2例高尿酸血症合并代谢综合征患者血尿酸达标后降尿酸治疗的用药分析和药学监护

Medication analysis and pharmaceutical care on the treatment of lowering uric acid in 2 patients with hyperuricemia and metabolic syndrome after reaching the standard of blood uric acid

1例48岁和1例61岁男性患者,因血糖控制不佳入院,入院后诊断为代谢综合征,48岁患者合并高尿酸血症既往痛风多次发作,入院后予患者非布司他20 mg·d-1降尿酸,同时非诺贝特100 mg·d-1降甘油三酯,达格列净5–10 mg·d-1降糖治疗,一周后患者血尿酸由550μmol·L-1降至182μmol·L-1,调整非布司他为20 mg,一周两次。61岁患者既往高尿酸血症,2年前尿酸治疗达标后规律使用苯溴马隆25 mg·d-1维持降尿酸治疗,血尿酸一直维持在目标范围内,患者同时使用瑞舒伐他汀5mg·d-1调脂治疗。临床药师在对患者的全程药学监护过程中,发现降尿酸药物超说明书用药,查阅相关文献,旨在找到合理的医学证据支持,但未发现高质量循证医学证据支持小剂量降尿酸药物的使用;治疗代谢综合征的药物如氯沙坦、非诺贝特、他汀类等可有效降低血尿酸,但尚无对于合并代谢综合征的患者血尿酸达标后能否用这些辅助降尿酸药物维持血尿酸在目标范围内的高质量循证医学证据。

A 48-year-old male patient and a 61-year-old male patient were admitted to the hospital because of uncontrolled high blood glucose.They were both diagnosed as metabolic syndrome after admission.The 48-year-old male patient with hyperuricemia had a medical history of several times of gout episodes.After admission,the patient was treated with febuxostat 20 mg·d-1 to reduce blood uric acid,fenofibrate 100 mg·d-1 to reduce triglyceride and dapagliflozin 5–10 mg·d-1 to decrease the blood glucose.His blood uric acid decreased from 550μmol·L-1 to 182μmol·L-1 one week later and the dose of febuxostat was reduced to 20 mg twice a week.The 61-year-old patient had a history of hyperuricemia.His blood uric acid reduced to normal level two years ago and maintained in the target range with the treatment of benzbromarone 25 mg·d-1.Rosuvastatain(5 mg·d-1)was given to him at the same time for lipid-lowering therapy.In the whole process of pharmaceutical care for patients,clinical pharmacist found that there were off-label uses of lowering uric acid drugs.But no high-quality evidences of evidence-based medicine(EBM)were found to recommend using small-dose of lowering uric acid drugs.Although drugs for the treatment of metabolic syndrome including losartan,fenofibrate and statins could effectively reduce blood uric acid,there was no high-quality EBM evidence to clarify whether these auxiliary drugs for lowering uric acid could be used to maintain blood uric acid in patients with metabolic syndrome whose uric acid had reached the standard.