别嘌呤醇保护糖尿病肾病患者肾功能的临床观察

CLINICAL OBSERVATION OF THE EFFECT OF ALLOPURINOL TO PROTECT RENAL FUNCTION IN PATIENTS WITH DIABETIC NEPHROPATHY

目的应用别嘌呤醇降低血尿酸水平,观察其对延缓糖尿病肾病患者肾衰竭进展的作用。方法选择糖尿病肾病伴有轻度高尿酸血症患者140例,随机分为治疗组72例和对照组68例。治疗组患者予别嘌呤醇控制血尿酸于正常范围内。慢性肾衰竭药物治疗方案两组相同。观察期限24个月,比较两组患者慢性肾衰竭进展的差异。观察终点为:血肌酐较基线翻倍,进入终末期肾病(透析治疗或血清肌酐>707μmol/L),全因死亡。结果两组患者血尿素氮和肌酐水平均有升高,但治疗组上升幅度低于对照组(t=2.22,p<0.01和t=3.35,p<0.05)。治疗组有16例患者达观察终点,对照组有36例患者达观察终点,治疗组终点事件发生率低于对照组(22.2%比52.9%。2=5.01,p=0.02)。结论糖尿病肾病患者通过降低血尿酸,可明显延缓肾衰竭的进展,应尽早降低血尿酸至正常水平。

Objective To observe the effect of allopurinol or benzbromarone on lowering blood uric acid level to delay the progression of diabetic renal failures.Methods 140 diabetic patients with mild hyperuricemia were randomly divided into treatment group（72 cases） and control group（68 cases）.The patients in the treatment group were treated with allopurinol or benzbromarone to control their uric acid to the normal range.The same drug treatment was used in chronic renal failure in the two groups.Observation period was 24 months to compare the differences of patients with chronic renal failure in two groups.The endpoint was that serum creatinine doubled the baseline into the end-stage renal disease（dialysis or serum creatinine 707 μmmol/L） and all-cause mortality.Results The patients had elevated blood urea nitrogen and creatinine levels,but the treatment group had a lower increasing degree of urea nitrogen and creatinine than that in the control group（t=2.22,p0.01 and t=3.35,p0.05）.In treatment group,16 patients reached end point,while in the control group,36 patients reached end point.The end point events in the treatment group were lower than those in the control group（22.9% vs 51.4%.χ2=5.011,p=0.023）.Conclusion Lowering serum uric acid in patients with diabetic nephropathy can significantly delay the progress of renal failures,which indicates that we should reduce the blood uric acid to normal levels as soon as possible.