尿酸干预对老年高血压合并糖尿病患者心功能的影响

Uric Acid Intervention Effect on Heart Function in Elderly Patients with Hypertension and Diabetes

目的观察尿酸干预对高尿酸血症的老年高血压合并糖尿病患者心功能的影响,探讨降尿酸治疗能否成为一种心血管疾病防治的新方法.方法选择云南省第三人民医院2011年3月后高尿酸血症的老年高血压合并糖尿病患者100例,随机分为尿酸干预组和对照组,2组患者均规律服用降压药及降糖药干预组给予低嘌呤饮食及苯溴马隆片50 mg/d,定期每3月,6月及1 a随访观察2组患者代谢指标(血尿酸、空腹血糖、血尿素氮、血肌酐)及动态血压,同时对心功能进行评定,包括NYHA心功能分级,左室射血分数(LVEF),6 min步行距离(6MWD),血浆脑利钠肽(BNP)及因充血性心衰再住院例次.结果 (1)3月,6月及1 a后血尿酸干预组明显低于对照组,6月及1 a后动态血压干预组低于对照组(P<0.05);(2)干预组干预后3月,6月及1 a血尿酸及动态血压明显低于干预前(P<0.01),2组间及干预前后空腹血糖、血尿素氮、血肌酐比较差异无统计学意义(P>0.05);(3)1 a后干预组NYHA心功能分级,LVEF及6MWD较干预前及对照组提高,血浆脑利钠肽(BNP)较干预前及对照组降低,充血性心衰再住院例次及比例低于对照组,差异均有统计学意义(P<0.05).结论苯溴马隆片在有效降低血尿酸的同时能够降低血压,改善高尿酸血症的老年高血压合并糖尿病患者心功能.降尿酸治疗有望成为1种心血管疾病防治的新方法.

Objective To observe uric acid intervention effect on cardiac function of elderly hyperuricemia patients with hypertensive and diabetes, and investigate the new method for cardiovascular disease prevention and control with dropping uric acid treatment. Methods 100 elderly hyperuricemia patients with hypertensive and diabetes in our hospital were selected from March 2011. They were randomly divided into uric acid intervention group and control group, and intervention group was given low purine diet and benzbromarone tablet 50 mg per day. Patients were followed up regularly at l, 3, 6 and 12 mouths to observe the metabolic indices （blood uric acid, fasting blood glucose, blood urea nitrogen and creatinine） and ambulatory blood pressure. At the same time cardiac function assessment was conducted, including NYHA classification, left ventricular ejection fraction （LVEF） , 6 minutes walking distance （6 MWD）, plasma brain natriuretic peptide （BNP） and rehospitalizations for patients with congestive heart failure. Results （1） The blood uric acid level of the intervention group was significantly lower than that of the control group after 3, 6 and 12 months, and ambulatory blood pressure of intervention group was lower than that of control group after 6 and 12 months （P 〈 0.05） （2） In the intervention group, blood uric acid and ambulatory blood pressure have decreased significantly （P 〈 0.01） after intervention with uric acid for 3, 6 and 12 months. However, the differences of fasting blood glucose, blood urea nitrogen and creatinine in both groups and before and after intervention were not statistically significant. （3） After 1 year, NYHA cardiac function classification, LVEF and 6 MWD in the intervention group have improved compared with before intervention and control group, but plasma brain natriuretic peptide （BNP） have reduced. The number and proportion of rehospitalizations for patients with congestive heart failure in the intervention group were lower than those in the control group. There were significant differences of all indices （P 〈 0.05）. Conclusion Benzbromarone tablet can effectively reduce blood uric acid and blood pressure at the same time, and can improve cardiac function of elderly hyperurieemia patients with hypertensive and diabetes. Dropping uric acid treatment is expected to become a new method for cardiovascular disease prevention and control.