NERVA

摘要

Goutwasthe favourite disease of doctors in the ancient world. In Galen's Rome, most of his wealthy clients ate food flavoured with bird droppings and wine laced with lead salts: rich pickings. But it remains a mystery why humans, alone among mammals (except for a few species of primate), have evolved to lackuricase and, moreover, possess kidneys that retain 90% of the uric acid that passes through them. There has to be some kind of evolutionary survival advantage, although a review of the subject in Rheumatology (2010;49:2010-5,doi:10.1093/rheumatology/ keq204) makes it clearthat we don't know what that advantage is. If early humans and the relevant species of primate had smoked, it would be easierto understand. A new study (Thorax2014, doi:10.1136/thoraxjnl-2014-205271), based on the Health Improvement Network primary care research database, shows that low levels of serum uric acid are associated with higher rates of chronic obstructive pulmonary disease and lung cancer in current smokers afteraccountingfor conventional risk factors.