不同剂量非布司他治疗痛风伴高尿酸血症的疗效观察及影响因素分析

Efficacy Observation and Influencing Factors Analysis of Different Doses of Febuxostat in the Treatment of Gout with Hyperuricemia

目的:探讨不同剂量非布司他治疗痛风伴高尿酸血症的疗效,并分析影响疗效的相关因素。方法:选取2020年3月至2022年2月该院收治的146例痛风伴高尿酸血症患者,采用随机数字表法分为A组、B组,各73例。A组患者以低剂量非布司他(40 mg/d)治疗,B组患者以高剂量非布司他(80 mg/d)治疗。持续治疗12周,评定两组患者的疗效,记录不良反应发生情况;比较治疗前后尿酸达标情况,血尿酸、过氧化物酶(MPO)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平变化,比较临床特征资料不同的患者尿酸达标率,采用Logistic回归模型分析尿酸达标率的影响因素。结果:A组、B组患者的总有效率[89.04%(65/73)vs.91.78%(67/73)]、尿酸达标率[54.79%(40/73)vs.57.53%(42/73)]比较,差异均无统计学意义(P>0.05)。治疗后,两组患者血尿酸,MPO、TNF-α和IL-6水平均较治疗前明显降低,差异均有统计学意义(P<0.05),但组间比较的差异无统计学意义(P>0.05)。治疗过程中,两组患者均未见明显不良反应。饮水情况、运动情况、肝功能不同及是否饮酒患者的尿酸达标率比较,差异有统计学意义(P<0.05);Logistic回归分析结果显示,饮水<2000 mL/d、运动<5周/次、饮酒及肝功能异常是痛风伴高尿酸血症患者尿酸达标的独立危险因素(P<0.05)。结论:不同剂量非布司他对痛风伴高尿酸血症患者疗效的影响不大,均能抑制炎症因子表达,达到明显的降尿酸效果,且安全性良好。饮水量、运动情况、饮酒及肝功能是影响其疗效的重要因素,建议根据个体情况,强化疾病管理,从而提高疗效,改善预后。

OBJECTIVE:To probe into the effects of different doses of febuxostat in the treatment of gout with hyperuricemia,and to analyze the related factors affecting the efficacy.METHODS:A total of 146 patients with gout and hyperuricemia admitted into the hospital(from Mar.2020 to Feb.2022)were extracted to be divided into the group A and group B via the random number table method,with 73 cases in each group.Group A was treated with low-dose febuxostat(40 mg/d),group B was given high-dose febuxostat(80 mg/d).The treatment was continued for 12 weeks,the efficacy of two groups was evaluated,the occurrence of adverse drug reactions was recorded,and the compliance rate,levels of uric acid and serum levels of myeloperoxidase(MPO),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were compared before and after treatment.The uric acid compliance rate of patients with different clinical characteristics was compared,and tLogistic regression model was used to analyze the influencing factors of uric acid compliance rate.RESULTS:There was no significant difference in the total effective rate[89.04%(65/73)vs.91.78%(67/73)]and uric acid compliance rate[54.79%(40/73)vs.57.53%(42/73)]between the group A and group B(P>0.05).After treatment,the levels of serum uric acid,MPO,TNF-αand IL-6 in two groups decreased significantly compared to before treatment,the differences were statistically significant(P<0.05),yet there was no significant difference between two groups(P>0.05).During the treatment,there were no obvious adverse drug reactions in two groups.There were statistically significant differences in the uric acid compliance rate in patients with different drinking status,exercise conditions,liver function and whether to consume alcohol(P<0.05).Logistic regression analysis showed that drinking water<2000 mL/d,exercise<5 weeks/time,alcohol consumption and abnormal liver function were independent risk factors for gout with hyperuricemia and uric acid control(P<0.05).CONCLUSIONS:The effect of different doses of febuxostat on the efficacy of patients with gout with hyperuricemia is not significant,and all of them could inhibit the expression of inflammatory factors and achieve significant uric acid-lowering effect with high safety.Water intake,exercise status,alcohol consumption and liver function are important factors affecting its efficacy.It is recommended to enhance disease management according to individual circumstances,thus improving the efficacy and prognosis.