苯溴马隆治疗高尿酸血症伴慢性肾脏病180例疗效分析

Clinical Observation of Benzbromarone in the treatment of hyperuricemia with chronic kidney disease

目的研究苯溴马隆治疗高尿酸血症(HUA)伴慢性肾脏病(CKD)患者的临床疗效。方法研究选择2015年6月至2018年1月海军军医大学附属长海医院风湿免疫科就诊的HUA伴CKD 3～4期患者180例,依据随机数字法分为对照组和观察组各90例。对照组给予碳酸氢钠片(0.6 g,每日3次)碱化尿液治疗;观察组给予苯溴马隆50 mg/d降尿酸治疗。观察比较两组患者给药前,第4周、8周、12周、24周时的临床疗效和药物不良反应。观察指标包括血常规、肝功能、血脂、肾功能、血尿酸、24 h尿蛋白定量、平均动脉压(MAP)等,并计算肾小球滤过率(eGFR)。结果两组患者在各时间点白细胞、红细胞、血小板、血红蛋白等血常规指标无明显变化,差异无统计学意义(P>0.05)。观察组经过24周治疗后24 h尿蛋白定量、平均动脉压较治疗前有所降低,且显著低于对照组,差异有统计学意义(P<0.05)。观察组丙氨酸氨基转移酶、天冬氨酸氨基转移酶等肝功能指标在治疗后有一过性上升,但均未超过正常值的2倍;三酰甘油、总胆固醇较治疗前有所上升,差异有统计学意义(P<0.05)。观察组血尿酸较治疗前呈明显下降趋势,且显著低于对照组,各时间点比较差异有统计学意义(P<0.05),24周治疗后血尿酸达标率高达79%。观察组血肌酐、胱抑素C等肾功能指标较治疗前有所下降,且显著低于对照组,各时间点比较差异有统计学意义(P<0.05);肾小球滤过率较治疗前有所上升,且显著高于对照组,各时间点比较差异有统计学意义(P<0.05)。结论苯溴马隆治疗HUA伴CKD 3～4期患者是安全有效的,且能够部分改善患者肾功能水平。

Objective To study the clinical efficacy of Benzbromarone in the treatment of hyperuricemia with chronic kidney disease.Methods we included 180 patients with hyperuricemia and chronic kidney disease at stage 3-4.According to the random number method,they were divided into control group and observation group(90 cases in each).The control group was given sodium bicarbonate tablets(0.6 g,3 times a day) for alkalized urine treatment.The observation group were treated with Benzbromarone 50 mg/d.The clinical efficacy and adverse effects were observed before treatment and 4,8,12,24 weeks after the first dose.The indicators observed included:blood routine,liver function,blood lipid,renal function,serum uric acid,urinary protein and mean arterial pressure(MAP),and glomerular filtration rate(eGFR) was calculated.Results There was no significant change in white blood cell,red blood cell,platelet or hemoglobin at different time points in the two groups,and the difference was not statistically significant(P>0.05).Urine protein and MAP decreased After 24 weeks of treatment in the observation group,and significantly lower than the control group,the difference was statistically significant(P<0.05).The liver function indexes,such as alanine aminotransferase and aspartate aminotransferase had a transient rise after treatment in the observation group,but non exceeded 2 times of the normal value.Triglyceride and total cholesterol were higher than those before treatment,and the difference was statistically significant(P<0.05).Serum uric acid level in the observation group showed a significant downward trend compared with that before treatment,and was significantly lower than the control group,the difference being statistically significant at each time point.(P<0.05).The rate of reaching the standard was up to 79% after 24 weeks.Renal function indexes such as serum creatinine and cystatin C in the observation group decreased after treatment,and was significantly lower than the control group,the difference was statistically significant between each time points(P<0.05);The eGFR increased after treatment,and significantly higher than the control group,the difference was statistically significant at each time point(P<0.05).Conclusion Benzbromarone is safe and effective in the treatment of HUA patients with CKD3-4.