ピタバスタチンの血清尿酸値に及ぼす影響を，アトルバスタチンとロスバスタチンを対照にしてレトロスペクテイブに検討した．各薬物投与前後で血清尿酸値が測定されている外来患者104例を対象に，薬物投与直前の血清尿酸値と薬物投与2.3ヶ月後の血清尿酸値を比較検討した．検討患者の薬物別の内訳はアトルバスタチン投与群42例（平均投与量5.24mg／日），ピタバスタチン投与群32例（平均投与量1.13mg／日），ロスバスタチン投与群30例（平均投与量2.5mg／日）であった．アトルバスタチン投与群では，投薬前の血清尿酸値が6.1±1.5mg／dlから投薬後に5.8±1.4mg／dlに有意に低下した（p＝0.008）．ロスバスタチン投与群では5.7±1.2mg／dlが5.5±1.2mg／dlに低下する傾向にあったが有意な変化ではなかった（p＝0.054）．一方，ピタバスタチン投与群では5.5±1.4mg／dlが5.6±1.2mg／dl（p＝0.65）と有意な変化はみられず，ピタバスタチンはアトルバスタチンのような血清尿酸値を降下させる多面的作用は期待できないと考えられた．いずれの投与群においても投薬前後で血清HbA1c値は有意な変動を示さなかった．尿酸は心血管障害の危険因子と推定されていることから，スタチン系薬物を必要とする心血管リスクの高い脂質異常症患者には，尿酸値も低下するアトルバスタチンが望ましいと考えられた．

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We describe unusually marked hyperuricemia and tumor lysis syndrome in a patient with Burkitt type leukemia. A 62-year-old Japanese man was introduced to our hospital because of an emergence of blastic cells in peripheral blood and acute renal failure. On admission, his vital signs were almost normal, but with oliguria. The levels of serum uric acid, creatinine, and urea nitrogen were 43.3 mg/dl, 7.4 mg/dl, and 83 mg/dl, respectively, indicating marked hyperuricemia that we had never seen before and acute renal failure. An increased phosphorous level indicated tumor lysis syndrome. The bone marrow examination confirmed his diagnosis as acute lymphoblastic leukemia (L3 by FAB classification, Burkitt type). The patient was initially treated using continuous hemodiafiltration (CHDF) to support renal dysfunction and to decrease a serum uric acid level.
Chemotherapy was initiated using the combination of cyclophosphamide, doxorubixin, vincristine, and dexamehtazone (Hyper-CVAD) on the 5th day from the start of CHDF when his serum uric acid and creati.nine were 10.7 mg/dl and 1.78 mg/dl, respectively. On the 28th day from the start of the chemotherapy, the disease achieved complete remission with a normalized uric acid level (2.6 mg/dl) and recovered renal function. Hyperuricemia of this patient was due to decreased renal excretion of uric acid, although cancer-associated hyperuricemia is usually attributed to the overproduction of uric acid. Burkitt type leukemia/lymphoma causes hyperuricemia and TLS frequently. This patient’s uric acid level was unusu.ally high according to the literature search. Nevertheless, he was successfully treated using CHDF and safely underwent the chemotherapy.

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