降尿酸治疗在老年慢性肾脏病合并高尿酸血症患者中的应用

Clinical application of urate lowering therapy in elderly hyperuricemic patients with chronic kidney disease

目的评价黄嘌呤氧化酶抑制剂对老年慢性肾脏病(CKD)合并高尿酸血症患者治疗的有效性和安全性。方法纳入2014年8月至2016年2月在宜宾市第二人民医院接受治疗的68例老年CKD(G2期和G3期)合并高尿酸血症的患者,按照随机数字表法分配为非布司他组(34例)和别嘌呤醇组(34例),两组患者均每个月复查血尿酸、肝肾功能等指标,随访6个月。结果至第6个月时,非布司他组有30例(88.2%)患者尿酸水平恢复正常,而别嘌呤醇组共有22例(64.7%)患者尿酸水平恢复正常,两组患者高尿酸血症治疗总有效率差异有统计学意义(P=0.022)。第6个月时,两组患者肾小球滤过率(e GFR)水平均较基线水平有所下降,但差异无统计学意义(P>0.05),而别嘌呤醇组e GFR水平下降幅度显著大于非布司他组[(6.6±7.5)mL·(min·1.73m^2)^(-1)比(2.5±7.2)mL·(min·1.73m^2)^(-1)](P=0.020)。结论所有老年CKD患者对黄嘌呤氧化酶抑制剂均有良好的耐受性。非布司他较别嘌呤醇更能有效降低老年CKD合并高尿酸血症患者血尿酸水平,并对患者肾脏具有一定的保护作用。

Objective To evaluate the safety and efficacy of xanthine oxidase inhibitors in the treatment of elderly hyperuricemic patients with chronic kidney disease（ CKD）. Methods A total of 68 elderly hyperuricemic patients with CKD（ stage G2 and stage G3）were included in this study. Patients were randomly assigned to a febuxostat treatment group or allopurinol treatment group,with 34 cases in each group. All patients were followed up for 6 months,and serum uric acid,liver funCTion and renal funCTion of these patients were measured every month. Results After 6 months,30 patients achieved a normal serum uric acid level in the febuxostat treatment group and only 22 patients decreased serum uric acid to the normal level in the allopurinol treatment group. The clinical efficacies in the febuxostat treatment group and allopurinol treatment group were 88. 2% and 64. 7%,respeCTively,and there was a significant difference between the two groups（ P = 0. 022）. All patients achieved a decreased e GFR level in comparison with the baseline level,but there were no significant differences in both groups（ P〉0. 05）. But allopurinol treatment group showed a significantly highly decreased e GFR level than febuxostat treatment group（ 6. 6 ± 7. 5 mL·（ min·1. 73 m^2）^（-1） vs. 2. 5 ± 7. 2 mL·（ min·1. 73 m^2）^（-1）（ P = 0. 020）.Conclusions All elderly patients with CKD were well tolerant to xanthine oxidase inhibitors. Febuxostat reduced serum uric acid level more effeCTively than allopurinol and might have a renoproteCTive effeCT in elderly hyperuricemic patients with CKD.