CH N

TRONG BNH GT

Ch n cho bnh nhn gt B Y t

1. n ung king khem trong bnh gt ch gim acid uric mu c
1mg/dl. Do vy vic king khem trong bnh gt khng qu quan
trng (The Merck Manual 1999, 17 th Ed., centennial Ed., P.460)
2. Trong cc thc phm, khi b bnh gt ch king n tht, khng cn
king n rau. Rau qu t ngha trong vic pht sinh bnh gt v
khi pht cn vim khp gt cp.
3. Trong bnh gt, n ung l iu tr. Cn king khem cht ch v
ung nc y iu tr bnh gt v nht l phng cc cn khi
pht vim khp gt cp. Ch dng thuc iu tr gt khi n ung
king khem nghim ngt m khng h c acid uric mu
(Harrisons Principles of Internal Medicine 18th Ed., 2012, Chapter
333).
4. B Y t Vit Nam c Hng dn ch n bnh vin Quyt
dnh s 2879/Q-BYT k ngy 10/08/2006 ca B trng B Y t.
Trong c ch n cho bnh nhn gt.
2

Ch n cho bnh nhn gt B Y t

(Trang 12-14)

Ch n cho bnh nhn gt B Y t

Ch n cho bnh nhn gt B Y t

Ch n cho bnh nhn gt B Y t

Ch n cho bnh nhn gt B Y t

Ch n cho bnh nhn tiu ng

Km theo gt B Y t

Ch n cho bnh nhn tiu ng

Km theo gt B Y t

NHNG THC PHM

GIU PURINE
Ngun:
- Eleanor Roberts, PhD, Washington D.C. Metro Area
Medically reviewed by Lindsey Marcellin, MD, MPH;
Washington D.C. Metro Area
- http://www.acumedico.com/purine.htm - Purine table - 2003:
+ Highest in purines (400 mg. uric acid/100 g and higher)
+ Moderately high in purines (100 to 400 mg. uric acid/100g)
+ Lowest in purines (100 mg. uric acid/100 g and less)
PGS. TS. V NH HNG
10

PGS. TS. V NH HNG

24

PGS. TS. V NH HNG

25

PGS. TS. V NH HNG

26

Tht ba ri (100-127)

Tht b (140-150)

Ni tng ng vt: Gan (243-554), lch (516), no (75-92)

Tht nai (111)

C cm (239)

* n v: mg uric acid/100g
27

C tuyt (109)

C vc (139)

C trch (219)

C thu (145)

C hi (297)

C mi (480)

* n v: mg uric acid/100g
28

Con s (ti: 136, chn: 390)

Con trai (112)

Ngoi ra cn c mt s loi rau giu purine, bao gm mng ty,

u kh, v u H Lan. Tuy nhin so vi cc loi tht v hi
sn, purine cc loi rau ny ch mc trung bnh.

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- Hi sn: Mc d c c khuyn
co l mt mn n tt cho sc khe,
nhng nhng ngi mc bnh gout
nn lu rng mt s hi sn c th
lm tng nng acid uric trong
mu, v c th lm cho bnh gt ti
t hn.
+ Hi si c purine cao: c cm
(239), c tuyt (109), c tuyt chm
en (139), c trch (190-219), c thu
(145), s (112), c mi (480), s ip
(ti: 136, chn: 390), c hi (297).
+ Hi sn c purine trung bnh: cua
(168), tm hm (118), hu (239), tm
(147).
30

- Tht: Ni tng ng vt nh gan

(243 554), lch (825), no (75-92)
l nhng thc phm nguy him nht
i vi nhng ngi b bnh gt.
+ Tht c purine cao: Tht ba ri
(100-127), g ty (110-175), tht
hu tht nai (105-138), th b (91172).

+ Tht c purine trung bnh: Tht b,

g, vt (131), tht hun khi (138), tht
ln (100-516).
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- Rau qu: Cc loi rau giu purine khng gy nh hng nhiu

ti bnh gt bng cc loi thc phm t ng vt giu purine.
Tuy nhin, c mt s loi thc phm t thc vt c bit giu
trong purine m bnh nhn gt cn trnh nh: Mng ty (23),
ht u kh (30-222), nm (30-488), u H Lan (109), rau
bina (rau chn vt) (57).

Ht u
(30-222)

Mng ty
(23)

Nm
(30-488)
Rau bina
(57)
32

VIC UNG TRONG BNH GT

1.Nhng loi khng nn ung:
- Ru (ethanol: C2H5OH): kch thch gan chuyn ha nucleotid, tng
hnh thnh acid lactic (do vy c ch thn o thi acid uric). Alcohol is
a major risk factor for gout but not wine. (Chaim Putterman, chief of
rheumatology Albert Einstein College of medicine New York).
- Nhng nc gii kht cha cn: cng theo c ch trn.
- Bia: c lm t:
+ Nguyn liu chnh: malt, go, Houblon, men, nc.
+ Nguyn liu ph: Cht oxy ha, cht h tr ln men, CaCl, Clorua
km, H2SO4, acid lactic,
+ Trong malt l mm ca la mch (malt in beer is high in purines),
Houblon lm cho bia c v bia (ng). Do vy, bia khng c li cho
ngi b gt v c: malt, acid lactic v c ru ethanol...
- Nc tri cy, thc phm c nhiu ng Fructose (C6H12O6) (cam,
to,), v tng nguy c b gt: nu ung 2 ln trong ngy th nguy c
gt s tng 85% so vi ung 01 ln/ thng.
33

VIC UNG TRONG BNH GT

2. Nhng loi nn ung:
-Nn ung nhiu nc trong 1 ngy (1,5l/ngy) duy tr lng nc tiu
bnh thng.
-Nn lm kim ha nc tiu bng cc nc khong kim (Alkaline), nc
ung khng c ethanol (soft drink).
-C th ung ru vang vi liu lng (cup/ ba)
-Vitamin C: + lm gim acid uric mu (c ung 0,5g vitamin C th nguy c
gt n ng gim 17% - nghin cu ko di 20 nm 1,317 nam pht
bnh gt/ 46,994 ngi nghin cu)
+ Vitamin C c th nh hng ti ti hp thu acid uric ti thn (tri cherry)
Alkaline

VIC N TRONG BNH GT

1. Rau qu:
1.1. Khng nn n:

- Nm (c 488 mg acid uric/ 100g)

- Ca cao (c 2300 mg acid uric/ 100g)
- Mt vi loi u (u xanh, u en: 222)

1.2. n c:
- Rau cn, sp l, da chut, ci xanh, c, ci bp, c ci, khoai ty,
b , b xanh, da hu, u , l, to, nho, sa b, u tng.

(TS. BS. Hong Khnh Ton (Vin 108)).

VIC N TRONG BNH GT

2. Thc phm t ng vt:
2.1. Khng c n:
- Khong 1/3 lng acid uric n t vic n ung (Prof. R.
Grahame, Dr. A. Simmonds and Dr. E. Carrey - Rheumatology
Vol. 43 No. 3 (c) British Society for Rheumatology 2003).
- C th ch n king tt lm urate mu <6mg/dl, khng c
tophi, khng c tn thng thn (nh n king ng trong
iu tr tiu ng type 2).
- Hi sn: c mi (480), c trch cm (804), nc mm (?),
- Tht : (?)
- Ni tng ng vt: gan heo (515), tim heo (530), lch heo
(516), thn heo (334),
* n v: mg uric acid/100g

VIC N TRONG BNH GT

2.2. Khng nn n:
- Hi sn: c hi (297), c ng (290), c cm (239), c thu
(145), tm hm (118), tm (147),
- Thy sn: c chp (160),
- Gia cm: g (159), vt (138),
- Tht : tht b (133), tht ln (166),
- Ni tng ng vt: tim b (256), thn b (269), li ln
(136),
2.3. n c:
- Hi sn: con hu (90)
- Thy sn: tm cng xanh (60), ln, c chnh (78),
- Ni tng ng vt: no ln (83), no b (92),
* n v: mg uric acid/100g

KT LuN
1. Hin c 2 khuynh hng v n ung trong bnh gt: (1)
khng cn king khem k v chng t nh hng n din
bin bnh, (2) v coi n ung l iu tr cho bnh nhn gt.
Vin Gt nn theo khuynh hng th (2).
2. Ni thc phm giu purine cng c ngha l thc phm cha
nhiu acid uric (ngun: Prof. R. Grahame, Dr. A. Simmonds
and Dr. E. Carrey - GOUT - Rheumatology Vol. 43 No. 3 (c)
British Society for Rheumatology 2003). Vy nghin cu
va qua trn ln, c, g ca Vin Gt l ng hng.
3. Tuy c nghin cu c bn v purine ca cc loi thc
phm c ng bo (224 thc phm), nhng nhng hi sn,
tht theo thi quen ca ngi Vit Nam cha c nghin
cu: c mc, tm bin, c, cua, c r, c lc, c iu hng,
tht ch, tht rng,

KT LUN
4. Nhng mc sau c dng chia cc thc n phi king,
phi n t v c n trong bnh gt:
- Khng c n (king): thc phm c acid uric 400mg/100g
- Khng nn n: thc phm c acid uric: 100 400 mg/100g.
- n c: Cc thc phm c acid uric: <100 mg/100g.
5. Khng c n ung:
- Ru ethanol (tr ru vang ) v cc loi thc ung c
ru (liquor).
- Bia (cc loi): v c malt, c ethanol, c acid lactic trong quy
trnh sn xut.
- Hi sn: C mi (480), c trch cm (804), nc mm (?)
- Rau qu: Nm (488), Ca cao (2300)

KT LUN
6. n hn ch:
- Hi sn: c hi (297), c ng (290), c cm (239), c thu
(145), tm hm (118), tm (147),
- Thy sn: c chp (160),
- Gia cm: g (159), vt (138),
- Tht : tht b (133), tht ln (166),
- Ni tng ng vt: tim b (256), thn b (269), li ln (136)
- Rau qu: mt vi loi u (u xanh, u en: 222)
- ung: Khng nn ung cc nc trai cy c nhiu fructose.
7. c quyn n:
- Hu nh tt c rau, c, qu (cherry, tri cy nhiu vitamin C,..)
- Hi sn: con hu (90), thy sn: tm cng xanh (60), ln, c
chnh (78), ni tng ng vt: no ln (83), no b (92), tht
trng, tht cc loi gia cm khc, trng.

KT LUN
8. Bn cnh n ung king khem nh trn:
- Bnh nhn phi gim cn khi BMI >23.
- Phi c thi quen ung nc nhiu, nc khong kim.
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