非布司他对比别嘌呤醇治疗慢性肾脏病合并高尿酸血症患者对于肾脏保护的作用

The Renal Protection Effect of Febuxostat Compared with Allopurinol in Treating Chronic Kidney Disease Patients with Hyperuricemia

目的探讨非布司他和别嘌呤醇在治疗慢性肾脏病(CKD)合并高尿酸血症(HUA)患者对肾脏保护作用的差异。方法本前瞻性队列研究共连续纳入CKDⅢ期合并HUA的患者99例。根据患者的用药情况分为非布司他组(n=42,20~40mg/d口服)和别嘌呤醇组(n=57,100~300mg/d口服)。结果与基线期比较,治疗6月后,非布司他组与别嘌呤醇组患者估算肾小球滤过率(eGFR)水平改变值及eGFR下降>10%患者比例差别均无统计学意义(P>0.05)。患者血清肌酐、24h尿蛋白、收缩压、舒张压、总胆固醇、总甘油三酯、低密度脂蛋白、高密度脂蛋白的改变值,组间比较差别均无统计学意义(P>0.05)。另外,与基线期比较,治疗6月后,非布司他组患者血清尿酸水平下降值显著高于别嘌呤醇组(P<0.001)。结论相比别嘌呤醇,非布司他对于治疗CKD合并HUA患者同样具有保护肾脏的作用,并且可更好地降低尿酸。

Objective To assess the renoprotection of Febuxostat compared with Allopurinol for chronic kidney disease（CKD）patients with hyperuricemia（HUA）. Methods 99 CKD stageⅢ patients with HUA were consecutively enrolled in this prospective cohort study. Patients were in the Febuxostat group（n=42,20-40 mg/d,oral）and Allopurinol group（n=57,100-300 mg/d,oral）according to their treatment conditions. Results Compared to baseline,there were no difference in change of estimated glomerular filtration rate（eGFR）（P=0.505）and the proportion of patients with a decrease of eGFR more than 10%（P=0.388）six months after the treatments between the two groups. No difference in change of the serum creatinine（SCr）（P=0.409）,24-hour proteinuria（P=0.091）,systolic blood pressure（SBP）（P =0.337）,diastolic blood pressure（DBP）（P =0.927）,total cholesterol（TC）（P=0.911）,total glyceride（TG）（P=0.890）,and low density lipoprotein（LDL）（P=0.791）,highdensity lipoprotein（HDL）（P=0.541）levels was observed between two groups. The change of serum uric acid（SUA）in the Febuxostat group was markedly greater than that in the Allopurinol group（P〈0.001）. Conclusion The renoprotection effect of Febuxostat in treating CKD patients with HUA is as effective as Allopurinol,and the uric acid lowering effect of Febuxostat is superior to Allopurinol.