625
49219322001004081117
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www.casopisvnitrnilekarstvi.cz442680400107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
VNITŘNÍ4268040010746106127172220280301
LÉKAŘSTVÍ748804001074185130188236280325378400
PŘEHLEDOVÉ42522001004388130181216258306358404446
ČLÁNKY88722001003973122176223272
Diagnostika4253300100456195134171210240267283317353
a794330010034
léčba8443300100155082120155
hyperurikemie101533001003773112148172210234251285319379394429
v1461330010035
kardiovaskulární15123300100336993131146185220256285319357372407431470485
prevenci20133300100376297133168205236251
na228033001003772
základě236833001003166100117152190226
patofyziologického26103300100377299137157196229244283299338376391422456490528567
mechanismu319333001005995126163198236251280340377
jejího3586330010015506580119158
vzniku376033001003568106122156194
Diagnosis425560015078113178246315382437471527
and990560015063132201
treatment122956001504696159224271373436504552
of1819560015066114
hyperuricemia1971560015067135203266316383432466520582683717782
in2791560015033101
cardiovascular2931560015052117166235269336401465520574642676742791
prevention3760560015067116180245306375422457524592
based4390560015068132188251320
on4748560015066134
its492056001503381136
pathophysiological4257000150671321792483153844525205746086757097778458809339981032
mechanism:1496700015099162216284349417452507608644
An2178700015077146
Expert2362700015067135203266316365
Consensus2765700015061128196252315383439507562
of3366700015066114
Czech3518700015061116179232301
and3857700015064132201
Slovak409670001506398165230294362
Specialists,4496700015063132195248283348382417472519575612
20245146700015072143213284
A425900012161
panel508900012157106161212236
of76690001215484
experts87290001215097154205238274315
from120990001212962117201
the143290001213388138
Czech1592900012158103153199254
and1868900012148103160
Slovak205090001214972128175223270
Republics,2342900012154104161217273298320365406427
with279190001217497130186
the299990001213388138
contribution315990001214599154187219243299355388411466522
of370390001215584
Professor380990001215385139168219258297352385
C.421690001215881
Borghi4319900012154110143198254277
from461890001212963117201
the484190001213388138
University5001900012165120143192241273314337370420
of544390001215584
Bologna,4251040012154109133188244299347368
discussed810104001215780118163218257296346403
the1230104001213388138
clinical138610400121456890145168213261284
approach16881040012148104161194248297341396
for2102104001212983116
the2236104001213388138
investigation2391104001212479125173213246269325372405428482538
and29461040012148103160
treatment3123104001213366115163195278328384416
of3556104001215584
hyperuricemia36581040012155100158208241296328352396445528551599
(HU)4274104001212992157184
in4476104001212378
patients45721040012156105137160210265297338
with4927104001217497130185
increased5130104001212378122155204252291341398
cardiovascular425118001214593126182205260307355394439494517565597
(CV)1040118001212984142173
risk.123111800121335695142165
Since1414118001214971127171220
elevated1652118001215074124172220253302359
uric2029118001215587111155
acid2202118001214893116173
(UA)2392118001212992150178
modifies25881180012183138195218248274324363
CV29691180012158116
risk,310311800121335695142165
it3286118001212356
should3360118001214095150205228285
be36631180012156107
considered3788118001214598154193216272322355405462
as4268118001214887
an43731180012148103
important44941180012124107163219252288336391424
modifier49361180012183138195218247273324356
of5310118001215584
CV54121180012158116
risk42513200121335695141
and5841320012148103160
patients7621320012156105137160210266298338
in1118132001212378
whom12141320012174129184268
its149913200121245797
therapeutic1614132001213388138171219276326381414437482
reduction2114132001213282139194239274297351407
may25391320012183131176
improve27331320012123106163196250297346
CV30971320012157115
parameters32301320012157106138186269320353402435475
should3723132001213994149204227284
be40251320012156107
identified.4150132001212380130185217240270296346403424
The45911320012150106156
lack4765132001212472116162
of4945132001215584
selection5047132001213990113164209244267322378
of5442132001215584
suitable425146001214094117150199256280330
patients7771460012157105138161211267299340
is1138146001212363
probably1222146001215790144201250307331378
the1622146001213388138
reason1782146001213382130170225281
for2084146001212984117
the2222146001213489139
inconsistent2383146001212378123177233272294334367417472505
results2909146001213383122177200233274
of3204146001215584
studies3309146001214074129185209259298
evaluating3629146001215097146169224272305328383439
the4089146001213388139
clinical424914600121456891146170214263286
outcomes45571460012155110143187241324375414
of4993146001215484
antihyperuricemic50981460012148103136159214260317368401425160001215588111156205288312356
therapy799160001213388139172220277323
to1140160001213387
date.12451600012157105137186206
The14691600012150107157
expert1644160001215097154206238274
panel19361600012157106161212236
suggests2189160001214094151207257296330371
treating2578160001213365115163196219274330
HU29261600012165130
due30741600012156111161
to3253160001213387
an33581600012149104
increase3480160001212378123156206254293343
in3841160001212379
xanthine3938160001214694149182237260315365
oxidase43211600012155101124181229268318
(XO)4657160001212987153179
activity,4854160001214993129152200224257307323
which51951600012173129152197252
is5465160001212362
associated425174001214887126182227250298331380437
with882174001217498131186
an10881740012148104
increase1212174001212379124156206254293344
in1576174001212378
CV16751740012158116
risk,181117400121335696142165
rather1997174001213281113169219252
than2269174001213388136192
HU24811740012165130
due26311740012157111162
to2813174001213387
decreased29211740012156106152184234282321372429
renal3370174001213383139187210
excretion3600174001215098141174224257280335391
of4011174001215584
UA,41151740012165123146
which42821740012173129152197252
is4554174001212463
not46371740012156111143
as4801174001214887
risky490817400121335796142193
from5121174001212963117201
a53421740012148
CV54111740012158116
perspective.4251880012157108141181238289334370393441490510
To954188001214998
differentiate,1070188001215780109142192225275331363386434466516535
he16241880012155106
proposes1748188001215790144201257297347387
to2153188001213387
use2258188001215595145
a24211880012149
new24881880012155106179
index2685188001212479136186233
of2936188001215585
the3039188001213388138
ratio3196188001213281113137192
of3406188001215584
serum3508188001214090123179262
UA37881880012165123
to3929188001213388
creatinine4035188001214577127175207230286309364414
(sUA/sCr),4468188001212866129187224260318350376395
which48811880012174130153197252
has51521880012155103142
been53131880012157108159214
shown425202001214095150223279
to726202001213387
correlate835202001214598131164214238286318368
with1225202001217397130185
the1432202001213388139
incidence1593202001212378123146203253309354403
of2018202001215584
CV21242020012158116
events.2262202001215097147202234275296
For25802020012149103136
the2738202001213388138
purpose28982020012157113145202258298348
of3268202001215584
CV33742020012158116
prevention,3512202001215790140187236292324347402458479
it4013202001212356
is4091202001212463
recommended4176202001213282128182265348399455511562619
to4817202001213387
investigate4926202001212378125174213247270326374407456
UA54042020012165123
levels425216001212373121169193232
in674216001212478
patients7702160012156105137160210265297337
with1125216001217396129184
increased1326216001212478123155204252291341398
CV17412160012158116
risk187421600121335695141
(hypertension,2033216001212883128185236268304353408447469524579600
diabetes,2650216001215779127183234267316355376
dyslipidemia,30432160012156104143166188245268324374457480527548
chronic3609216001214499131185240263308
kidney3934216001214771128182232279
disease,4230216001215679118168216255305324
accumulation4572216001214892135190272327350397430452507562
of5152216001215483
CV52532160012158115
risk538621600121325694141
factors425230001212977121155208240280
or722230001215486
CVD)8252300012157114181206
and10482300012148102157
to1222230001213386
initiate1325230001212377100132154201233281
intervention1623230001212378109157190240288342374396450505
to2145230001213386
target2248230001213280112166216248
serum2513230001214089121175257
UA27872300012164121
levels2925230001212473120168191229
<31712300012159
36032472300012151100151
μmol/l34152300012155137191215248272
in3704230001212377
men37982300012183132187
and40022300012147102157
<41762300012159
30042522300012151100152
μmol/l44212300012155137191215248272
in4710230001212377
women48042300012173126209258313
with5134230001217295128182
sUA/53332300012139101158195
sCr425244001213996127
index570244001212377133183229
>8172440012159
3.6.893244001215170121142
Intervention1052244001212479110159191242290345377399454509
consists1578244001214497152191213251285325
of1920244001215483
patient20202440012157105137159209264295
education23332440012149106160204252284307361416
and27662440012148102158
lifestyle294124400121244675125164197246270319
modification,32782440012182137193216245270315363394417471526547
optimization38422440012154111143166248271313362394416471526
of4385244001215483
treatment4485244001213365114161193275325380412
of4914244001215583
other5014244001215587142191224
CV52552440012157115
risk538724400121325594140
factors425258001212978123158212245286
and7292580012148103160
administration9072580012149105189212267290329363396444477500555610
of1536258001215584
an16382580012148104
XO17602580012157124
inhibitor,1902258001212379134157214237270324357373
allopurinol229425800121487195150207262295318374429453
in2765258001212479
the2862258001213388139
first301925800121295688128162
line.3200258001212346101152172
The33902580012150106157
dose35652580012157112151202
of3785258001215584
allopurinol388725800121497295150207263295319374429453
should4359258001213994150205228285
be46622580012157108
gradually4788258001215689137194249297320343391
titrated,519725800121335689122170203252310330
usually425272001215594149197220243291
in741272001212378
the844272001213388138
range1007272001213381137193243
of1275272001215584
100–3001384272001215197150204254304357
mg/day,17662720012183140174227275320336
according2127272001214893137190223279303358414
to2566272001213387
the2677272001213389139
achievement2841272001214893148171221269318401452508540
of3406272001215584
the3514272001213389139
target3678272001213382114170220254
level3956272001212474122171195
of4176272001215584
UA,42842720012165123146
with4455272001217497130185
regular4665272001213383140194218266298
checks49882720012145100150196242285
every5297272001215098147180230
4–64252860012151104159
weeks.6022860012173122173220262283
Aer9032860012161110142
stabilization1063286001214073122178202225248290340372395450505
of1586286001215483
the1687286001213388138
condition,1843286001214498153210233265288343398419
continued2280286001214498153185208263317367424
treatment2722286001213365115163195278328384416
with3155286001217497130185
regular3358286001213282138193216264296
monitoring36722860012183138193216249303335359414469
every4159286001215097146179229
644062860012151
months44742860012184138194226281320
is4811286001212462
recommended.4891286001213382128181264347397453509559616637
Key4253030012357106153
words:5943030012374128162219259281
uric892303001215485108151
acid,1059303001214791112167187
hyperuricemia,1262303001215598154204235289320343386433514537583603
xanthine1881303001214592145176230252305354
oxidase,2251303001215498120175222259308327
cardiovascular2594303001214491122177199252297344382426479501547578
risk,318930300121325492137159
sUA/sCr33643030012139100157192227283314
index,3694303001212376131180225246
xanthine3957303001214592145176230252305354
oxidase4327303001215497120175221259308
inhibitors,4651303001212376130152207229261313345384404
allopurinol.507130300121476992145200254285308361414437457
Metabolismus4253530013899158203264329392424457509603667719
kyseliny11813530013860127178237270303367430
močové16483530013890153204266327384
Kyselina565370001074481116160180200248289
močová8733700010772121162209250292
(2,6,8-trihydroxypurin)118437000107236682128144190220248276296344383432459506545588639688715735783805
je2008370001071963
u20903700010747
lidí215637000107183887106
a22813700010740
vyšších2340370001074084118152171211260
primátů261937000107487696169210238286
konečným425384001073887138184226276317393
produktem839384001074978127179228268300345420
degradace1280384001074995147175218269312354398
purinů16993840010750100128149199248
(Obr.1968384001072484136165179
1)2168384001074463
(1).225238400107246585100
U23723840010757
ostatních2449384001074884114158186237257299349
živočichů2818384001073757425398001074088130150191240288
je732398001071964
kyselina815398001073882117162182202250292
močová11263980010773122164212253295
(KM)1441398001072368141165
dále1625398001074890110155
metabolizována17993980010773118147189240289310330367415456499548589
urát2408398001074774117145
oxidázou2572398001074887107157198237284333
(EC425412001072467120
1.574412001074457
7.660412001074453
3.3)742412001074461108131
na902412001074891
5-hydroxyizourát,1022412001074473124165215243292332376398436485535563607636654
který1705412001073870115143188
je1922412001071965
degradován2016412001074995147175219270320362405455
v25004120010741
závislosti2570412001073781122143178199249284315335
na425426001074891
druhu539426001074977127177226
organismu788426001074877127170219240274349399
na1210426001074890
allantoin,132442600107406182124174202251272321339
ureu1686426001074876120170
nebo1879426001074894146197
amoniak.20994260010741116166217237279319339
U24614260010756
hominidů2541426001074898174194244264315364
je425440001071965
tento520440001072873123151200
enzym750440001074494133178255
plně1035440001074971121167
deficientní1232440001074995121142185205251301330380401
z16634400010736
důvodu1729440001074998141191243292
kumulace2051440001073989164214235277320364
genetických2445440001074995146192222242285324369411461
variant3047356001074184112133175225254
vedoucích3330356001074186138188238280301342392
ke3752356001073883
ztrátě386435600107366998141170214
funkce,4108356001072374124163205249265
které4403356001073870115143188
postupně46203560010750101136167217268318364
vznikly5014356001074081131152191214256
v52993560010741
průběhu53693560010750791293047370001075096146195
miocénu.3266370001077394144187231281330348
Kyselina3187384001074480113156175192239279
močová34813840010773121161206245286
je3782384001071962
u38603840010747
člověka3923384001073957104144186223264
efektivně4203384001074366108145175193233281324
renálně4543384001072668115155173220263
reabsorbována4822384001072668107155188235261310358398438485525
(glomerulární53633840010723708913630473980010773116142189208247273321339
filtrace,34013980010724436188114155195236250
reabsorpce,3667398001072668107156189236262312352394408
sekrece,4090398001073377114141183224265279
postsekreční4385398001074997130158192235273300342382429447
reabsorpce).4848398001072668107156189236262312352394414427
Sérová5291398001074184110156196236
hladina3047412001074867108158176224265
kyseliny3339412001073881115159178197245283
močové36494120010774122164210251294
vykazuje3969412001074184123166203252271315
intra-431041200107196794121162190
i45274120010719
extrapersonální4572412001074484114141183233278304339387436477496544562
variabilitu,5161412001074082108128168218237256275303351366
a30474260010741
její310742600107196382101
hladina3227426001074867108157176224264
je3511426001071963
významně3593426001074184123172212286334378
ovlivňována3990426001074889108127168217265305347395435
věkem4445426001074083121165238
a47034260010740
pohlavím.4763426001074999147166207247266340356
Vylučování5138426001074687107154194241281323371389
KM30474400010744116
je3179440001071962
ze3257440001073678
dvou3351440001074989136184
třetin355144000107275395123141188
zajišťováno375544000107367896115146176221261301349397
ledvinami,4168440001071862111152171218258330349364
třetinou454844000107275395123141188236283
gastrointestinálním4847440001074989122150176223241289315357390418437484524542590608680
Vysokopurinová1337489001074687121169208255305354380399447495536577
strava193448900107346389131171212
„568676008960
Genetické7086750010756101149193221240280318361
faktory1089675001072366104134181208251
„568690008960
Metabolický7086890010770114142184233282302320361398441
syndrom1169689001073475124173200247321
„568704008960
Porucha708703001074592118167207255296
funkce1024703001072372120158198240
ledvin1284703001071963113154174221
„568718008960
Léky708717001074083122164
snižující892717001073482100136185204222262281
renální1192717001072770118159178226244
funkce1456717001072372120158198240
Osteoatróza4937667001076094123166215257284310357393435
Puriny1449530001074592119138186224
z16935300010736
potravy1749530001075099126153194234277
Purinové2490530001074592119138186234274318
nukleotidy2827530001074996134154198247275294343383
a32305300010741
báze3290530001075092129172
Pool2140598001074592141160
KM23205980010745117
v24575980010740
séru2517598001073478104153
a26895980010741
tkáních2750598001072866108156175215263
Syntéza3929524001074279128155198235277
a42265240010741
metabolismus42865240010774118146188237286306324357430478511
purinů4072536001075098124144192239
v43315360010740
tkáních4391536001072866108156175215263
Obezita42224890010760111156193212240282
Krystaly3718581001094980125161192237258301
urátu4038581001095079123153203
sodného4260581001093586137188233284334
703603520001094690
%37135200010971
302167520001094692
%22785200010972
Renální1374620001094894145188210260281
exkrece1674620001094588131162207249293
701986620001094691
%20966200010971
302950620001094692
%30616200010972
intestinální3152620001092171100145181212233283326348398419
ekrece3590620001094588119164206250
Obr.4254670011362114150173
1.625467001135478
Metabolismus7314680010768106133176221267286304333403449478
kyseliny1226468001073776107144163181227263
močové15054680010771116154198236273
v17944680010738
lidském184846800107183782111147184256
organismu2120468001074571114160206224253323368
(1)250546800107246078
Legenda42574700953366107141183223264
obrázku:70374700954081105143175208249262
Dietní97974700955067102125167183
příjem1176747009541648097132195
purinů138674700954081104121162202
a1602747009541
metabolický165774700956498122161201242259276309342377
obrat204974700954081104142166
orgánů222974700954063102143184225
a2468747009540
tkání25237470095235695137153
je269174700951650
zdrojem27557470095327194134150184248
purinových301874700954081104120162202236271305346
bází,337874700954081114130144
které35377470095325891114147
jsou36987470095164383124
transfomovány38367470095234785126153174214278318352391433465
na431574700954182
kyselinu44117470095336896130146163204245
močovou.4670747009564104138177211251292307
Ta499174700953571
je507774700951550
následně514174700954282109125159200241275
eliminována5430747009534516842575700956480121162195235276317
z756757009532
organismu80275700954063102143184200227289330
močí,1146757009564104139155169
přibližně13297570095406480120137154185226260
jedna16047570095155091132172
třetina17917570095234679103119160201
denního200675700954075116158174216257
obratu227775700954081104143166207
(který24987570095215480112136171
představuje26847570095406396137163187226260301317351
asi30507570095406783
1000314775700953770109147
mg)3309757009563104125
je344875700951650
odstraněna351375700954081108131154193234268309350
intestinální38777570095175881113142165181223263280321338
exkrecí.422975700953468101125158191208223
Všechny446675700954068102135177218250
tyto47307570095235984123
procesy486875700954063103137170198231
podléhají511475700954081122139173215255271288
genetické5416757009541754257670095417699116149182216
regulaci6557670095235697137154194228244
a914767009540
jsou9687670095164383124
značně110676700953273114147188222
závislé134276700953272106122149164198
na155576700954182
faktorech16517670095206093118157181214247289
zevního19547670095316599141157199240
prostředí220876700954064103130154176209250267
(především24897670095216285118159193228255271335
příjmu2838767009540648097161201
purinů305476700954081104121162202
v3270767009534
dietě).33187670095415791115148168179
Nabytek351276700954989130162188221254
kyseliny37807670095336896130146163204236
močové4030767009564105139178212245
se428976700952862
může4365767009563104135168
ve454776700953467
formě46297670095206083147181
krystalů48257670095325692119143182198239
urátu507876700954164102125166
sodného525976700952767109150184226266
ukládat4257770095407491131172212236
v675777009534
kloubech7237770095335091132172207241282
a1020777009540
měkkých107477700956498131164200233274
tkání,13627770095245696138154168
u1544777009541
disponovaných15997770095415784123164206247280320361393426467
jedinců20817770095165091107149182222
vede231877700953366107142
tato24747770095236285125
depozice261377700954075116157188204238270
k2898777009533
zánětlivé294577700953171113147170187203237271
reakci32307770095235696130163179
s3423777009528
rozvojem34657770095236394130170186220284
dny.376377700954182114126