so vdi 61,4%). Benh nhan gut cd can njng
(73,5 ± 16,8 so vdi 66,7 ± 15,3 i<g), chi so khoi CO the BMI (26,6 ± 13,5 so vdi 24,2 ± 11,7 i(g/m^), vdng bung (89,7 ± 8,3 so vdi 83,5 ± 7,9 cm) cao hdn (p <0,001) so vdi nhdm chu'ng. Ty le thira can (32,2 so vdi 29,1%), beo phi (25,1 so vdi 14,5%) va beo bung (45,7 so vdi 29,9%) cung cao hdn (p <0,001) so vdi nhdm chirng.
3.2. C|c diem acid uric va iipid m^u Bing 2. DSc diem acid uric va iipid
Thong so Acid uric (pmol/l) Acid uric mau >420, n (%) Cholesterol toan phan (mmol/l) Cholesteroi toan phan >5,2, n (%) HDL-C (mmol/i)
HDL-C <1,0, n (%) Ty so Cholesterol/HDL-C LDL-C (mmoi/i) LDL-C >2,6, n (%) Trigiycerides (mmol/l) Triglycerides >1,7, n (%)
nau Gi:it(n=127)
456,9 ± 87,5 91 (71,7) 5,1 ± 0,9 61 (48,0) 1,29 ± 0,67
68 (53,5) 3,95 ± 1,37
3,6 ± 1,9 65 (51,2) 3,57 ± 1,24
72 (56,7)
Chu'ng (n =127) 347,1 ± 79,3
33 (25,9) 4,9 ± 0,8 43 (33,9) 1,42 ± 0,85
29 (22,8) 3,45 ± 1,83
3,1 ± 1,8 47 (37,0) 3,09 ± 1,17
41 (32,3) P
<0,001
<0,001
<0,001
<0,001
<Q,001
<0,001
<0,001
<0,001
<0,001
<0,001
<0,001 Nhin xit: Benh nhan gut cd acid uric mau
(456,9 ± 87,5 SO vdi 347,1 ± 79,3 pmoi/i) va ty le tang acid uric mau cao hdn (p <0,001) d benh nhan so vdi nhdm chu'ng (71,7 so vdi 25,9%).
Vdi iipid mau, so vdi nhdm chu'ng, benh nhan gilt cd mot so chi so cao hdn (p <0,001) nhu' cholesterol toan phan (5,1 ± 0,9 so vdi 4,9 ± 0,8 mmoi/l), LDL-C (3,6 ± 1,9 so vdi 3,1 ± 1,8 mmoi/i), chi so danh gia xd vuS mach mau
(cholesterol toan phan/HDL-C (3,95 ± 1,37 so vdi 3,45 ± 1,83), triglycerides (3,57 ± 1,24 so vdi 3,09 ± 1,17 mmol/l); ngUdc iai HDL-C iai thap hdn (1,29 ± 0,67 so vdi 1,42 ± 0,85 mmoi/i; p <0,001). Ty ie tang cholesterol toan phan (48,0 so vdi 33,9%), tang LDL-C (51,2 so vdi 37,0%), HDL-C thap (53,5 so vdi 22,8%) va tang trigiycerides (56,7 so vdi 32,3%) cung cao hdn so vdi nhdm chii'ng.
3.3. D|c diem cua bSnh nhan gut du'a vao co roi ioan iipid mau hay I(h6ng Bangs. Oac diem cua benh nhan gut dUS vao cd roi ioan lipid mau hay i<h6na
Thong so Nhan trac
Tuoi
Tien sii gia dinh benh tim mach, n (%) Hut thuoc ia, n (%)
Uong rUdu, n (%)
Tap the due thu'dng xuyen, n (%) BMI (i<g/m^)
Chung (n= 127) 49,3 ± 15,6
66 (51,9) 85 (66,9) 69 (54,3) 53 (41,7) 26,6 ± 13,5
HDL-C thap (n =68) 52,7 ± 14,6
38 (55,9) 57 (83,8) 48 (70,6) 16 (23,5) 27,9 ± 14,6
HDL-C bt (n = 59) 45,9 ± 12,4
28 (47,5) 28 (47,5) 21 (36,8) 37 (62,7) 25,3 ± 12,7
P
<0,001
<0,001
<0,001
<0,001
<0,001
<0,001
YHOC VIETNAM THANG • so 2/2015 Vdng bung (cm)
Dac diem benh gut Thdi gian mac benh (nam) Nong do acid uric mau (pmol/l) Cd hat tophi, n (%)
89,7 ± 8,3 2,5 ± 1,6 456,9 ± 87,5
24 (18,9)
91,8 ± 10,6 2,6 ± 1,7 482,5 ± 92,7
16 (23,5)
87,6 ± 8,1 2,4 ± 1,6 431,3 ± 89,8
8(13,6)
<Q,001 0,573 0,015 0,017 Nhin xet: So vdi nhffng benh nhan cd HLD-C
binh thffdng thi nhdm benh nhan cd HLD-C thap cd mpt sd chi sd cao hdn nhff tudi (52,7 ± 14,6 so vdi 45,9 ± 12,4), tien sff gia dinh cd benh ly tim mach (55,9 so vdi 47,5%), hut thudc la (83,8 so vdi 47,5%), uong rffdu, bia (70,6 so vdi 36,8%), BMI (27,9 ± 14,6 so vdi 25,3 ± 12,7 kg/m^), vdng bung (91,8 ± 10,6 so vdi 87,6 ± 8,1 cm), nong do acid uric mau (482,5 ± 92,7 so vdi 431,3 ± 89,8 \xn\o\l\), xuat hien hat tophi (23,5 so vdi 13,6%) va ty le tap the due thffdng xuyen thap hdn (23,5 so vdi 62,7%). Khong cd sff khac biet ve thdi gian mac benh giu^ 2 nhdm.
IV. BAN LUAN
4.1. D|c diem chung cua ddi tu'dng nghien ciihi
Trong nghien cffu nay, tudi trung binh cua 127 nam benh nhan Gut la 49,3 ± 15,6, thdi gian mac benh 2,5 ± 1,6 ndm. Ket qua nay phii hdp vdi nhffng nghien cffu trffdc (1-3), Nhffng nghien cffu djch te trong cong dong vdi so Iffdng Idn benh nhan ghi nhan rang benh chlem 0,5-2%
dan so, tuoi trung nien vdi dinh cao nhat la SO- SO tuoi va thffdng gap nhat d nam gidi. So vdi nhdm chffng, benh nhan gut cd nguy cd tim mach cao hdn (p <0,001) nhff tien sff gia dinh benh tim mach (51,9 so vdi 33,1%), hut thuoc la (66,9 so vdi 38,6%), udng rffdu bia (54,3 so vdi 30,7%), It tap the due thffdng xuyen (41,7 so vdi 61,4%). Ket qua nay cung ung ho nhffng nghien cffu trffdc (5-7), ghi nhan rang nguyen nhan sinh benh cd sff tham gia cua nhieu yeu td nhff di truyen, che dp an uong, sinh hoat nhff thdi quen udng rffdu bia, nffdc ngpt cd dffdng fructose, an nhieu chat dam, Idi sdng tTnh tai. Viet nam la nffdc dang phat trien, vdi sff thay ddi Idi song va thdi quen sinh hoat theo chieu hffdng Au hda trong nhffng nam gan day da lam gia tang nhanh chdng mot sd benh ly man tinh, khdng lay nhiem trong dd cd benh gut, DTD, THA, thieu mau cd tim, dot quy. Do vay, can khuyen khich
benh nhan thay ddi nhffng thdi quen sinh hoat va ldi sdng tTnh tai khdng cd ldi nhff ke tren de phdng ngffa cac nguy cd tim mach cung vdi bien chffng nang ne cua nd. Trong nghien cffu nay, so sanh vdi nhdm chffng thi benh nhan gut cd nguy cd tim mach cao hdn, the hien bang cac chi sd nhff can n§ng (73,5 ± 16,8 so vdi 66,7 ± 15,3 kg), chi sd khdi cd the BMI (26,6 ± 13,5 so vdi 24,2 ± 11,7 kg/m^), vdng bung (89,7 ± 8,3 so vdi 83,5 ± 7,9 cm), ty le thda can (32,2 so vdi 29,1%), beo phi (25,1 so vdi 14,5%) va beo bung (45,7 so vdi 29,9%), Trong cac yeu td tren thi ty le beo bung cao hdn nhieu so vdi nhdm chffng, chffng td xu hffdng beo bung, di kem vdi hau qua cua nd nhff THA, DTD can dffdc quan tam hdn d benh nhan gut, mat khac, chffng td chi sd vdng bung cd gia tri tien Iffdng nguy cd tim mach tdt hdn chi sd BMI (5).
4.2. Rdi loan lipid mau va cac yeu td lien quan d benh nhan gut
Ndng dp cholesterol trong mau cao la nguyen nhan chu yeu cua qua trinh vffa xd ddng mach va dan dan lam hep cac dpng mach cung cap mau cho tim va cac cd quan khac ciia cd the. Khi ddng mach vanh bi hep se lam giam ddng mau tdi nudi cd tim gay ra cdn dau that ngffc, tham chi nhoi mau cd tim. Hau het Iffdng cholesterol toan phan trong mau la LDL-C, loai cholesterol cd hai, chi cd mpt Iffdng nhd cholesterol la HDL-C, loai cholesterol cd fch, cd tac dyng bao ve chdng lai benh vffa xd ddng mach. Nguy cd bj benh ddng mach vanh va cac benh ly tim mach khac cang tang cao hdn neu cd cac yeu td nguy cd khac bao gom hut thudc la, tang huyet ap, dai thao dffdng, thdi quen it van dpng va thffa can, beo phi (2,6).
Trong nghien cffu nay, chung toi nhan thay so vdi nhdm chffng, benh nhan gut cd mdt sd chi sd chi diem cho nguy cd tim mach cao hdn (p
<0,001) nhff cholesterol toan phan (5,1 ± 0,9 so vdi 4,9 ± 0,8 mmol/l), LDL-C (3,6 ± 1,9 so vdi 3,1 ± 1,8 mmol/l), chi sd danh gia xd vffa mach
Y HOC VIET NAM THANG 5 - SO 2/2015
mau (cholesterol toan phan/HDL-C (3,95 ± 1,37 so vdi 3,45 ± 1,83), triglycerides (3,57 ± 1,24 so vdi 3,09 ± 1,17 mmol/l); ngu'dc lai HDL-C lai thap hdn (1,29 ± 0,67 so vdi 1,42 ± 0,85 mmol/l; p <0,001). Ty le tang cholesterol toan phan (48,0 so vdi 33,9%), tang LDL-C (51,2 so vdi 37,0%), HDL-C thap (53,5 so vdi 22,8%) va tang triglycerides (56,7 so vdi 32,3%) cung cao hOn so vdi nhdm chffng. Ket qua nay cung phu hdp vdi nghien cffu trffdc dd (2,3,6,7). Oe danh gia nhffng yeu t d lien quan den rdi loan lipid mau ma cu the la nong dp HDL-C thap, mdt trong nhffng rdi loan lipid gap vdi ty le cao d benh nhan gut, chung tdi so sanh dac diem lam sang va can lam sang cua 2 nhdm benh nhan gut dffa vao tieu chi cd hay khong cd rdi loan HDL-C.
Chung tdi nhan thay, so vdi nhffng benh nhan cd HLD-C binh thffdng thi nhdm benh nhan cd HLD- C thap cd mpt so chi sd cao hdn nhff tudi (52,7
± 14,6 so vdi 45,9 ± 12,4), tien sff gia dinh cd benh ly tim mach (55,9 so vdi 47,5%), hut thudc la (83,8 so vdi 47,5%), udng rffdu, bia (70,6 so vdi 36,8%), BMI (27,9 ± 14,6 so vdi 25,3 ± 12,7 kg/m^), vdng bung (91,8 ± 10,6 so vdi 87,6 ± 8,1 cm), nong dp acid uric mau (482,5 ± 92,7 so vdi 431,3 ± 89,8 pmol/l), xuat hien hat tophi (23,5 so vdi 13,6%) va ty le tap the due thffdng xuyen thap hdn (23,5 so vdi 62,7%). Ket qua nay cung phCi hdp vdi cac nghien cffu trffdc (2- 6). Cac yeu to nay cung la cac yeu t d nguy cd kinh dien lien quan den rdi loan lipid mau da dddc chffng minh d nhffng ngffdi khde manh binh thffdng, do do can khuyen khich benh nhan • thay doi Idi sdng va sinh boat hdp ly, tang cffdng tap the due thffdng xuyen, giff can nang hdp ly de lam giam nguy ed rdi loan lipid mau.
V. Kii LUAN
Tan suat eac rdi loan lipid mau d benh nhan gut nguyen phat la triglycerides tang cao (56,7%), HDL-C thap (53,5%), LDL-C tang
(51,2%) va cholesterol toan phan tang (48,0%).
Cac yeu t d lien quan den roi loan lipid mau d benh nhan gut la tudi, tien sff gia dinh cd benh tim mach, hut thudc la, udng rffdu, bia, it boat dpng the due, beo phi, nong do acid uric mau va xuat hien hat tophi. Do do, kiem soat tdt tinh trang benh gut, khuyen khich benh nhan thay ddi Idi sdng va sinh hoat hdp ly* tang cffdng tap the due thffdng xuyen, giff can nang hdp ly de lam giam nguy cd rdi loan lipid mau, qua do han che nguy cd tim mach d benh nhan gut.
T A I UEU T H A M K H A O
1. Ciarson LE, Hider SL, Belcher 3, et al (2015).
Increased risk of vascular disease associated with gout; a retrospective, matched cohort study in the UK clinical practice research datalink. Ann Rheum Dis,7A{A):6A2-7.
2. Emmerson B (1998). Hyperlipidaemia in hypenjiicaemia and gout. Ann Rheum Dis; 57:509-10.
3. Inokuchi T, Tsutsumi Z, TakahashI S, et al (2010). Increased frequency of metabolic syndrome and its individual metabolic abnormalities in Japanese patients with primary gout. J Dm Rheumatol; 16:109-12.
4. 300 K, Kwon SR, Urn M3,et a) (2014).
Prevention of comorbidity and acute attacit of gout by uric acid lowenng therapy. J Korean Med Sci;29i5y.657-ei.
5. Kuo CF, See LC, Luo SF, et al (2010). Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology;49:141-6.
6. TakahashI S, Yamamoto T, Moriwaki Z, et al (1994). Impaired lipoprotein metabolism in patients with primary gout: influence of alcohol intake and body weight. Br J Rheumatol;33:731-4.
7. van Durme C, van Echteld IA, Falzon L, et al (2014). Cardiovascular nsk factors and comorbidities in patients with hyperuncemia and/orgout; a systematic review of the literature.
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