尿酸冠狀動脈鈣化 | Uric Acid Coronary Calcification

Store/尿酸冠狀動脈鈣化 | Uric Acid Coronary Calcification

探討無症狀高尿酸血症患者尿酸單鈉（MSU）晶體沉積與冠心病（CAD）嚴重程度及範圍的關係。

方法: 在這項橫斷面研究中，入選了連續住院的非ST段抬高急性冠狀動脈事件和無症狀高尿酸血症（血清尿酸濃度≥7.0 mg/dl）或正常血尿酸（血清尿酸濃度<7.0 mg/dl）患者。在無症狀高尿酸血症患者中，通過超聲評估雙膝和第一跖趾關節以及補償偏振光顯微鏡來確定MSU晶體的存在。冠心病通過冠狀動脈造影進行評估，並考慮以下變數：1）中度至重度冠狀動脈鈣化的存在，2）顯著冠狀動脈狹窄的數量，以及3）多支血管疾病的存在。多元回歸分析表明冠心病嚴重程度的變數與MSU晶體的存在之間的關聯。

結果: 140名患者入選。在進行超聲和顯微鏡分析後，將患者分為正常尿毒癥（n = 66）、無症狀高尿酸血症（n = 61）和無症狀高尿酸血症伴MSU晶體（n = 13）。無症狀高尿酸血症伴MSU晶體的患者中，中度至重度冠狀動脈鈣化的患病率顯著高於無症狀高尿酸血症單獨患者和正常尿酸血症患者（P = 0.003）。觀察到中度至重度鈣化與無症狀高尿酸血症伴晶體之間存在獨立相關性（比值比16.8，P = 0.002）。其他變數無顯著相關性。

結論: 無症狀高尿酸血症患者無症狀的MSU晶體沉積與更嚴重的冠狀動脈鈣化有關，提示與晶體沉積相關的更嚴重的CAD。(1)

溶解尿酸冠狀動脈鈣化的部份研究:

  • 心臟鈣化的進展被完全阻斷(2)
  • 心臟鈣化的發展受到高達80%的抑制(2)
  • 植酸六鈉鹽作為人類心臟鈣化治療的新選擇(2)
  • 植酸六鈉鹽治療52周可减少心臟鈣化進展(3)
  • 大多數冠心病患者的CAC評分降低(4)
  • 鈣化的冠狀動脈斑塊體積减少(4)
  • 心絞痛減輕或消失16例（84%）(4)
  • 腎臟、肝臟或血液系統未見不良生理反應(4)
  • 顯著降低了結石的大小(5)
  • 新結石形成顯著降低(5)
  • 防止新結石的形成，並减少殘留結石(5)


Uric Acid Coronary Calcification

Abstract

Objective: To evaluate the association between monosodium urate (MSU) crystal deposits in patients with asymptomatic hyperuricemia and the severity and extension of coronary artery disease (CAD).

Methods: In this cross‐sectional study, consecutive inpatients with a non–ST elevation acute coronary event and asymptomatic hyperuricemia (serum uric acid concentration of ≥7.0 mg/dl) or normouricemia (serum uric acid concentration of <7.0 mg/dl) were enrolled. In patients with asymptomatic hyperuricemia, the presence of MSU crystals was determined by ultrasound evaluation of both knees and first metatarsophalangeal joints and by compensated polarized light microscopy. CAD was assessed by coronary angiography, and the following variables were considered: 1) the presence of moderate‐to‐severe coronary artery calcification, 2) the number of significant coronary stenoses, and 3) the presence of multivessel disease. The association between variables indicating the severity of CAD and the presence of MSU crystals was analyzed by multivariate regression.

Results: One hundred forty patients were enrolled. After ultrasonography and microscopic analyses were performed, the patients were classified as having normouricemia (n = 66), asymptomatic hyperuricemia alone (n = 61), and asymptomatic hyperuricemia with MSU crystals (n = 13). The prevalence of moderate‐to‐severe coronary calcification was significantly higher in the patients with asymptomatic hyperuricemia with MSU crystals compared with patients with asymptomatic hyperuricemia alone and patients with normouricemia (P = 0.003). An independent association was observed between the presence of moderate‐to‐severe calcification and asymptomatic hyperuricemia with crystals (odds ratio 16.8, P = 0.002). No significant association was observed for the other variables.

Conclusion: Silent deposition of MSU crystals in patients with asymptomatic hyperuricemia was associated with more severe coronary calcification, which suggests more severe CAD in relation to crystal deposition.(1)

Partial study on dissolution of uric acid (coronary artery calcification)

  • The progression of cardiac calcification was completely blocked (2)
  • The development of cardiac calcification was inhibited by up to 80% (2)
  • Phytate hexasodium as a new choice for the treatment of human cardiac calcification (2)
  • Phytic acid hexasodium salt treatment for 52 weeks can reduce the progression of cardiac calcification (3)
  • CAC score decreased in most patients with coronary heart disease (4)
  • Reduced plaque volume in calcified coronary artery (4)
  • Angina was relieved or disappeared in 16 cases (84%) (4)
  • No adverse physiological reaction was found in kidney, liver or blood system (4)
  • The size of stone was significantly reduced (5)
  • Significant reduction of new stone formation (5)
  • Prevent the formation of new stones and reduce residual stones (5)

Refs:

  1. Andrés M, Quintanilla MA, Sivera F, Sánchez-Payá J, Pascual E, Vela P, Ruiz-Nodar JM. Silent Monosodium Urate Crystal Deposits Are Associated With Severe Coronary Calcification in Asymptomatic Hyperuricemia: An Exploratory Study. Arthritis Rheumatol. 2016 Jun;68(6):1531-9. doi: 10.1002/art.39581. PMID: 26748935.
  2. Characterization of SNF472 pharmacokinetics and efficacy in uremic and non-uremic rats models of cardiovascular calcification. Miguel D. Ferrer, Markus Ketteler, Fernando Tur, Eva Tur, Bernat Isern, Carolina Salcedo, Pieter H. Joubert, Geert J. Behets, Ellen Neven, Patrick C. D’Haese, Joan Perelló. PLoS One. 2018; 13(5): e0197061. Published online 2018 May 9. doi: 10.1371/journal.pone.0197061. PMCID:PMC5942814
  3. Effects of SNF472, a Novel Inhibitor of Hydroxyapatite Crystallization in Patients Receiving Hemodialysis — Subgroup Analyses of the CALIPSO Trial
    Paolo Raggi, Antonio Bellasi, Smeeta Sinha, Jordi Bover, Mariano Rodriguez, Markus Ketteler, David A. Bushinsky, Rekha Garg, Joan Perelló, Alex Gold, Glenn M. Chertow. Kidney Int Rep. 2020 Dec; 5(12): 2178–2182. Published online 2020 Nov 4. doi: 10.1016/j.ekir.2020.09.032. PMCID: PMC7710828
  4. Maniscalco BS, Taylor KA. Calcification in coronary artery disease can be reversed by EDTA-tetracycline long-term chemotherapy. Pathophysiology. 2004 Oct;11(2):95-101. doi: 10.1016/j.pathophys.2004.06.001. PMID: 15364120.
  5. Citrate salts for preventing and treating calcium containing kidney stones in adults. Phillips, Rebecca; Hanchanale, Vishwanath S; Myatt, Andy; Somani, Bhaskar; Nabi, Ghulam; Biyani, C Shekhar. Published in:Cochrane Database of Systematic Reviews. DOI:10.1002/14651858.CD010057.
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