别嘌醇对慢性肾脏病合并无症状高尿酸血症患者肾功能的影响

王垚; 于博

doi:10.3969/j.issn.1671-2390.2017.02.004

别嘌醇对慢性肾脏病合并无症状高尿酸血症患者肾功能的影响

王垚,
于博

Effect of allopurinol on renal function in chronic kidney disease patients with asymptomatic hyperuricemia

WANG Yao,
YU Bo

摘要

摘要: 目的探讨别嘌醇在慢性肾脏病（chronic kidney disease，CKD）早期合并无症状高尿酸血症患者中降尿酸治疗的临床效果。方法选取2014年2月至2015年2月在扬州市第一人民医院肾内科确诊为CKD 2~3a期且合并无症状性高尿酸血症的患者87例，随机分为别嘌醇治疗组和对照组，对照组和治疗组常规给予低盐、低脂、低优蛋白、低嘌呤饮食，控制血压、血糖等基本治疗，别嘌醇治疗组另再给予别嘌醇200 mg/d口服。治疗1年后观察2组患者血压、估算肾小球滤过率（estimated glomerular filtration rate，eGFR）下降和蛋白尿情况。结果别嘌醇治疗组中有3例（占7.14%）患者因皮疹退出治疗，治疗后血尿酸水平（280.21±72.58）μmol/L较治疗前的（515.28±114.13）μmol/L明显降低（P<0.01）。eGFR治疗前水平为（73.46±18.38）ml·min^-1·（1.73 m²）^-1、治疗后水平为（70.37±20.11）ml·min^-1·（1.73 m²）^-1，治疗前、后无明显变化（P>0.05），而对照组1年后血尿酸水平较治疗前的（545.43±89.56）μmol/L升高为（487.02±78.57）μmol/L（P<0.01）。eGFR治疗前水平为（70.43±20.65）ml·min^-1·（1.73 m²）^-1，治疗后水平明显下降为（64.21±17.42）ml·min^-1·（1.73 m²）^-1（P<0.05）；别嘌醇治疗组24 h尿蛋白定量治疗后为（0.48±0.12）g/24h，较治疗前水平（0.62±0.43）g/24h轻度下降，但差异无统计学意义（P>0.05）。对照组24 h尿蛋白定量治疗前水平（0.60±0.47）g/24h、治疗后水平（0.64±0.37）g/24h，治疗前、后无变化（P>0.05）。2组患者治疗后收缩压分别为（125.21±10.08）mmHg、（128.45±9.64）mmHg，较治疗前收缩压（155.44±12.12）mmHg、（157.42±14.12）mmHg显著降低；治疗后舒张压分别为（80.45±9.23）mmHg、（82.27±6.25）mmHg，较治疗前的（88.56±10.21）mmHg、（86.45±11.56）mmHg均显著降低（P<0.05），但组间比较无统计学差异（P>0.05）。结论 CKD 2~3a期合并无症状高尿酸血症患者给予别嘌醇降尿酸治疗可延缓肾功能减退。

Abstract: Objective To investigate the effect of allopurinol treatment on renal function in chronic kidney disease (CKD) patients with asymptomatic hyperuricemia.Methods Select the patients whom diagnosed CKD 2~3a phase with asymptomatic hyperuricemia from February 2014 to February 2015 in nephrology department of yangzhou NO.1 people's hospital. All patients were randomly divided into allopurinol treatment group and control group. Both groups treated with low salt, low fat, low protein and low purine diet, control blood pressure and blood glucose. Allopurinol treatment group received allopurinol 200 mg per day, the control group was not given uric acid lowering treatment. One year after the treatment, observing two groups of eGFR, albuminuria and blood pressure in patients.Results In allopurinol treatment group, 3 patients withdrawal due to rash, the incidence rate is 7.14%. Allopurinol treatment significantly lower blood uric acid levels after 1 year later(515.28±114.13 vs 280.21±72.58, P<0.01), the eGFR has no obvious change before and after the treatment(73.46±18.38 vs 70.37±20.11, P>0.05), while control group's blood uric acid higher(487.02±78.57 vs 545.43±89.56, P<0.05)and eGFR decline dramatically in a year later(70.43±20.65 vs 64.21±17.42, P<0.05). In allopurinol treatment group, the level of proteinuria decreased slightly(0.62±0.43 vs 0.48±0.12, P>0.05), but there was no statistical significance(P>0.05), in the control group, albuminuria have no difference before and after treatment(0.60±0.47 vs 0.64±0.37, P>0.05). Systolic blood pressure(155.44±12.12 vs 125.21±10.08, P<0.05; 157.42±14.12 vs 128.45±9.64, P<0.05) and diastolic blood pressure(88.56±10.21 vs 80.45±9.23, P<0.05; 86.45±11.56 vs 82.27±6.25, P<0.05) were significantly lower than before after treatment in both groups, but there was no statistical difference between the two groups(P>0.05).Conclusions Allopurinol slowed the decline of eGFR in CKD 2~3a phase with asymptomatic hyperuricemia.

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