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目的:观察别嘌醇治疗高尿酸血症对慢性肾功能不全(CKD)患者肾功能的影响。方法:选择伴有高尿酸血症的CKD3或4期患者65例,随机分为观察组34例和对照组31例。观察组别嘌醇起始剂量为100mg/d,最大剂量不超过200mg/d;对照组不使用别嘌醇治疗。比较两组治疗3个月、6个月、12个月和24个月时平均动脉压(MAP)、24h尿蛋白定量、血红蛋白、C反应蛋白(CRP)、血尿酸、血肌酐水平,并计算肾小球滤过率(eGFR)的变化;观察组同时记录有无别嘌醇相关不良反应发生。结果:两组各时间节点MAP、24h尿蛋白定量、血红蛋白及CRP水平与治疗前差异不显著(P>0.05),各时间节点组间比较也差异不显著(P>0.05)。观察组治疗3个月、6个月、12个月、24个月时血尿酸水平显著低于治疗前,且显著低于对照组(P<0.05)。对照组治疗12个月、24个月时,血肌酐水平显著高于治疗前,且显著高于观察组(P<0.05);eGFR水平显著降低,且显著低于观察组(P<0.05)。观察组口服别嘌醇6周时出现发热、皮疹及血肌酐快速升高1例,其他未见明显不良反应。结论:别嘌醇治疗可降低伴高尿酸血症CKD患者的血尿酸水平,并延缓肾功能损害的进展。
Objective: To observe the effects of allopurinol treatment of hyperuricemia on renal function in patients with chronic renal failure (CKD). Methods: Sixty-five patients with CKD stage 3 or 4 with hyperuricemia were randomly divided into observation group (34 cases) and control group (31 cases). Observation group allopurinol initial dose of 100mg / d, the maximum dose does not exceed 200mg / d; control group without allopurinol treatment. Mean arterial pressure (MAP), urinary protein excretion, hemoglobin, C-reactive protein (CRP), serum uric acid and serum creatinine were calculated at 3, 6, 12 and 24 months after treatment Glomerular filtration rate (eGFR) changes; observation group also recorded whether allopurinol-related adverse reactions. Results: The levels of urinary protein, hemoglobin and CRP in MAP and 24 h were not significantly different between before and after treatment (P> 0.05). There was no significant difference between the two groups at each time point (P> 0.05). The level of serum uric acid in observation group at 3, 6, 12 and 24 months was significantly lower than that before treatment and significantly lower than that in control group (P <0.05). The level of serum creatinine was significantly higher in the control group at 12 months and 24 months than that in the control group (P <0.05). The level of eGFR in the control group was significantly lower than that in the observation group (P <0.05). In the observation group, fever, rash and serum creatinine increased rapidly in 1 patient after oral administration of allopurinol at 6 weeks. Other patients showed no obvious adverse reactions. Conclusion: Allopurinol treatment can reduce serum uric acid level in CKD patients with hyperuricemia and delay the progression of renal dysfunction.