【摘要】 目的研究非布司他治疗维持性血液透析伴高尿酸血症对患者血管内皮功能、氧化应激反应的影响,并进行安全性评价。方法维持性血液透析(透龄>6个月)伴高尿酸血症患者34例随机分为非布司他组和对照组,每组17例。对照组采用常规治疗,非布司他组在对照组基础上加用非布司他进行治疗。观察2组血管内皮功能[血浆髓过氧化物酶(MPO)、一氧化氮(NO)、内皮素-1(ET-1)]、氧化应激[丙二醛(MDA)、超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPP)]水平,观察2组患者不良反应发生情况和痛风发作情况。结果对照组治疗1、3个月MPO、ET-1水平均低于治疗前,差异有统计学意义(P<0.05),对照组治疗前,治疗1、3个月NO水平比较,差异均无统计学意义(P>0.05)。非布司他组治疗1、3个月MPO、NO、ET-1水平均低于治疗前,且治疗3个月ET-1水平低于治疗1个月,差异均有统计学意义(P<0.05)。非布司他组治疗前,治疗1、3个月MOP、NO水平与对照组比较,差异无统计学意义(P>0.05)。非布司他组治疗前,治疗1个月ET-1水平与对照组比较差异无统计学意义(P>0.05),治疗3个月低于对照组,差异有统计学意义(P<0.05)。对照组治疗3个月MAD水平低于治疗前,差异有统计学意义(P<0.05),对照组治疗前,治疗1、3个月AOPP水平两两比较,差异均有统计学意义(P<0.05)。非布司他组治疗前,治疗1、3个月MAD、AOPP水平两两比较,差异均有统计学意义(P<0.05)。2组治疗前,治疗1个月MAD、SOD水平,治疗3个月SOD水平比较差异无统计学意义(P>0.05)。非布司他组治疗1个月AOPP水平,治疗3个月MAD、AOPP水平低于对照组,差异有统计学意义(P<0.05)。非布司他组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。非布司他组治疗1、3个月痛风发作率低于对照组,但差异无统计学意义(P>0.05)。结论非布司他治疗维持性血液透析伴高尿酸血症能够改善患者内皮功能,增强抗氧作用,同时不良反应发生率低,可能对减少痛风发作有一定作用。更多还原

【Abstract】 Objective To investigate the effects of febuxostat on vascular endothelial function and oxidative stress reaction in patients undergoing maintenance hemodialysis with hyperuricemia,and to evaluate its safety. Methods Thirty-four patients with hyperuricemia who underwent maintenance hemodialysis(over 6 months) were randomly divided into febuxostat group and control group,with 17 patients in each group. The patients in control group were treated by conventional therapy,however,the patients in febuxostat group,on the basis of control group were treated by febuxostat. The vascular endothelial function including plasma myeloperoxidase(MPO),nitric oxide(NO),endothelin-1(ET-1) ],oxidative stress ability including MDA,SOD and advanced oxidative protein product(AOPP) as well as the incidence of adverse reactions and gout attack were observed and compared between two groups. Results The levels of MPO and ET-1 at 1 m,3 m after treatment in control group were significantly lower than those before treatment(P < 0. 05). There were no significant differences in NO levels in control group before treatment and at 1 m,3 m after treatment(P > 0. 05). The levels of MPO,NO,and ET-1 in febuxostat group at 1 m,3 m after treatment were significantly lower than those before treatment(P < 0. 05),moreover,the levels of ET at 3 m after were significantly lower than those at 1 m after treatment(P > 0. 05). Before treatment,there were no significant differences in the levels of MOP and NO levels at 1 m,3 m after treatment between the two groups(P > 0. 05),and there were no significant differences in the levels of ET-1 before treatment and at 1 m after treatment between the two groups(P > 0. 05),however,which at 3 m after treatment were significantly lower than those in control group(P < 0. 05). Moreover the MAD levels at 3 m after treatment in control group were significantly lower than those before treatment(P < 0. 05),and there were significant differences in the levels of AOPP in control group before treatment and at 1 m,3 m after treatment(P < 0. 0 5). In addition there were significant differences in the levels of MAD and AOPP in febuxostat group before treatment and at 1 m,3 m after treatment(P <0. 05). There were no significant differences in the levels of MAD and SOD before treatment and at 1 m after treatment between the two groups(P > 0. 05),and nor were the SOD levels at 3 m after treatment(P > 0. 05). Besides the levels of AOPP at 1 m after treatment and the levels of MAD and AOPP at 3 m after treatment in febuxostat group were significantly lower than those in control group(P < 0. 05),and the incidence rates of adverse reactins in febuxostat group were significantly lower than those in control group(P < 0. 05),and the incidence rates of gout attack at 1 m,3 m after treatment in febuxostat group were lower than those in control group,however,there were no significant differences between the two groups(P > 0. 05). Conclusion The application of febuxostat in treatment of patients undergoing maintenance hemodialysis with hyperuricemia can improve the endothelial function of patients,enhance the anti-oxidation effects,with lower incidence of adverse reactions,which may have a certain effect in decreasing the incidence of gout attacks.更多还原