高尿酸血症與痛風
楊惟婷整理
台灣近年痛風患者已有年輕化趨勢。發作起來痛得冷汗直流，拖著腿也走不動。但這種病不發作的時候人好好的，到醫院也查不出來什麼毛病，醫生只是告訴你尿酸高點，其他沒事。
但尿酸怎麼會高？醫生說是因為海鮮吃過多、吃了太多高蛋白食物。很多人聽了馬上控制飲食，可是不管怎麼忌口，該發作它還是痛。
一、何謂高尿酸血症？
普林是體內遺傳物質上的一種含氮物質，普林可來自於身體自行合成、身體組織的分解及富含核蛋白的食物；普林經由肝臟代謝形成尿酸，最後由腎臟將尿酸排出體外。
當男性每100毫升血液中的尿酸值在7毫克以上，女生在6毫克以上時，便稱為高尿酸血症。
二、造成高尿酸血症的原因
可能造成高尿酸血症的原因如下﹕
1、攝取富含普林或導致普林合成增加的食物
2、尿酸的合成增加
3、腎臟排除尿酸受阻
4、腸道排除尿酸受阻
理想的血中尿酸值不超過6(mg/dL)，使用降尿酸藥物，可減少急性發作、關節變形、腎臟傷害的風險，患者應長期追蹤治療，搭配飲食控制。普林含量高的食物，列為患者依照醫囑，宜限量的食物。
普林含量高的食物如下：
■發芽豆類、黃豆。
■雞肝、雞腸、鴨肝、豬肝、豬小腸、牛肝等。
■白鯧魚、鰱魚、虱目魚、吳郭魚、白帶魚、烏魚、吻仔魚、鯊魚、海鰻、
沙丁魚、小魚干、扁魚干等。
■小管、草蝦、牡蠣、蛤蜊、蚌蛤、干貝等。
■豆苗、黃豆芽、蘆筍、紫菜、香菇。
■肉汁、濃肉湯(汁) 、雞精等。
■酵母粉。
其中，黃豆，雞肝、雞脾、豬小腸、豬肝、鴨肝、牛肝等肉類與內臟、白鯧魚、鰱魚、虱目魚、吳郭魚、皮刀魚、四破魚、白帶魚、烏魚、鯊魚、海鰻、沙丁魚、小管、草蝦、牡蠣、蛤蜊、蚌蛤、干貝、小魚干、扁魚干、烏魚皮、白帶魚皮、吻仔魚等水產品，以及曬乾香菇、紫菜、酵母粉等，最好不要食用。
三、長期高尿酸血症引起的併發症
長期高尿酸血症可能引起什麼併發症？
1、痛風性關節炎
2、腎臟病
3、尿路結石
4、並常併有高脂血症
5、糖尿病及心血管疾病
四、痛風成因
（一）西醫觀點
痛風的發生是因體內的普林代謝異常，導致高尿酸血症，而使尿酸鈉鹽沉積在關節腔內，造成關節腫脹和變形。
■痛風和高尿酸血症有什麼關係？
痛風，聽起來好像很痛的疾病，其實並不會讓人「全身痠痛」。
如果全身到處痠痛，比較可能的原因是因為過度的工作或激烈運動（例如參加運動會後幾天的全身痠痛），身體負荷不了而產生全身性的反應，或者是因為身體被病毒或細菌感染（例如流行性感冒的時候會覺得肌肉痠痛，全身懶洋洋的），很少是因為痛風所引起的。
據文獻報告：罹患痛風的機率，隨著血液中尿酸濃度的升高而顯著增加。
■痛風的臨床徵狀分為四個階段：
1、無症狀的高尿酸血症
2、急性痛風
3、不發作期
4、慢性痛風性關節炎
■誘發性痛風的因素有：
外傷、飲酒、手術、暴飲暴食、出血、感染、放射線治療、藥物或饑餓等。
（二）中醫觀點
痛風其實這也是腎虛的一種症狀，因為腎的過濾功能減弱了，血液裏的酸毒排不出去，隨著血液迴圈流動。
由於大腳趾關節是人體的最末梢關節，酸毒的結晶體最容易積聚在這裏，也有的人是大拇指關節痛，都是同樣的道理。
所以，如果你不去調整腎臟，恢復它的過濾功能，酸毒結晶長期擠壓關節，最後關節不能正常活動，出現變形了。
所以痛風患者不僅要改變飲食習慣，更關鍵在於恢復腎臟的機能，提高過濾能力，把酸毒排出體外才不會再復發。 腎乃“先天之本”，不可不知也。
腎有藏精、主生長、發育、生殖、主水液代謝等功能，被稱為“先天之本”。
腎虧精損是引起臟腑功能失調，產生疾病的重要因素之一。
五、痛風患者的飲食保健
■痛風患者的飲食原則：
- 維持理想體重
- 理想體重可以下列公式估算：
- 理想體重(公斤) = 體重 ¸ 身高2 (公尺2) = 22 ± 10%
- 若體重超過理想值的10%時，應慢慢減輕，每月以減重1~2公斤為宜；但不宜於急性發病期減輕體重。
- 不過量攝取蛋白質。在正常情形下，每人每天每公斤理想體重以攝取1公克蛋白質為宜。
- 急性病發期間，應儘量選擇普林含量低的食物，如：蛋類、奶類、米、麥、甘薯、葉菜類、瓜類、蔬菜及各式水果，蛋白質最好完全由蛋類、奶類供應。
- 非急性病發期，則應力求飲食均衡，並避免食用普林含量過高的食物(請參考附表：普林含量高的食物)。
- 烹調時用油要適量。少吃油炸食物，避免經常外食。
- 黃豆及其製品(如：豆腐、豆干、豆漿、味噌、醬油、豆芽等)，雖含較高量的普林，但因普林的種類與肉類不同，故於非急性發病期，仍可適量攝取。
- 避免攝食肉湯或肉汁(因為經過長時間烹調的肉湯或肉汁，通常含有大量溶出的普林)。
- 食慾不佳時，須注意補充含糖液體，以避免身體組織快速分解，誘發痛風。
- 多喝水。
- 避免喝酒(空腹飲酒易飲起急性發作)。
- 避免暴飲暴食。
■影響痛風較大的是肥胖、喝酒、水分不足、海產食物及肉類吃太多。
美國流行病學自1986年至1998年追蹤12年，針對5萬多個白人男性調查發現，影響痛風發生因素的就是肥胖，男性21歲以後體重每增加15公斤，痛風危險性就增至平常人的2.47倍，反之，每減少5公斤體重，痛風發生率就減30％，因此，痛風患者應適度減重。
■大量的肉與海鮮是痛風的危險因子，痛風者應減少蝦貝、魚類的攝取，每周吃一至二次就好。
■另外，每天2000至3000CC的水分，有助尿酸從腎臟排泄，最好定時每2至3小時喝300CC的水，每天喝6到8次。
■此外，研究顯示，低脂奶品與痛風的危險性有負相關，已獲得實證，因此建議患者每天喝杯240CC的脫脂奶或低脂優酪乳。
■1876年以來證實「喝發酵酒會造成痛風」，針對頗令貪杯痛風患者扼腕的酒類，近年的研究仍顯示，一天喝15公克的酒精量，就足以增加血清尿酸值0.99mg／dl。不過，根據第3屆美國營養調查，攝取葡萄酒15公克的酒精量，卻可降低血清尿酸值-0.23mg／dl，不過機轉未知。劉玉來表示，也許與其飲食習慣有關，但如果痛風者有高血壓、心臟病，仍不建議喝葡萄酒。
六、怎樣養腎？
1、 足部保暖
足部保暖是養腎的一種方法。這是因為腎經起於足底，而足部很容易受到寒氣的侵襲。因此，足部要特別注意保暖，睡覺時不要將雙腳正對空調或電扇;不要赤腳在潮濕的地方長期行走。
另外，足底有許多穴位，如湧泉穴。“腎出於湧泉，湧泉者足心也。”每晚睡覺前可以按揉腳底湧泉穴，按摩湧泉穴可起到養腎固精之功效。
2、防治便秘
大便不暢，宿便停積，濁氣上攻，不僅使人心煩氣躁，胸悶氣促，而且會傷及腎臟，導致腰酸疲憊，噁心嘔吐。因此，保持大便通暢，也是養腎的方法。
大便難解時，可用雙手手背貼住雙腎區，用力按揉，可激發腎氣，加速排便;行走時，用雙手背按揉腎區，可緩解腰酸症狀。
3、飲水養腎
水是生命之源。水液不足，則可能引起濁毒的留滯，加重腎的負擔。因此，定時飲水是很重要的養腎方法。
4、不要忍尿
膀胱中貯存的尿液達到一定程度，就會刺激神經，產生排尿反射。這時一定要及時如廁，將小便排乾淨。否則，積存的小便會成為水濁之氣，侵害腎臟。因此，有尿時就要及時排出，也是養腎的最好的方法之一。
5、吞津養腎
口腔中的唾液分為兩部分：清稀的為涎，由脾所主;稠厚的為唾，由腎所主。你可以做一個實驗，口裏一有唾液就把它吐出來，不到一天時間，就會感到腰部酸軟，身體疲勞。這反過來證明，吞咽津液可以滋養腎精，起到保腎作用。
6、保腎食療
能夠補腎的食物有很多。除了黑色的黑芝麻、黑木耳、黑米、黑豆等黑色食物可養腎外，核桃、韭菜、蝦、羊腰等也可以起到補腎養腎的作用。
7、睡眠養腎
充足的睡眠對於氣血的生化、腎精的保養起著重要作用。臨床發現，許多腎功能衰竭的患者有過分熬夜、過度疲勞、睡眠不足的經歷。因此，不要過度熬夜，養成良好的作息習慣，早睡早起，有利於腎精的養護。
★泡腳能治腎病！
腳是陰血的大本營，三條陰經都彙集於此：足少陰腎經、足太陰脾經、足厥陰肝經。腎生血、肝藏血、脾統血。
■晚上泡腳為什麼能補血 ？
血虛、血淤→手腳冰涼、舌質黯淡、臉上有斑、心臟發緊、憋悶、喘不過氣。
晚上泡腳 — 熱水中放紅花（味辛，性溫，歸肝經和心包經，破血、行血、和血、調血），活血化淤；疏通腎、肝、脾三條陰經。
■泡腳的竅門
春天泡腳，開陽固脫；
夏天泡腳，祛濕除熱；
秋天泡腳，清腸潤肺；
冬天泡腳，丹田暖和。
（1）水中放生薑、陳皮、薄荷→脾胃虛→暖脾胃，祛濕邪。
（2）水中放花椒→除臭祛濕、利氣行水、扶助陽氣。
（3）水中放白芍、益母草、當歸→痛經→痛經一般是體寒或氣滯血瘀引起，白芍除陰氣、祛腹痛、通順血脈；益母草去瘀生新，活血調經；當歸補血活血、調經止痛，還可以使皮膚白皙紅潤，改善手腳冰涼的問題。
（4）水中放乾薑→風濕骨痛、怕冷怕涼→幹姜溫中散寒、回陽通脈。
（5）水中放黃芪10克、透骨草10克、伸筋草10克、花椒6克→糖尿病（陰虛所致）→花椒祛濕；黃芪補氣固表；透骨草可以幫助藥物透過皮膚深入肌體，發揮藥力。
■泡腳五忌諱：
一忌剛吃飯或空腹後泡腳。應飯後半小時後。
二忌水溫過高。應40-50度。
三忌時間過長。應20分左右，微微出汗既可。
四忌自作主張，亂放中藥。
五忌月經期不泡。
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