节点文献
别嘌呤醇对高尿酸血症患者动脉弹性短期影响的临床观察
【作者】 王霞；
【导师】 高燕燕；
【作者基本信息】 青岛大学 ， 内分泌与代谢性疾病， 2010， 硕士
【摘要】 目的观察高尿酸血症对动脉弹性的影响及别嘌呤醇对高尿酸血症患者动脉弹性、高敏C反应蛋白(hsCRP).尿酸(UA)、血压、血糖、血脂及肝肾功的短期影响,分析动脉弹性的影响因素,为动脉粥样硬化早期干预提供指导。方法选择高尿酸患者59例,29-60岁,平均年龄46.24岁,同时选择非高尿酸血症患者28例,32-60岁,平均49岁。高尿酸组随机分为别嘌呤醇组29例和对照组30例,分别给予别嘌呤醇0.1g3次／日+碳酸氢钠1.0g3次／日和碳酸氢钠1.0g3次／日3个月,观察治疗前后血压、血糖、血脂、肝肾功、hsCRP.UA,臂踝脉搏波速度(baPWV)及踝臂指数(ABI)的变化,观察药物副作用。结果(1)高尿酸血症患者baPWV (1502.93±149.71 VS 1382.21±188.56,p<0.01),hsCRP(4.66±2.40 VS 0.90±0.52,p<0.01)显著高于非高尿酸血症者。相关回归分析显示高尿酸血症组年龄(r=0.259,P<0.05),收缩压(r=0.409,P<0.01), hsCRP(r=0.357, P<0.01)与baPWV相关,校正年龄、血压、血脂、血糖后,UA为baPWV的独立影响因素(β=0.695, P<0.01).hsCRP与UA呈显著正相关(r=0.695,P<0.01)。(2)所有高尿酸血症患者均完成随访,无严重不良反应发生。治疗3个月后,别嘌呤醇组收缩压(118.93±8.64 VS 127.73±10.27,D<0.01).舒张压(77.24±8.24 VS 82.20±9.92,p<0.01)均显著低于对照组。别嘌呤醇组hsCRP(1.11±0.71 VS 1.88±1.16,p<0.05)低于对照组。(3)别嘌呤醇组治疗后收缩压(118.93±8.64 VS 128.97±9.76,p<0.01)、舒张压(77.24±8.24 VS 80.62±6.52,p<0.01).hsCRP(1.11±0.71 VS 4.87±2.31,p<0.01),UA(386.68±102.92 VS 490.80±77.16,p<0.01). baPWV(1384.48±126.15 VS 1524.48±139.49,p<0.01)较治疗前显著下降。(4)对照组hsCRP(1.88±1.16 VS 4.45±2.51,p<0.01)及UA(393.19±75.39 VS 455.36±82.93,p<0.01)较治疗前显著下降。GFR(63.77±14.45 VS 66.14±13.90,p<0.05)较治疗前下降。(5)相关回归分析显示,baPWV的下降与hsCRP的下降(r=0.630,p＜0.01)和UA的下降(r=0.371,p＜0.05)相关。多元逐步回归分析显示别嘌呤醇的应用及hsCRP的下降为baPWV下降的独立影响因子。尿酸的变化未进入方程。结论高尿酸血症患者baPWV及hsCRP高于非高尿酸血症者,提示高尿酸血症为一种慢性炎症状态,是早期动脉硬化的危险因素。别嘌呤醇及碳酸氢钠治疗均可降低血尿酸和hsCRP,在尿酸下降的同时可改善高尿酸血症的炎症状态。别嘌呤醇可安全有效治疗高尿酸血症,同时可以降低血压及baPWV,改善血管弹性,逆转早期动脉硬化,baPWV的下降与炎症状态改善有关,不依赖于尿酸的变化。
【Abstract】 Objective To observe the effect of hyperuricemia on arterial elasticity and evaluate the short-term impact of allopurinol on arterial elasticity、high sensitive C reactive protein (hsCRP)、uric acid(UA)、blood pressure、blood glucose,blood lipids, liver and kidney function in patients with hyperuricemia,as well as the impact factors of arterial elasticity. Methods Select 59 patients with hyperuricemia (29～60 year, mean 46.24 year) and 28 patients without hyperuricemia(32～60 year, mean 49 year). Patients with hyperuriemia were randomly divided into allopurinol group(n=29) and control group(n=30) and treated for 3 months.The allopurinol group was given allopurinol O.lg 3 times/day and sodium bicarbonate 1.0g 3 times/day, control group was given sodium bicarbonate 1.0 3 times/day. Blood pressure, blood glucose, blood lipids, liver and kidney function, hsCRP, UA, brachial-ankle pulse wave velocity(baPWV) and ankle-brachial index(ABI)were observed before and after treatment,and the side effects of the drug.was also observed. Results (1)In hyperuricemia group, baPWV (1502.93±149.71 VS 1382.21±188.56,p<0.01)and hsCRP(4.66±2.40 VS 0.90±0.52,p<0.01)were significantly higher than that of non-hyperuricemia group. Correlation regression analysis showed that age(r=0.259,P<0.05),systolic blood pressure(r=0.409,P<0.01),hsCRP(r=0.357,P<0.01)associated with baPWV in hyperuricemia group.After adjusting for age, blood pressure, blood lipids, blood glucose, UA was the independent impact factor for baPWV(β=0.695,P<0.01).UA was significantly correlated with hsCRP(r=0.695,P<0.01).(2)A11 patients with hyperuricemia accomplished observation, no serious side effects happened. After treatment, in allopurinol group, systolic blood pressure(118.93±8.64 VS 127.73±10.27, p<0.01), diastolic blood pressure (77.24±8.24 VS 82.20±9.92, p<0.01),and hsCRP(1.1±0.71 VS 1.88±1.16,p<0.05)were significantly lower than that of the control group. (3)In allopurinol group, systolic blood pressure(118.93±8.64 VS 128.97±9.76, p<0.01), diastolic blood pressure (77.24±8.24 VS 80.62±6.52, p<0.01), hsCRP(1.11±0.71 VS 4.87±2.31,p<0.01),UA(386.68±102.92 VS 490.80±77.16,p<0.01),and baPWV (1384.48±126.15 VS 1524.48±139.49,p<0.01)decreased significantly after treatment. (4) In control group, hsCRP(1.88±1.16 VS4.45±2.51,p<0.01),UA(393.19±75.39 VS 455.36±82.93,p<0.01)decreased significantly after treatment, glomerular filtration rate(GFR)(63.77±14.45 VS 66.14±13.90,p<0.05)decreased after treatment. (5) Correlation analysis showed that the decrease of hsCRP(r=0.630,P<0.01)and UA (r=0.371,P<0.05)were associated with the baPWV derease. Allopurinol and decrease of hsCRP were independent impact factors of the baPWV by multiple stepwise regression analysis. Conclusion Patients with hyperuricemia had higher baPWV and hsCRP than patients without hyperuricemia which suggest that hyperuricemia was a chronic inflammatory state and a risk factor for early atherosclerosis.Allopurinol and sodium bicarbonate can reduce the level of the blood uric acid and hsCRP. With the decline in UA, the inflammation state can be improved.Allopurinol is safe and effective in the treatment of hyperuricemia,at the same time, allopurinaol can lower blood pressure and baPWV,improve blood vessel elasticity, reversing early atherosclerosis. The decline in baPWV was associated with the improvement of inflamation state, not depending on the change in UA.