降尿酸药物在冠心病合并高尿酸血症介入术患者中的应用

Application of uric acid lowering drugs in interventional patients with coronary heart disease and hyperuricemia

目的探讨降尿酸药物对冠心病合并高尿酸血症介入术患者造影剂肾病(CIN)的预防作用,以及对超敏C反应蛋白(hs-CRP)水平的影响。方法选取2017年1月~2019年1月在广州市增城区人民医院心血管内科住院,并且诊断为冠心病合并高尿酸血症,入院后接受冠状动脉造影术或支架植入术治疗的90例患者,采用随机数字表法分为对照组、非布司他组和苯溴马隆组,每组各30例。患者在造影或支架植入术前均采用冠心病二级预防治疗。非布司他组术前24 h开始口服非布司他40 mg/d,苯溴马隆组术前24 h开始口服苯溴马隆50 mg/d,对照组不服用降尿酸药物。比较三组术前48 h及术后72 h血肌酐、血尿酸、胱抑素C(Cys-C)、hs-CRP水平,并记录CIN发生率。结果三组术后72 h血肌酐、Cys-C水平比较,差异无统计学意义(P>0.05)。非布司他组和苯溴马隆组术后72 h血尿酸、hs-CRP低于对照组(P<0.05)。非布司他组及苯溴马隆组术后72 h的血尿酸水平均低于术前48 h,差异有统计学意义(P<0.05);非布司他组及苯溴马隆组术后72 h的血肌酐、Cys-C及hs-CRP水平与术前48 h比较,差异无统计学意义(P>0.05)。非布司他组CIN发生率为13.33%(4/30),苯溴马隆组CIN发生率为13.33%(4/30),对照组CIN发生率为16.67%(5/30),组间两两CIN发生率比较,差异无统计学意义(P>0.05)。结论术前24 h开始降尿酸治疗不能降低冠心病合并高尿酸血症患者CIN的发生率,但可以降低hs-CRP水平,对于术后远期肾功能的影响则需进一步研究。

Objective To investigate the preventive effect of uric acid lowering drugs on coronary artery disease complicated with contrast-induced nephropathy(CIN),and the effect on hypersensitive C reactive protein(hs-CRP)levels.Methods A total of 90 patients who were hospitalized in the Department of Cardiology of the Zengcheng District People′s Hospital of Guangzhou from January 2017 to January 2019 and were diagnosed with coronary heart disease and hyperuricemia were admitted to the hospital for coronary angiography or stent implantation patient.Random number table method was used to divide patients into control group,febuxostat group and benzbromarone group,30 cases in each group.Patients were treated with secondary prevention of coronary heart disease before angiography or stent implantation.The patients in the febuxostat group was treated with Febuxostat 40 mg/d 24 hours before surgery,and the patients in the benzbromarone group was treated with Benzbromarone 50 mg/d 24 hours before surgery.The patients in the control group did not receive any uric acid lowering drugs.The levels of blood creatinine,blood uric acid,cystatin C(Cys-C),and hs-CRP were compared among the three groups at 48 hours before surgery and 72 hours after surgery,and the incidence of CIN was recorded.Results There were no significant differences in serum creatinine and Cys-C levels among the three groups after 72 hours(P>0.05).The blood uric acid and hs-CRP of the febuxostat group and benzbromarone group at 72 hours after surgery were lower than those of the control group(P<0.05).The blood uric acid level in the febuxostat group and the benzbromarone group at 72 hours after surgery was lower than that at 48 hours before surgery,the difference was statistically significant(P<0.05).The levels of serum creatinine,Cys-C and hs-CRP at 72 hours after surgery in febuxostat group and benzbromarone group were compared with 48 hours before surgery,the differences were not statistically significant(P>0.05).The incidence of CIN in the febuxostat group was 13.33%(4/30),the incidence of CIN in the benzbromarone group was 13.33%(4/30),and the incidence of CIN in the control group was 16.67%(5/30).There was no significant difference in the incidence of CIN among groups(P>0.05).Conclusion Starting uric acid lowering therapy 24 hours before surgery cannot reduce the incidence of CIN in patients with coronary heart disease and hyperuricemia,but it can reduce the level of hs-CRP.The effect on long-term renal function after surgery needs further study.