500 | www.casopisvnitrnilekarstvi.cz VNITŘNÍ LÉKAŘSTVÍ PŘEHLEDOVÉ ČLÁNKY Diagnostika a léčba hyperurikemie v kardiovaskulární prevenci na základě patofyziologického mechanismu jejího vzniku Body k zapamatování Kolektiv českých a slovenských odborníků připravil v roce 2024 expertní konsenzus pro diagnostiku a léčbu zvýšené hladiny kyseliny močové u pacientů se zvýšeným kardiovaskulárním rizikem, který lze shrnout v následujících bodech: Hyperurikemie představuje KV rizikový faktor. U pacientů s hypertenzí, diabetem, dyslipidemií, CKD, kumulací KV rizikových faktorů či KV onemocněním je třeba stanovit hladinu KM a při zjištěné hyperurikemii také index sKM/sCR. V prevenci KV rizika je třeba zahájit intervenci při hodnotách indexu sKMµmol/l/sCrµmol/l ≥ 3,6. Ten identifikuje pacienty s HU v důsledku zvýšené produkce KM, která je spojena se zvýšeným KV rizikem. Pacienty je třeba edukovat o rizicích spojených s HU a o úpravě životního stylu (omezení konzumace fruktózy (slazené nápoje), vnitřností, mořských plodů, alkoholu, udržování zdravé tělesné hmotnosti a dostatečné hydratace). Léčba je vedena k cílovým hladinám KM < 360 µmol/l u mužů a < 300 µmol/l u žen. Poklesy koncentrace KM pod 250 umol/l nejsou pravděpodobně spojeny s benefitem. Terapií 1. volby je inhibitor XO alopurinol, který se podává v postupně titrovaných dávkách obvykle v rozmezí od 100 do 300 mg/den. Do dosažení cílové hladiny KM jsou vhodné kontroly po 4–6 týdnech. Léčba má pokračovat i po dosažení cílové hladiny KM při pravidelném monitorování 2× ročně. Léčba hyperurikemie vyžaduje mezioborový přístup. LITERATURA 1. Rees F, Hui M, Doherty M. Optimizing current treatment of gout. Nat Rev Rheumatol. 2014 May;10(5):271-283. 2. Du L, Zong Y, Li H et al. Hyperuricemia and its related diseases: mechanisms and advances in therapy. Signal Transduct Target Ther. 2024;9(1):212. 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