上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (7): 885-892.doi: 10.3969/j.issn.1674-8115.2022.07.006
• 论著 · 临床研究 • 上一篇
赖秀秀1(), 朱青燕1, 谈佳奇2, 杨令1, 朱琰1, 周公民1(
)
收稿日期:
2022-03-09
接受日期:
2022-06-10
出版日期:
2022-07-25
发布日期:
2022-07-25
通讯作者:
周公民
E-mail:lxx1989lxx@163.com;whazqp@163.com
作者简介:
赖秀秀(1989—),女,主治医师,硕士;电子信箱:lxx1989lxx@163.com。
基金资助:
LAI Xiuxiu1(), ZHU Qingyan1, TAN Jiaqi2, YANG Ling1, ZHU Yan1, ZHOU Gongmin1(
)
Received:
2022-03-09
Accepted:
2022-06-10
Online:
2022-07-25
Published:
2022-07-25
Contact:
ZHOU Gongmin
E-mail:lxx1989lxx@163.com;whazqp@163.com
Supported by:
摘要:
目的·探讨小剂量非布司他治疗慢性肾脏病(chronic kidney disease,CKD)合并无症状高尿酸血症(hyperuricemia,HUA)的高龄患者的效果、安全性及对肾功能的影响。方法·采用前瞻性队列研究,选取2021年2月—2021年7月在浙江省人民医院望江山院区住院并符合入组标准的102例高龄患者作为研究对象,根据药物使用剂量分为小剂量组(20 mg/d)、正常剂量组(40 mg/d)和对照组(未予药物治疗,生活方式干预为主)。总疗程3个月。计算各组患者每个月血尿酸(serum uric acid,SUA)达标率,收集并计算患者基线及治疗1、3个月后的SUA、血肌酐(serum creatinine,Scr)、内生肌酐清除率(creatinine clearance rate,Ccr)、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)等指标的变化,其中eGFR1、eGFR2的计算分别采用简化的肾脏病饮食改良研究公式及慢性肾脏病流行病学协作公式。同时观察药物引起的心脑血管事件、痛风、过敏等不良反应。采用χ2检验比较性别构成、基础疾病、用药情况的组间差异,采用单因素方差分析(one-way ANOVA)比较SUA、Scr、Ccr、eGFR1、eGFR2的组间差异。结果·治疗1、2、3个月后,小剂量组和正常剂量组的SUA达标率分别93.8%、93.8%、90.6%和93.8%、93.8%、96.9%。相较于对照组,上述2组SUA水平显著降低(均P=0.000)。此外,治疗3个月后小剂量组的Ccr、eGFR1、eGFR2高于基线值(P=0.006,P=0.013,P=0.015)及对照组同期水平(P=0.019,P=0.020,P=0.021)。同时,小剂量组和正常剂量组SUA的下降幅度差异无统计学意义,但均显著大于对照组(均P=0.000)。小剂量组Ccr、eGFR1、eGFR2的升高幅度均较对照组显著增加(P=0.004,P=0.002,P=0.003),与正常剂量组相比差异无统计学意义。所有患者观察期间均未出现严重不良反应。结论·小剂量和正常剂量非布司他对CKD合并无症状HUA的高龄患者的降尿酸疗效相当,均可获得较高的SUA达标率,并可一定程度改善肾功能,且不良反应少,安全性高。建议非布司他干预无症状HUA可从小剂量开始。
中图分类号:
赖秀秀, 朱青燕, 谈佳奇, 杨令, 朱琰, 周公民. 小剂量非布司他改善无症状高尿酸血症高龄患者肾功能的临床研究[J]. 上海交通大学学报(医学版), 2022, 42(7): 885-892.
LAI Xiuxiu, ZHU Qingyan, TAN Jiaqi, YANG Ling, ZHU Yan, ZHOU Gongmin. Clinical study of low dose febuxostat on improving renal function in elderly patients with asymptomatic hyperuricemia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(7): 885-892.
Item | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) | F/χ2 value | P value |
---|---|---|---|---|---|
Age/year | 88.66±2.88 | 89.28±3.47 | 89.68±3.35 | 0.824 | 0.442 |
Male/n (%) | 18 (56.3) | 13 (40.6) | 15 (44.1) | 1.735 | 0.420 |
SBP/mmHg | 126.34±11.23 | 127.13±8.95 | 126.38±13.92 | 0.046 | 0.955 |
DBP/mmHg | 65.16±9.04 | 65.91±5.53 | 65.85±9.46 | 0.083 | 0.920 |
BMI/(kg·m-2) | 24.97±4.08 | 25.20±5.50 | 24.58±3.32 | 0.171 | 0.843 |
HbA1c/% | 6.34±0.75 | 6.23±0.53 | 6.30±0.66 | 0.204 | 0.816 |
HB/(g·L-1) | 115.56±16.42 | 121.66±16.89 | 119.94±16.07 | 1.170 | 0.315 |
Albumin/(g·L-1) | 39.50±3.50 | 39.68±3.64 | 39.65±3.38 | 0.025 | 0.976 |
TAG/(mmol·L-1) | 1.23±0.53 | 1.37±0.65 | 1.36±0.73 | 0.486 | 0.616 |
TC/(mmol·L-1) | 3.94±0.95 | 3.72±0.85 | 4.09±0.85 | 1.457 | 0.238 |
HDL-C/(mmol·L-1) | 1.24±0.24 | 1.22±0.31 | 1.22±0.28 | 0.063 | 0.939 |
LDL-C/(mmol·L-1) | 2.12±0.95 | 1.89±0.62 | 2.25±0.68 | 1.859 | 0.161 |
SUA/(μmol·L-1) | 494.16±57.12 | 487.34±70.03 | 492.00±61.98 | 0.097 | 0.907 |
Scr/(μmol·L-1) | 119.71±24.01 | 115.80±23.52 | 117.33±22.81 | 0.227 | 0.798 |
Cys-C/(mg·L-1) | 1.71±0.36 | 1.68±0.35 | 1.71±0.37 | 0.109 | 0.897 |
Ccr/(mL·min-1) | 33.05±8.69 | 31.75±7.55 | 30.18±7.08 | 0.228 | 0.796 |
eGFR1/[mL·min-1·(1.73 m2)-1] | 48.52±10.47 | 47.28±9.27 | 47.12±7.62 | 0.227 | 0.797 |
eGFR2/[mL·min-1·(1.73 m2)-1] | 42.91±9.79 | 41.89±8.63 | 41.54±6.91 | 0.230 | 0.795 |
UACR | 0.06 (0.05, 0.14) | 0.06 (0.04, 0.09) | 0.09 (0.06, 0.13) | 3.547 | 0.170 |
Hcy/(μmol·L-1) | 17.03±5.23 | 17.51±5.24 | 16.83±5.28 | 0.141 | 0.868 |
Comorbidity/n (%) | |||||
Diabetes mellitus | 13 (40.6) | 7 (21.9) | 7 (20.6) | 4.083 | 0.147 |
Hypertension | 26 (81.3) | 26 (81.3) | 28 (82.4) | 0.018 | 0.991 |
Coronary atherosclerotic heart disease | 20 (62.5) | 23 (71.9) | 17 (50.0) | 3.355 | 0.187 |
Drug/n (%) | |||||
ACEI/ARB | 17 (53.1) | 12 (37.5) | 12 (35.3) | 2.521 | 0.283 |
Calcium antagonists | 9 (28.1) | 10 (31.3) | 16 (47.1) | 2.986 | 0.225 |
Diuretics | 11 (34.4) | 13 (40.6) | 10 (29.4) | 0.917 | 0.632 |
Sodium bicarbonate | 2 (6.3) | ‒ | ‒ | ‒ | ‒ |
SGLT2i | ‒ | ‒ | ‒ | ‒ | ‒ |
Calcium dobesilate | ‒ | 1 (3.1) | ‒ | ‒ | ‒ |
表1 3组患者基线临床特征
Tab 1 Clinical characteristics of patients at baseline in the three groups
Item | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) | F/χ2 value | P value |
---|---|---|---|---|---|
Age/year | 88.66±2.88 | 89.28±3.47 | 89.68±3.35 | 0.824 | 0.442 |
Male/n (%) | 18 (56.3) | 13 (40.6) | 15 (44.1) | 1.735 | 0.420 |
SBP/mmHg | 126.34±11.23 | 127.13±8.95 | 126.38±13.92 | 0.046 | 0.955 |
DBP/mmHg | 65.16±9.04 | 65.91±5.53 | 65.85±9.46 | 0.083 | 0.920 |
BMI/(kg·m-2) | 24.97±4.08 | 25.20±5.50 | 24.58±3.32 | 0.171 | 0.843 |
HbA1c/% | 6.34±0.75 | 6.23±0.53 | 6.30±0.66 | 0.204 | 0.816 |
HB/(g·L-1) | 115.56±16.42 | 121.66±16.89 | 119.94±16.07 | 1.170 | 0.315 |
Albumin/(g·L-1) | 39.50±3.50 | 39.68±3.64 | 39.65±3.38 | 0.025 | 0.976 |
TAG/(mmol·L-1) | 1.23±0.53 | 1.37±0.65 | 1.36±0.73 | 0.486 | 0.616 |
TC/(mmol·L-1) | 3.94±0.95 | 3.72±0.85 | 4.09±0.85 | 1.457 | 0.238 |
HDL-C/(mmol·L-1) | 1.24±0.24 | 1.22±0.31 | 1.22±0.28 | 0.063 | 0.939 |
LDL-C/(mmol·L-1) | 2.12±0.95 | 1.89±0.62 | 2.25±0.68 | 1.859 | 0.161 |
SUA/(μmol·L-1) | 494.16±57.12 | 487.34±70.03 | 492.00±61.98 | 0.097 | 0.907 |
Scr/(μmol·L-1) | 119.71±24.01 | 115.80±23.52 | 117.33±22.81 | 0.227 | 0.798 |
Cys-C/(mg·L-1) | 1.71±0.36 | 1.68±0.35 | 1.71±0.37 | 0.109 | 0.897 |
Ccr/(mL·min-1) | 33.05±8.69 | 31.75±7.55 | 30.18±7.08 | 0.228 | 0.796 |
eGFR1/[mL·min-1·(1.73 m2)-1] | 48.52±10.47 | 47.28±9.27 | 47.12±7.62 | 0.227 | 0.797 |
eGFR2/[mL·min-1·(1.73 m2)-1] | 42.91±9.79 | 41.89±8.63 | 41.54±6.91 | 0.230 | 0.795 |
UACR | 0.06 (0.05, 0.14) | 0.06 (0.04, 0.09) | 0.09 (0.06, 0.13) | 3.547 | 0.170 |
Hcy/(μmol·L-1) | 17.03±5.23 | 17.51±5.24 | 16.83±5.28 | 0.141 | 0.868 |
Comorbidity/n (%) | |||||
Diabetes mellitus | 13 (40.6) | 7 (21.9) | 7 (20.6) | 4.083 | 0.147 |
Hypertension | 26 (81.3) | 26 (81.3) | 28 (82.4) | 0.018 | 0.991 |
Coronary atherosclerotic heart disease | 20 (62.5) | 23 (71.9) | 17 (50.0) | 3.355 | 0.187 |
Drug/n (%) | |||||
ACEI/ARB | 17 (53.1) | 12 (37.5) | 12 (35.3) | 2.521 | 0.283 |
Calcium antagonists | 9 (28.1) | 10 (31.3) | 16 (47.1) | 2.986 | 0.225 |
Diuretics | 11 (34.4) | 13 (40.6) | 10 (29.4) | 0.917 | 0.632 |
Sodium bicarbonate | 2 (6.3) | ‒ | ‒ | ‒ | ‒ |
SGLT2i | ‒ | ‒ | ‒ | ‒ | ‒ |
Calcium dobesilate | ‒ | 1 (3.1) | ‒ | ‒ | ‒ |
Group | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) | P value① | P value② |
---|---|---|---|---|---|
SUA/(μmol·L-1) | |||||
Baseline | 494.16±57.12 | 487.34±70.03 | 492.00±61.98 | 0.884 | 0.775 |
1 month after treatment | 233.00±89.20③ | 267.87±52.98③ | 448.79±46.74 | 0.000 | 0.000 |
3 months after treatment | 245.28±86.41③ | 269.78±58.87③ | 439.15±64.21③ | 0.000 | 0.000 |
Scr/(μmol·L-1) | |||||
Baseline | 119.71±24.01 | 115.80±23.52 | 117.33±22.81 | 0.681 | 0.789 |
1 month after treatment | 120.00±25.76 | 109.85±18.80④ | 117.95±25.20 | 0.745 | 0.146 |
3 months after treatment | 117.41±32.71 | 109.13±20.11⑤ | 120.42±24.30 | 0.671 | 0.045 |
Ccr/(mL·min-1) | |||||
Baseline | 33.05±8.69 | 31.75±7.55 | 30.18±7.08 | 0.120 | 0.329 |
1 month after treatment | 33.17±9.47 | 33.64±8.95⑥ | 29.96±7.27 | 0.126 | 0.070 |
3 months after treatment | 34.46±10.44 | 33.97±9.01⑥ | 29.21±7.07 | 0.019 | 0.019 |
eGFR1/[mL·min-1·(1.73 m2)-1] | |||||
Baseline | 48.52±10.47 | 47.28±9.27 | 47.12±7.62 | 0.536 | 0.941 |
1 month after treatment | 48.67±11.35 | 50.27±11.31⑦ | 47.12±8.27 | 0.528 | 0.200 |
3 months after treatment | 51.20±13.49④ | 50.65±11.00⑦ | 45.28±6.97 | 0.027 | 0.020 |
eGFR2/[mL·min-1·(1.73 m2)-1] | |||||
Baseline | 42.91±9.79 | 41.89±8.63 | 41.54±6.91 | 0.511 | 0.855 |
1 month after treatment | 43.04±10.57 | 44.62±10.35⑧ | 41.55±7.56 | 0.511 | 0.170 |
3 months after treatment | 45.54±12.65⑨ | 44.98±10.15⑩ | 40.07±6.44 | 0.029 | 0.021 |
表2 3组患者SUA与肾功能变化比较
Tab 2 Comparison of the changes in SUA and renal function among the three groups
Group | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) | P value① | P value② |
---|---|---|---|---|---|
SUA/(μmol·L-1) | |||||
Baseline | 494.16±57.12 | 487.34±70.03 | 492.00±61.98 | 0.884 | 0.775 |
1 month after treatment | 233.00±89.20③ | 267.87±52.98③ | 448.79±46.74 | 0.000 | 0.000 |
3 months after treatment | 245.28±86.41③ | 269.78±58.87③ | 439.15±64.21③ | 0.000 | 0.000 |
Scr/(μmol·L-1) | |||||
Baseline | 119.71±24.01 | 115.80±23.52 | 117.33±22.81 | 0.681 | 0.789 |
1 month after treatment | 120.00±25.76 | 109.85±18.80④ | 117.95±25.20 | 0.745 | 0.146 |
3 months after treatment | 117.41±32.71 | 109.13±20.11⑤ | 120.42±24.30 | 0.671 | 0.045 |
Ccr/(mL·min-1) | |||||
Baseline | 33.05±8.69 | 31.75±7.55 | 30.18±7.08 | 0.120 | 0.329 |
1 month after treatment | 33.17±9.47 | 33.64±8.95⑥ | 29.96±7.27 | 0.126 | 0.070 |
3 months after treatment | 34.46±10.44 | 33.97±9.01⑥ | 29.21±7.07 | 0.019 | 0.019 |
eGFR1/[mL·min-1·(1.73 m2)-1] | |||||
Baseline | 48.52±10.47 | 47.28±9.27 | 47.12±7.62 | 0.536 | 0.941 |
1 month after treatment | 48.67±11.35 | 50.27±11.31⑦ | 47.12±8.27 | 0.528 | 0.200 |
3 months after treatment | 51.20±13.49④ | 50.65±11.00⑦ | 45.28±6.97 | 0.027 | 0.020 |
eGFR2/[mL·min-1·(1.73 m2)-1] | |||||
Baseline | 42.91±9.79 | 41.89±8.63 | 41.54±6.91 | 0.511 | 0.855 |
1 month after treatment | 43.04±10.57 | 44.62±10.35⑧ | 41.55±7.56 | 0.511 | 0.170 |
3 months after treatment | 45.54±12.65⑨ | 44.98±10.15⑩ | 40.07±6.44 | 0.029 | 0.021 |
图1 3组患者SUA、Scr、Ccr、eGFR变化幅度比较Note: ①P=0.000, ②P=0.004, ③P=0.045, ④P=0.010, ⑤P=0.002, ⑥P=0.011, ⑦P=0.003, compared with the control group.
Fig 1 Comparison of changes in SUA, Scr, Ccr, eGFR among the three groups
Adverse event | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) |
---|---|---|---|
Gout/n (%) | 0 (0) | 0 (0) | 0 (0) |
Rash/n (%) | 1 (3.1) | 0 (0) | 0 (0) |
Cardiovascular and cerebrovascular event/n (%) | 0 (0) | 0 (0) | 0 (0) |
Gastrointestinal event/n (%) | 1 (3.1) | 1 (3.1) | 0 (0) |
Respiratory event/n (%) | 6 (18.8) | 7 (21.9) | 5 (14.7) |
Hepatic dysfunction/n (%) | 3 (9.4) | 1 (3.1) | 2 (5.9) |
Pollakiuria/n (%) | 0 (0) | 1 (3.1) | 0 (0) |
Allergy/n (%) | 0 (0) | 0 (0) | 0 (0) |
表3 各组不良反应发生情况
Tab 3 Adverse events in the three groups
Adverse event | Normal dose group (n=32) | Low dose group (n=32) | Control group (n=34) |
---|---|---|---|
Gout/n (%) | 0 (0) | 0 (0) | 0 (0) |
Rash/n (%) | 1 (3.1) | 0 (0) | 0 (0) |
Cardiovascular and cerebrovascular event/n (%) | 0 (0) | 0 (0) | 0 (0) |
Gastrointestinal event/n (%) | 1 (3.1) | 1 (3.1) | 0 (0) |
Respiratory event/n (%) | 6 (18.8) | 7 (21.9) | 5 (14.7) |
Hepatic dysfunction/n (%) | 3 (9.4) | 1 (3.1) | 2 (5.9) |
Pollakiuria/n (%) | 0 (0) | 1 (3.1) | 0 (0) |
Allergy/n (%) | 0 (0) | 0 (0) | 0 (0) |
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