非诺贝特联合非布司他治疗高尿酸血症合并高脂血症有效性及安全性评价

Evaluation of the efficacy and safety of fenofibrate combined with febuxostat in treatment of hyperuricemia with hyperlipidemia

目的:观察非布司他治疗效果不佳的高尿酸血症(HUA)合并高脂血症患者加用非诺贝特治疗的有效性和安全性。方法:80例HUA患者作为研究对象,随机分为治疗组(40例)和对照组(40例)。对照组单用非布司他治疗,治疗组在非布司他的基础上加用非诺贝特治疗,两组同时进行健康教育和生活方式指导。分别于基线和治疗12周后超声检查肝脏,测量体质量、收缩压(SBP),测定血尿酸(SUA)、甘油三酯(TG)、空腹血糖(FPG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、肝肾功能和血常规,并在两组间进行比较。结果:治疗12周后,两组患者体质量、SUA和TG水平均较治疗前显著降低,差异均有统计学意义(P<0.05)。治疗组SUA、TG均显著低于对照组,差异均有统计学意义(P<0.05)。治疗组在体质量、SBP、TC、HDL-C、LDL-C等方面的变化明显优于对照组(P<0.05)。治疗组SUA低于420μmol/L的患者比例为100%,其中92.3%的患者低于360μmol/L;脂肪肝好转率:轻度23%,中度11%,重度8%。对照组70%的患者SUA低于420μmol/L,27.5%的患者低于360μmol/L;脂肪肝好转率:轻度15%,中度7.5%,重度2%。两组尿酸达标率、脂肪肝好转率比较,差异均有统计学意义(P<0.05)。结论:对于单用非布司他治疗效果不佳的HUA合并高脂血症患者,加用非诺贝特在降低血脂的基础上能够有效降低SUA,改善脂肪肝,且不增加不良反应。

Objective:To observe the efficacy and safety of fenofibrate in patients with hyperuricemia(HUA)combined with hyperlipidemia inadequately controlled by febuxostat.Methods:80 patients with HUA were randomly divided into treatment group(40 cases)and control group(40 cases).The control group was treated with febuxostat alone.The treatment group was treated with fenofibrate on the basis of febuxostat.The two groups were given health education and lifestyle guidance at the same time.At baseline and 12 weeks after treatment,the liver of all the patients were examined by ultrasonography,and the body weight,systolic blood pressure(SBP),serum uric acid(SUA),triglyceride(TG),fasting plasma glucose(FPG),blood lipids(TG,TC,HDL-C,LDL-C),liver and kidney function,and blood routine were measured.The results were compared between the two groups.Results:After 12 weeks of treatment,the body weight,SUA and TG levels of the two groups were significantly lower than those before treatment,and the differences were statistically significant(P<0.05);the SUA and TG in the treatment group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05);the changes in body weight,SBP,TC,HDL-C and LDL-C in the treatment group were significantly better than those in the control group(P<0.05).The percentage of patients with SUA below 420μmol/L in the treatment group was 100%,of which 92.3%were below 360μmol/L;the improvement rate of fatty liver:mild 23%,moderate 11%,severe 8%.The SUA of 70%of patients in the control group was lower than 420μmol/L,and 27.5%of patients were lower than 360μmol/L;the improvement rate of fatty liver:mild 15%,moderate 7.5%,and severe 2%.The differences between the two groups were statistically significant(P<0.05).Conclusion:For patients with HUA and hyperlipidemia who have poor treatment with febuxostat alone,the addition of fenofibrate can effectively reduce SUA,improve fatty liver,without increasing adverse reactions.