尿酸结晶在非布司他治疗尿酸性肾病患者中的临床意义  

Clinical significance of uric acid crystals in febuxostat treatment of patients with uric acid nephropathy

作　　者：辛家东 高建东[1] XIN Jia-dong;GAO Jian-dong(Department of Nephrology,Shuguang Hospital,Shanghai Universiyty f Traditional Chinese Medicine、Traditional Chinese Medicine Institute of Kidney Disease,Shanghai University of Traditional Chinese Medicine、Key Laboratory of Liver and Kidney Diseases,Ministry of Education、Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海中医药大学中医肾病研究所,肝肾疾病病证教育部重点实验室,上海市中医临床重点实验室,上海201203

出　　处：《中国临床药理学杂志》2023年第19期2752-2755,共4页The Chinese Journal of Clinical Pharmacology

基　　金：上海市科委科技计划基金资助项目(20Y21901800);上海市中医临床重点实验室基金资助项目(20DZ2272200)。

摘　　要：目的观察尿酸结晶在非布司他片治疗尿酸性肾病患者的临床意义。方法将B超显示是否有肾结晶沉积分为对照组(无结晶)和试验组(有结晶)。2组患者均给予非布司他每次40 mg,每天1次,口服治疗12周。比较2组患者的临床疗效、血尿酸、肾功能,以及药物不良反应的发生情况。结果试验组和对照组各纳入36例进行统计分析。治疗后,试验组和对照组的总有效率分别为83.33%(30例/36例)和55.55%(20例/36例),差异有统计学意义(P<0.05)。试验组治疗前和治疗后的血尿酸分别为(495.89±71.25)和(352.22±39.53)μmol·L^(-1),对照组分别为(476.54±96.89)和(383.83±80.61)μmol·L^(-1),差异均有统计学意义(均P<0.05),且试验组治疗后的血尿酸显著低于对照组(P<0.05)。治疗后,试验组和对照组的血清肌酸酐分别为102.00和110.00μmol·L^(-1),肾小球滤过率估计值分别为59.98和55.88 mL·min^(-1)·1.73 m^(-2),尿β2微球蛋白(β2-MG)分别为0.30和1.45 mg·L^(-1),尿视黄醇结合蛋白(RBP)分别为0.50和1.25 mg·L^(-1),尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)分别为7.45和11.70 U·L^(-1);试验组治疗后的尿β2-MG、尿RBP和尿NAG与对照组比较,差异均有统计学意义(均P<0.05),而对照组患者肾功能改善不明显。入组患者共有8例发生药物不良反应。结论当发生高尿酸血症伴有肾结晶沉积时,及时采取降尿酸治疗具有明显的积极意义,非布司他在降低血尿酸浓度的同时可以延缓慢性肾病的进展。Objective To observe the clinical significance of uric acid crystals in the treatment of patients with uric acid nephropathy with febuxoat tablets.Methods The renal crystal deposition was divided into control group(without crystal)and treatment group(with crystal).Two groups were given febuxostat 40 mg once a day for 12 weeks.The clinical efficacy,serum uric acid(SUA),renal function and the occurrence of adverse drug reactions were compared between the two groups.Results The treatment and control groups included 36 cases for statistical analysis.After treatment,the total effective rates of treatment and control groups were 83.33%(30 cases/36 cases)and 55.55%(20 cases/36 cases)with significant difference(P0.05).SUA levels of the treatment group before and after treatment were(495.89±71.25)and(352.22±39.53)μmol·L^(-1),while those of the control group were(476.54±96.89)and(383.83±80.61)μmol·L^(-1),and the diferences were statistically significant(all P<0.05),and the SUA of treatment group after treatment was significantly lower than that of control group(P<0.05).After treatment,the serum creatinine of treatment and control groups were 102.00 and 110.00μmol·L^(-1);the estimated glomerular filtration rates were 59.98 and 55.88 mL·min^(-1)·1.73 m^(-2);the urineβ2-microglobulin(β2-MG)were 0.30 and 1.45 mg·L^(-1);the urine retinol binding protein(RBP)were 0.50 and 1.25 mg·L^(-1);the urine N-acetyl-beta-D-glucosidase(NAG)were 7.45 and 11.70 U·L^(-1),respectively.There were significant differences in the after treatment of urineβ2-MG,urine RBP and urine NAG between the treatment group and the control group(all P<0.05);while the control group had no significant improvement in renal function.A total of 8 patients had adverse drug reactions.Conclusion In the case of hyperuricemia accompanied by renal crystal deposition,timely uric acid lowering therapy has obviously positive significance.Febuxoat can reduce the SUA concentration and delay the progression of chronic kidney disease at the same time.

关 键 词：非布司他片 高尿酸血症 尿酸结晶 慢性肾病 尿酸性肾病 临床试验 

分 类 号：R983.2[医药卫生—药品]