痛风患者血尿酸与血脂水平的关系及非布司他的降血脂作用

doi:10.13481/j.1671-587x.20150528

摘要/Abstract

摘要：

目的:探讨痛风患者血尿酸(UA)与血脂水平的关系及非布司他的降血脂作用。方法: 选择60例男性痛风患者作为痛风组,25例健康体检的男性作为正常对照组,比较2组研究对象的UA及血脂水平。对痛风组中有高脂血症的42例患者进行降UA治疗,采用双盲试验,根据患者使用药物情况分为低剂量非布司他组(非布司他40 mg·d^-1,n=13)、高剂量非布司他组(非布司他80 mg·d^-1,n=16)和别嘌醇治疗组(别嘌醇 300 mg·d^-1,n=13),观察各组研究对象治疗前后血UA及血脂水平。结果:与正常对照组比较,痛风组患者UA、血清甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)水平均升高(P<0.05),且痛风组患者UA与TG水平呈正相关关系(r=0.275,P<0.05);低剂量非布司他组患者治疗后高密度脂蛋白(HDL)水平较治疗前升高(P<0.05),且治疗后HDL水平与正常对照组比较差异无统计学意义(P>0.05);与治疗前比较,高剂量非布司他组患者治疗后TC、LDL和TG水平下降,HDL水平升高(P<0.05),且治疗后TC、HDL、LDL和TG水平与正常对照组比较差异无统计学意义(P>0.05);别嘌醇组患者治疗前后TC、HDL、LDL和TG水平比较差异均无统计学意义(P>0.05)。高、低剂量非布司他组和别嘌醇组患者治疗后UA水平均下降,与治疗前比较差异均有统计学意义(P<0.05);高剂量非布司他组患者治疗后UA水平与正常对照组比较差异无统计学意义(P>0.05)。结论:痛风患者常并发高脂血症,非布司他在降低UA水平的同时可以降低血脂水平,非布司他(80 mg·d^-1)能降低痛风患者LDL、TC和TG水平,升高HDL水平。

关键词: 痛风, 高脂血症, 非布司他, 别嘌醇

Abstract:

Objective To explore the relationship between serum uric acid (UA)and serum lipid levels in the patients with gout and the effect of febuxostat on reducing the serum lipid levels. Methods 60 male patients with gout were chosen as gout group,and 25 healthy controls were chosen as control group.The serum uric acid and lipid levels of the objects were compared between gout and control groups.42 patients with hyperlipidemia in gout group were chosen and divided into three subgroups,such as low dose of febuxostat group (febuxostat 40 mg·d^-1,n=13), high dose of febuxostat group(febuxostat 80 mg·d^-1,n=16),and allopurinol group(allopurinol 300 mg·d^-1,n=13).The double blind method was used.The serum UA and lipid levels of the objects in three subgroups and control group before and after treatment were compared. Results The levels of serum UA,triglycerides (TG),total cholesterol (TC),low density lipoprotein (LDL) of the patients in gout group were higher than those in control group(P<0.05).The level of UA was positively correlated with TG in gout group (r=0.275,P<0.05).Compared with before treatment,the level of high density lipoprotein (HDL) after treatment in low dose of febuxostat group was increased (P< 0.05);compared with control group,the levels of HDL of the patients in low dose of febuxostat group after treatment had no significant difference (P> 0.05).Compared with before treatment,the levels of TC,HDL,LDL,and TG of patients after treatment in high dose of febuxostat group were increased(P< 0.05);Compared with control group,the levels of TC,HDL,LDL and TG of the patients in high dose of febuxostat group after treatment had no significant difference (P> 0.05).There were no significant differences of TC,HDL,LDL,and TG of the patients in allopurinol group between before and after treatment(P> 0.05).Compared with before treatment,the UA levels were decreased after treatment in low dose of febuxostat group,high dose of febuxostat group and allopurinol group (P< 0.05);compared with control group,the UA level of the patients in high dose of febuxostat group had no statistically significant difference (P>0.05). Conclusion The patients with gout are often combined with hyperlipidemia.Febuxostat may lower the levels of serum UA and lipids, and febuxostat (80 mg·d^-1) may reduce the levels of LDL,TC,TG,and increase the level of HDL.

Key words: gout, hyperlipidemia, febuxostat, allopurinol

中图分类号:

张进, 刘涛, 姜振宇, 鄢海波, 张彦东. 痛风患者血尿酸与血脂水平的关系及非布司他的降血脂作用[J]. 吉林大学学报(医学版), 2015, 41(05): 1018-1022.

ZHANG Jin, LIU Tao, JIANG Zhenyu, YAN Haibo, ZHANG Yandong. Relationship between serum uric acid and lipid levels in patients with gout and effect of febuxostat on reducing serum lipid levels[J]. Journal of Jilin University Medicine Edition, 2015, 41(05): 1018-1022.

参考文献

[1] Lawrence RC,Felson DT,Helmick CG,et al.Estimates of the prevalence of arthritis and other rheumatic conditions in the United States:part Ⅱ[J].Arthritis Rheum,2008,58(1):26-35.

[2] Robinson PC,Taylor WJ,Merriman TR.Systematic review of the prevalence of gout and hyperuricaemia in Australia[J].Intern Med J,2012,42(9):997-1007.

[3] Grassi D,Ferri L,Desideri G,et al.Chronic hyperuricemia,uric acid deposit and cardiovascular risk[J].Curr Pharm Design,2013,19(13):2432.

[4] 许海燕,顼志敏,陆宗良.中国成人血脂异常防治指南 (2007) 概要与解读 [J].中华老年心脑血管病杂志,2008,10(3):238-240.

[5] Lu W,Song K,Wang Y,et al.Relationship between serum uric acid and metabolic syndrome:an analysis by structural equation modeling[J].J Clin Lipidol,2012,6(2):159-167.

[6] MarottaT,LiccardoM,SchettiniF,et al.Association of hyperuricemia with conventional cardiovascular risk factors in elderly patients[J].J Clin Hypertens (Greenwich),2015(1):27-32.

[7] Xu J,Peng H,Ma Q,et al.Associations of non-high density lipoprotein cholesterol and traditional blood lipid profiles with hyperuricemia among middle-aged and elderly Chinese people:a community-based cross-sectional study[J].Lipids Health Dis,2014,13(1):117.

[8] Tinahones JF,Perez-Lindon G,C-Soriguer FJ,et al.Dietary alterations in plasma very low density lipoprotein levels modify renal excretion of urates in hyperuricemic-hypertriglyceridemic patients 1[J].J Clin Endocrinol Metab,1997,82(4):1188-1191.

[9] Choi HK,Ford ES,Li C,et al.Prevalence of the metabolic syndrome in patients with gout:the third national health and nutrition examination survey[J].Arthrit Care Res,2007,57(1):109-115.

[10] Becker MA,Schumacher HR,Espinoza LR,et al.The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout:the confirms trial[J].Arthrit Care Res,2010,12:R63.

[11] Real JT,Martínez-Hervás S,García-García AB,et al.Circulating mononuclear cells nuclear factor-kappa B activity,plasma xanthine oxidase,and low grade inflammatory markers in adult patients with familial hypercholesterolaemia[J].Eur J Pharmacol,2010,40(2):89-94.

[12] Povoa Jr H,Sa LD,Lessa VM.Xanthine oxidase and triglycerides in serum of patients with hyperlipoproteinemia,type Ⅳ[J].Biomed Biochim Acta,1983,43(10):1201-1203.

[13] Sezai A,Soma M,Nakata K,et al.Comparison of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients (NU-FLASH Trial)[J].Circ J,2013,77(8):2043-2049.

[14] Sánchez-Lozada LG,Tapia E,Bautista-García P,et al.Effects of febuxostat on metabolic and renal alterations in rats with fructose-induced metabolic syndrome[J].Am J PhysiolRenal,2008,294(4):F710-F718.

[15] Reungjui S,Roncal CA,Mu W,et al.Thiazide diuretics exacerbate fructose-induced metabolic syndrome[J].J Am Soc Nephrol,2007,18(10):2724-2731.

[16] Ziga N,Becic F.Allopurinol effect on values of lipid profile fractions in hyperuricemic patients diagnosed with metabolic syndrome[J].Mater Sociomed,2013,25(3):167.

[17] Okamoto K,Eger BT,Nishino T,et al.An extremely potent inhibitor of xanthine oxidoreductase crystal structure of the enzyme-inhibitor complex and mechanism of inhibition[J].J Biol Chem,2003,278(3):1848-1855.

[18] 时佳,沈震,苗慧,等.血脂水平与慢性丙型肝炎患者抗病毒疗效的相关性分析[J].临床肝胆病杂志,2014,30(6):496-500.