疾病营养治疗指导方案：代谢性疾病营养治疗痛风.pdf

代谢性疾病营养治疗痛风Goutisahereditarydiseasewithadisturbanceofuricacidmetabolismoccurringprincipallyinmalesafter30yearsofage.Womenaremoresusceptibleafterthemenopause.Hyperuricemia(highbloodlevelofuricacid)istransmittedbyasingledominantautosomalgenewhichisnotsexlinked.Thecauseforthehyperuricemiahasnotbeenfullyestablishedbutvarioustheoriesascribeitto(1)decreaseddestructionofuricacidinthebody(2)increasedproductionofuricacidinthebodyor(3)decreasedexcretionofuricacid.Overeatingandexcessivedrinkingofalcoholicbeveragesarenotprimaryetiologicagentsbutalcoholhigh-fatdietsandobesitycanaggravateanexistingcondition.Alargepercentageofindividualswithhyperuricemiasoonerorlaterwillhaveacuteattacksofgoutcharacterizedbysuddeninflammationandswellingaccompaniedbyseverepainofthejointsespeciallythemetatarsalkneeandtoejoints.Duringtheacuteattacksalow-purinedietisoftenorderedinadditiontodrugtherapy.Allglandularorgans(suchasliverpancreaskidney)fleshfoodsandextractivesfromthemsuchasgraviesandsoupsmustbeeliminatedforthelow-purinediet.Sinceobesityhasadverseeffectsongeneralhealthaswellasgouttheoverweightindividualshouldgraduallyloseweight.Patientsshouldnotbeplacedonlow-caloriedietsduringacuteattacksofgoutsincethecatabolismofadiposetissuereducestheexcretionofuricacid.Becausethenitrogenofthepurinenucleusissuppliedbyproteintheintakerestrictedtoabout0.8-1g/kg.Fatisoftenrestrictedto40-50g/d.Thedailyintakeoffluidsshouldbeatleast2-3liters.一、概述痛风（gout）是嘌呤合成代谢紊乱和(或)尿酸（uricacid）排泄减少、血尿酸增高所致的一组疾病。其临床特点为高尿酸血症（hyperuricemia）及尿酸盐结晶、沉积所引起的特征性关节炎、痛风石、间质性肾炎和尿酸肾结石形成严重者可致关节活动功能障碍和畸形。根据导致血尿酸升高的原因痛风可分为原发性和继发性两大类。原发性痛风除少数由于嘌呤代谢的一些酶的缺陷引起外大多病因尚未明确属遗传性疾病病人常伴有高脂血症、肥胖、原发性高血压、糖尿病和动脉粥样硬化等。继发性痛风可由肾脏病、血液病、药物、高嘌呤食物等多种因素引起。痛风多见于体型肥胖的中老年男性女性很少发病如有发病多在绝经期后。发病前常有漫长的无症