非布司他治疗痛风性关节炎的疗效及其安全性评价

Curative effect of febuxostat in treatment of gouty arthritis and its safety evaluation

目的:观察非布司他治疗痛风性关节炎的疗效及治疗前后患者受累关节彩色超声图像的变化。方法:选择66例男性痛风性关节炎患者,根据药物使用情况分为非布司他组(非布司他40 mg·d-1,n=37)和别嘌醇组(别嘌醇100mg·d-1,n=29),观察2组患者治疗前后血尿酸(UA)、血脂水平和滑膜周围血流信号及受累关节的彩色多普勒超声图像的变化。结果:2组患者治疗后血UA水平下降,与治疗前比较差异均有统计学意义(P<0.05);在16、20和24周,非布司他组患者达到目标血UA值的百分率均较别嘌醇组高,2组间比较差异有统计学意义(P<0.05)。与治疗前比较,治疗后非布司他组患者高密度脂蛋白(HDL)水平明显升高(P=0.001),而总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白(LDL)水平无明显变化(P>0.05);别嘌醇组患者治疗前后TC、HDL、LDL和TG水平均无明显变化(P>0.05)。2组患者治疗后大部分痛风结晶消失(非布司他组占71.4%,别嘌醇组占58.9%),非布司他组较别嘌醇组痛风结晶溶解效果更佳。2组患者痛风急性发作期的关节腔积液、关节周围软组织肿胀和滑膜周围血流信号均有改善,但2组之间比较未见明显差别。2组患者痛风慢性发作期表现比较无明显差异。结论:非布司他可更有效地降低痛风性关节炎患者血UA水平,改善痛风急性发作期表现,痛风结晶溶解效果更佳。

Objective： To observe the efficacy of febuxostat in the treatment of gouty arthritis and the changes of ultrasound image of the affected joints before and after treatment.Methods： Sixty-six patients with gouty arthritis were selected and divided into febuxostat group（febuxostat 40 mg·d-1,n=37） and allopurinol group（allopurinol 100 mg·d-1,n=29） according to the situation of drugs.The serum uric acid（UA）,lipid levels of the subjects in two groups and the changes of synovial membrane surrounding blood flows signals and ultrasound images of the affected joints before and after treatment were observed.Results： Compared with before treatment,the UA levels of patients in two groups were decreased after treatment（P〈0.05）;At 16,20,24 weeks, the percentages of the patients whose serum UA level reached the target value in febuxostat group was higher than that of the patients in allopurinol group（P〈0.05）.Compared with before treatment,the level of high density lipoprotein（HDL） in febuxostat group after treatment was increased（P=0.001）;the levels of triglyceride（TG）,total cholesterol（TC） and low density lipoprotein（LDL） had no significant changes（P〉0.05）.There were no statistically significant differences of TC,TG,LDL and HDL of the patients in allopurinol group between before and after treatment（P〉0.05）. Most of the UA crystal disappeared after treatment of the patients in two groups （febuxostat group 71.4%, allopurinol group 58.9%）;febuxostat was better than allopurinol in dissolving UA crystal with acute gout attack.The articular effusion at acute stage of gout,joint soft tissue swelling and synovial membrane surrounding blood flow signals of the patients in two groups were improved,but there were no notably changes between two groups.There were no significant changes in chronic gout attack of the patients in two groups.Conclusion： Febuxostat can effectively reduce the UA levels of the patients with gouty arthritic, improve the performance of acute gout attack, and effectively dissolve the crystal.