| 徐涵.高尿酸血症对未透析慢性肾脏病残余肾功能的影响及非布司他的保护效果分析[J].安徽医药,2021,25(6):1224-1228. |
| 高尿酸血症对未透析慢性肾脏病残余肾功能的影响及非布司他的保护效果分析 |
| Effect of hyperuricemia on residual renal function in patients with non-dialysis chronic kidney disease and protective effect of febuxostat |
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| DOI：10.3969/j.issn.1009-6469.2021.06.040 |
| 中文关键词: 高尿酸血症 肾功能不全，慢性 未透析 慢性肾脏病 残余肾功能 非布司他 |
| 英文关键词: Hyperuricemia Renal insufficiency, chronic Non-dialysis Chronic kidney disease Residual renal function Febutastat |
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| 中文摘要: |
| 目的分析高尿酸血症(HUA)对未透析慢性肾脏病(CKD)病人残余肾功能的影响及非布司他的保护效果。方法回顾性纳入 2017年 8月至 2018年 8月于滁州市第一人民医院肾病科住院的未透析 CKD病人 188例，其中合并 HUA者 86例，HUA者 102例。对合并 HUA者的 86例根据治疗方法不同分为非布司他组( 46例)和别嘌醇组( 40例)。病人均接受常规治疗，无别嘌醇组给予别嘌醇片口服，非布司他组给予非布司他片口服， 4周为 1个疗程，持续治疗 6个疗程。检测合并 HUA组和无 HUA组入组时的空腹血尿酸、肾功能指标［血清肌酐、血尿素氮、估算肾小球滤过率( eGFR)检测非布司他组和别嘌醇组治疗前后的血尿酸水平及肾功能指标、血浆白蛋白、总胆固醇、三酰甘油水平的变化。结果合并，HUA组病人的血尿酸( 510.42± 124.28)μmol/L、血尿素氮( 23.64±6.27)mmol/L、血清肌酐( 358.88±92.14)μmol/L水平均显著高于无 HUA组的血尿酸( 388.95±98.26)μmol/L、血尿素氮( 18.20±5.70)mmol/L、血清肌酐(270.33±75.26)μmol/L，eGFR(38.24±10.74)mL·min?1·(1.73 m2)?1水平显著低于无 HUA组( 46.20±12.68)mL·min?1·(1.73 m2)?1(P<0.05)； Pearson相关性分析显示，合并 HUA的病人血尿酸水平与 eGFR负相关( r=-0.526，P<0.05)与血尿素氮、血清肌酐水平正相关( r=0.422、0.398，P<0.05)；非布司他组的治疗有效率 91.30%显著高于别嘌醇组 70.00%(P<05)治疗后非布司他组的血尿酸( 320.44±60.38)μmol/L、血尿素氮( 14.23±2.78)mmol/L、血清肌酐.0，(230.52±44.21)μmol/L水平均低于别嘌醇组的血尿酸( 388.24±64.55)μmol/L、血尿素氮( 16.53±3.33)mmol/L、血清肌酐显著，(278.55±60.23)μmol/L，eGFR(56.92±12.38)mL·min?1·(1.73 m2)?1水平显著高于别嘌醇组 eGFR(49.70±12.70)mL·min?1·(1.73 m2)?1(P<0.05)；非布司他组和别嘌醇组治疗前后的白蛋白、总胆固醇、三酰甘油水平比较，均差异无统计学意义( P>0.05)。结论 HUA可对未透析 CKD病人残余肾功能造成严重影响；非布司他对病人肾功能具有保护作用，采用非布司他积极治疗可有效降低血尿酸水平，或可延缓 CKD进展。 |
| 英文摘要: |
| Objective To analyze the effect of hyperuricemia (HUA) on residual renal function in patients with non-dialysis chronic kidney disease (CKD) and the protective effect of febuxostat.Methods A hundred and eighty-eight patients with non-dialysis CKD,who were admitted to Department of Nephropathy, Chuzhou First People′s Hospital between August 2017 and August 2018, were enrolled in the study, including 86 patients with HUA and 102 without HUA. Eighty-six patients with HUA were assigned into febuxostatgroup (46 cases) and allopurinol group (40 cases) according to different treatment methods. All patients were given conventional treatment. The allopurinol group was treated with oral allopurinol tablets, and the febuxostat group was treated with oral febuxostat tabletsfor 6 courses of continuous treatment with 4 weeks as a course. The fasting serum uric acid (SUA) and renal function indicators [serumcreatinine (SCr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR)] in the HUA group and the non-HUA group atthe beginning of the study, changes of SUA levels, renal function indexes, plasma albumin (Alb), total cholesterol (TC) and triglyceride(TG) in the butastat group and allopurinol group before and after treatment were detected.Results The levels of SUA [(510.42±124.28) μmol/L], BUN [(23.64±6.27) mmol/L] and Scr [(358.88±92.14) μmol/L] in HUA group were significantly higher than the levelsof SUA [(388.95±98.26)μmol/L], BUN [(18.20±5.70)mmol/L, Scr [(270.33±75.26)μmol/L] in non-HUA group, and the level of eGFR [(38.24±10.74) mL·min?1·(1.73m2)?1 ]wassignificantlylowerthaneGFR [(46.20±12.68)mL·min?1·(1.73 m2)?1] in non-HUA group (P< 0.05). Pearson correlation analysis showed that SUA levels in patients with HUA were negatively correlated with eGFR (r =-0.526, P< 0.05), but were positively correlated with BUN and Scr levels (r=0.422, 0.398, P<0.05). The effective rate of treatment in the febuxostat group was significantly higher than that in the allopurinol group [91.30% vs. 70.00%, P<0.05]. The levels of SUA [(320.44±60.38)μmol/L], BUN [(14.23±2.78)mmol/L], Scr [(230.52±44.21)μmol/L] in the febuxostat group were significantly lower than SUA [(388.24±64.55)μmol/L], BUN [(16.53±3.33)mmol/L], Scr [(278.55±60.23)μmol/L] in the allopurinol group, and eGFR [(56.92±12.38) mL·min?1·(1.73 m2)?1] was significantly higher than eGFR [(49.70±12.70) mL·min?1·(1.73 m2)?1] in the allopurinol group (P<0.05). There were no significant differences in Alb, TC or TG levels between the febuxostat group and the allopurinol group (P>0.05).Conclusions HUA can seriously affect the residual renal function of patients with non-dialysis CKD. Febuxostat has a protective effect on renal function. Activetreatment with febuxostat can effectively reduce the level of SUA and delay the progression of CKD. |
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