非布司他治疗痛风合并慢性肾功能不全的老年患者疗效观察

Evaluation of Clinical Efficacy of Febuxostat in Treatment of Elderly Gout Patients with Chronic Renal Insufficiency

目的观察非布司他治疗痛风合并慢性肾功能不全老年患者的临床效果以及对肾功能的影响。方法回顾性分析武汉市第四医院2014年1月至2018年12月非布司他治疗的89例老年痛风合并慢性肾功能不全患者。比较非布司他治疗前后血尿酸(UA)、尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(eGFR)的变化。结果①治疗后,老年痛风合并慢性肾功能不全患者的UA和Scr明显降低,差异有统计学意义,eGFR有明显升高,差异有统计学意义。BUN在治疗前后无明显改变。②与治疗前相比,各组UA在非布司他治疗后均有明显降低,差异有统计学意义,eGFR在CKD 2~3期患者中有明显升高,差异有统计学意义,而在CKD 4期患者中无明显改变,差异无统计学意义。结论非布司他在治疗合并慢性肾功能不全的老年痛风患者时,其降尿酸水平的疗效较好,且非布司他有较好改善慢性肾功能不全2~3期患者肾功能的作用。但对于已达到慢性肾功能不全4期的老年痛风患者,非布司他对其肾功能的影响不明显,可能与研究中样本量较少有关。非布司他在中国人群中心血管安全性/心血管风险仍需要更多临床数据和更长时间的临床观察。

Objective To evaluate the clinical effect and the influence on renal function of the elderly gout patients with chronic renal insufficiency treated by febuxostat. Methods A retrospective analysis of 89 elderly gout patients with chronic renal insufficiency from January 2014 to December 2018 was made. The changes of serum uric acid(UA),urea nitrogen(BUN),serum creatinine(Scr),and estimated glomerular filtration rate(eGFR)before and after treatment with febuxostat were compared. Results ① After treatment,the UA and Scr of elderly gout patients with chronic renal insufficiency were significantly reduced,with statistical significance,and eGFR was significantly increased,with statistical significance. There was no significant change in BUN before and after treatment. ②Compared with before treatment, UA in each group was significantly reduced after febuxostat treatment,the difference was statistically significant,eGFR was significantly increased in patients with CKD stage 2-3,the difference was statistically significant,and there was no significant change in patients with CKD stage 4,and the difference was not statistically significant. Conclusion In the treatment of elderly gout patients with chronic renal insufficiency,febuxostat is effective in lowering uric acid levels,and it has a better effect on improving renal function in patients with CKD stage 2-3. However,for elderly gout patients who have reached CKD stage 4,the effects of febuxostat are not obvious on renal function,which may be related to the small sample size in the study. More clinical data and longer clinical observation are needed for the cardiovascular safety/risk of febuxostat in China.