阿魏酸哌嗪联合非布司他对尿酸性肾病血管保护作用的研究

摘要

目的 探讨阿魏酸哌嗪联合非布司他对尿酸性肾病患者肾功能影响及血管保护作用.方法 将60例尿酸性肾病患者随机分为非布司他组和联合组,每组30例.非布司他组在常规治疗基础上给予非布司他片40 mg/次口服,1次/d;联合组在非布司他组治疗基础上给予阿魏酸哌嗪片20 mg/次口服,3次/d.2组观察时间均为1年.检测2组治疗前后血尿酸(UA)、血肌酐(SCr)、血尿胱抑素C(CysC)、血尿β2-微球蛋白(β2-MG)及血清高敏C反应蛋白(hs-CRP)水平,计算肾小球滤过率(eGFR);进行肾动脉及颈动脉超声检测,测量肾动脉管壁厚度及内径,记录肾动脉平均流速(Vm)、阻力指数(RI)及颈动脉内中膜厚度;观察2组治疗过程中不良反应发生情况.结果 治疗后,2组尿液CysC、β2-MG水平及eGFR均明显升高(P均＜0.05),且联合组明显高于非布司他组(P均＜0.05);2组血清CysC、β2-MG、SCr、UA水平均明显降低(P均＜0.05),且联合组明显低于非布司他组(P均＜0.05);2组hs-CRP水平均明显降低(P均＜0.05),但治疗后2组比较差异无统计学意义(P＞0.05).治疗后,联合组肾动脉管壁厚度变薄,管壁内径增宽,RI明显降低,Vm明显增快,与本组治疗前及非布司他组比较差异均有统计学意义(P均＜0.05);非布司他组仅肾动脉管壁厚度变薄(P＜0.05),管壁内径增宽(P＜0.05),RI和Vm均无明显变化(P均＞0.05);2组颈动脉内膜厚度均明显低于治疗前(P均＜0.05),且联合组明显低于非布司他组(P＜0.05).2组各有1例发生肝功能异常,经减少非布司他用量后恢复正常.结论 阿魏酸哌嗪联合非布司他可明显降低尿酸性肾病患者UA水平,有明显肾脏保护作用,能明显改善患者动脉粥样硬化程度,且安全.%Objective It is to investigate the effects of piperazine ferulate combined with febuxostat on renal function and vascular protection in patients with uric acid nephropathy. Methods Sixty patients with uric acid nephropathy were randomly divided into febuxostat group and combination group, 30 cases in each group. On the basis of conventional treatment, the febuxostat group was given 40 mg/time orally, 1 time/d; the combination group was given 20 mg/time of oral piperazine tablets on the basis of the febuxostat group, 3 times/d. The observation time of both groups was 1 year. The levels of blood uric acid (UA), serum creatinine (SCr), hematuria cystatin C (CysC), hematuria β2-microglobulin (β2-MG) and serum high-sensitivity C-reactive protein (hs-CRP) were measured before and after treatment in the two groups, the glomerular filtration rate (eGFR) was calculated; ultrasound examination of renal artery and carotid artery were performed to measure renal artery wall thickness and inner diameter, renal artery mean velocity (Vm), resistance index (RI) and carotid intima-media thickness were recorded; the occurrence of adverse reactions during the treatment of the two groups were observed. Results After treatment, the levels of CysC, β2-MG and eGFR in the two groups were significantly increased (P＜0.05), and the levels of the combination group were significantly higher than those of the febuxostat group (P＜0.05); The levels of serum CysC, β2-MG, SCr and UA were significantly decreased (P＜0.05), and the decrease in the combination group was more significant than that in the febuxostat group (P＜0.05); The hs-CRP levels in the two groups were significantly decreased (P＜0.05), but there was no significant difference between the two groups after treatment (P＞0.05). After treatment, the thickness of the renal artery wall of the combined group became thinner, the inner diameter of the wall was widened, the RI was significantly decreased, and the Vm was significantly increased, compared with that before treatment and in the febuxostat group, the differences were significant (P＜0.05); only the thickness of renal artery wall was thinner (P＜0.05), the inner diameter of the wall was widened (P＜0.05), and there was no significant change in RI and Vm in febuxostat group (P＞0.05); The intima thickness of the arteries was significantly lower than that before treatment in the two groups (P＜0.05), and the combination group was significantly lower than the febuxostat group (P＜0.05). One patient in each of the two groups had abnormal liver function and returned to normal after reducing the amount of febuxostat. Conclusion Piperazine ferulate combined with febuxostat can significantly reduce the level of UA, protect the renal function well, significantly improve the degree of atherosclerosis in patients with uric acid nephropathy.