碱制剂联合别嘌醇可改善高尿酸血症患者的肾功能
摘要 目的 高尿酸血症是一种代谢性疾病,是引起痛风和肾损害的重要健康问题。尿液碱化药如枸橼酸制剂有助于尿酸分泌,但对黄嘌呤氧化酶抑制剂的辅助作用尚无研究,我们采用前瞻性随机研究,了解别嘌呤醇和枸橼酸制剂对血尿酸超过7.0mmol/L的高尿酸血症或曾诊断为高尿酸血症的70例患者的肾功能影响。
方法:随机入2个研究组:单用别嘌呤组和别嘌呤醇与枸橼酸制剂联合组。别嘌醇(100-200 mg/day)和枸橼酸制剂(3 g/d)应用12周,评估治疗前后的血尿酸水平、尿尿酸清除率和肾脏肾小球滤过率(Ccr)。
结果 两组的血尿酸水平均明显降低,但联合组更为明显。联合组的尿尿酸清除率明显增高,而单用别嘌醇组无改变。总体来看,Ccr在两组均无改变,但有肾功能降低的联合组部分患者的CCr明显增高。
结论:枸橼酸制剂与黄嘌呤氧化酶抑制剂联合治疗对高尿酸血症患者有益,可降低血循环中的尿酸,并改善其肾小球滤过率。
附原文:Abstract OBJECTIVE: Hyperuricemia, an integral component of metabolic syndrome, is a major health problem causing gout and renal damage. Urine alkalizers such as citrate preparations facilitate renal excretion of the uric acid, but its supportive effect on xanthine oxidase inhibitors has not been tested yet. We performed a randomized, prospective study of the effect of a combination of allopurinol and a citrate preparation on renal function in patients with hyperuricemia, employing 70 patients who had hyperuricemia with serum uric acid levels ≥7.0 mg/dL, or those diagnosed as having hyperuricemia in the past. METHODS: They were randomly enrolled into two study groups: the allopurinol monotherapy (MT) group or combination treatment (CT) group with allopurinol and a citrate preparation. Allopurinol (100-200 mg/day) in the absence or presence of a citrate preparation (3 g/day) was administered for 12 weeks and levels of serum uric acid, its urinary clearance (Cua), and the renal glomerular filtration rates assessed with the creatinine clearance (Ccr) were evaluated before and after the treatment. RESULTS: Serum levels of uric acid decreased significantly in both groups, whereas the change observed was much greater in CT group. Cua was significantly increased in CT group but not in MT group. Ccr was not altered in both groups in general, whereas it was significantly increased in a fraction of CT group with decreased renal function. CONCLUSIONS: These results indicate that an additional use of citrate preparations with xanthine oxidase inhibitors is beneficial for patients with hyperuricemia, reducing circulating uric acid and improving their glomerular filtration rates.
引自:Saito J, Matsuzawa Y, Ito H, Omura M, Ito Y, Yoshimura K, Yajima Y, Kino T, Nishikawa T. The alkalizer citrate reduces serum uric Acid levels and improves renal function in hyperuricemic patients treated with the xanthine oxidase inhibitor allopurinol. Endocr Res. 2010;35(4):145-54