中國臨床營養網（lcyycc）
Case study No.19
文/亞太臨床營養雜誌（中文版）
摘自：亞太臨床營養雜誌中文版訂閱號（APJCN-in-China）
George W. a robust extrovert male aged 45,is overweight (100 kg unclad) and for the previous 9 years has had on averagetwo attacks of acute gout each year. He takes no regular medication, is mildlyhypertensive, BP around 150/95, and has normal renal function. He has beenadvised to lose weight.
Whichof the following dietetic programmes his various friends have advised him tofollow are likely to lead to fewer and less severe attacks?
A daily energy restrictionsufficient to lose 0.5-1kg weekly.
The same with daily diuretics.
The same with restriction ofnucleoprotein.
A strict 800 kcal/d -or less - reductiondiet.
Strict restriction of alcoholicbeverages.
(Correct answers A, C and E)
Diuretics (B)tend to precipitate acute attacks and (D) the crash diet aiming to cause arapid loss of weight by near starvation tends to elevate serum urate levels andprecipitate acute attacks by reducing ketosis. A more modest reduction, if practisedproperly and regularly, will in many, but not all, caseslead to a modest lowering of serum urate levels and fewer acute attacks.Alcoholic beverages, particularly rich fermented wines taken frequently, maystimulate increased purine production increasing hyperuricaemia anduricaciduria. Bouts of heavy drinking cause hyper-lacticacidaemia risesin serum urate levels and precipitation of acute attacks of gout.
病例研究20：合理的飲食計劃有可能減輕痛風發作
喬治是一位精力充沛、性格外向的45歲男性，超重（淨重100kg）並且在前9年每年平均會有2次痛風發作。他沒有服用常規藥物，患有輕度高血壓，血壓約150/95mmHg, 腎功能正常。他被建議減肥。
他各種朋友建議的哪些飲食計劃有可能減輕痛風發作？
A．充分限制每日能量，每周體重減少0.5-1kg
B．每天使用利尿劑
C．每天限制核蛋白
D．嚴格限制飲食800kcal/d或更少
E．嚴格限制酒精飲料
（正確答案為A、C 和 E）
利尿劑(B選項)可導致痛風突然發作，用近乎飢餓狀態的快速減重的飲食（D選項），使得血清尿酸鹽水平升高，導致痛風突然發作。如果飲食控制溫和、適度且規律，然後逐漸加強，這樣會減少血清尿酸鹽水平下降和痛風急性發作。酒精飲料，特別是經常喝充分發酵的葡萄酒，會刺激嘌呤增加，導致血內尿酸過多和尿酸尿。過度飲酒會導致尿酸鹽水平上升和痛風急性發作。
附：
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