非布司他对维持性血液透析患者残余肾功能及炎性因子水平的影响

Effect of febuxostat on residual renal function and inflammatory factors in patients undergoing maintenance hemodialysis

目的探讨非布司他对维持性血液透析患者残余肾功能(RRF)及炎性因子水平的影响。方法收集2017年6月至2019年8月湖南省人民医院收治的74例维持性血液透析患者的临床资料行回顾性分析。根据治疗方案不同将患者分为对照组和观察组,各37例。对照组接受常规治疗,观察组在常规治疗基础上加用非布司他治疗,均连续治疗3个月。比较治疗前及治疗3个月后2组血尿酸、RRF和炎性因子[高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]水平。同时记录比较肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]水平及不良反应、痛风发作情况。结果治疗后2组血尿酸水平均较治疗前明显降低,且观察组低于对照组[(451±25)μmol/L比(515±41)μmol/L],差异均有统计学意义(均P<0.05);RRF均较治疗前降低,但观察组高于对照组[(1.27±0.14)ml/min比(0.48±0.10)ml/min],差异均有统计学意义(均P<0.05)。治疗后2组hs-CRP、IL-6、TNF-α水平均较治疗前明显降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。2组治疗后ALT、AST水平与本组治疗前比较差异无统计学意义(P>0.05)。观察组不良反应发生率明显低于对照组[21.6%(8/37)比43.2%(16/37)],差异有统计学意义(P<0.05)。治疗3个月期间观察组痛风发作率低于对照组,但差异无统计学意义(P>0.05)。结论非布司他对维持性血液透析患者RRF具有很好的保护作用,同时可以显著降低血尿酸及炎性因子水平,对肝功能影响较小、安全性较高。

Objective To investigate the effect of febuxostat on residual renal function(RRF)and inflammatory factors in patients undergoing maintenance hemodialysis.Methods Clinical data of 74 patients undergoing maintenance hemodialysis in Hunan Provincial People’s Hospital from June 2017 to August 2019 were retrospectively analyzed.The patients were divided into control group and observation group according to different treatment plans.The control group received routine treatment and the observation group was treated with febuxostat additionally for 3 months.Levels of serum uric acid,RRF,inflammatory factors[high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)],adverse reactions and gout attack were analyzed.Results Serum uric acid level significantly decreased after treatment in both groups and the level in observation group was lower than that in control group[(451±25)μmol/L vs(515±41)μmol/L](all P<0.05).RRF decreased after treatment but it was higher in observation group than that in control group[(1.27±0.14)ml/min vs(0.48±0.10)ml/min](all P<0.05).Levels of hs-CRP,IL-6 and TNF-αsignificantly decreased after treatment and the levels in observation group were lower than those in control group(all P<0.05).There were no significant changes in ALT and AST levels after treatment(P>0.05).The incidence of adverse reactions in observation group was significantly lower than that in control group[21.6%(8/37)vs 43.2%(16/37)](P<0.05).The incidence of gout in observation group was lower than that in control group but the difference was not statistically significant(P>0.05).Conclusions Febuxostat shows a good protective effect on RRF in patients undergoing maintenance hemodialysis.It can significantly reduce serum uric acid and inflammatory factors and has few adverse impact on liver function.