别嘌醇在慢性肾脏病进展和心血管风险中的作用

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Clin JAm Soc Nephrol.2010Aug；5：1388-93.Epub 2010Jun 10.

Effect of allopurinol in chronic kidney disease progression and cardiovascular risk.

Goicoechea M,de Vinuesa SG,Verdalles U,Ruiz-Caro C,Ampuero J,Rincón A,Arroyo D,Lu&ntilde；o J.

Servicio de Nefrología,Hospital General Universitario Gregorio Mara&ntilde；ón,Madrid,Spain.albvia@terra.es Abstract BACKGROUND AND OBJECTIVES：Hyperuricemia is associated with hypertension,inflammation,renal disease progression,and cardiovascular disease.However,no data are available regarding the effect of allopurinol in patients with chronic kidney disease.

DESIGN,SETTING,PARTICIPANTS,&MEASUREMENTS：We conducted aprospective,randomized trial of 113patients with estimated GFR(eGFR)60ml/min.Patients were randomly assigned to treatment with allopurinol 100mg/d(n=57)or to continue the usual therapy(n=56).Clinical,biochemical,and inflammatory parameters were measured at baseline and at 6,12,and 24months of treatment.The objectives of study were：(1)renal disease progression；(2)cardiovascular events；and(3)hospitalizations of any causes.

RESULTS：Serum uric acid and C-reactive protein levels were significantly decreased in subjects treated with allopurinol.In the control group,eGFR decreased 3.3+/-1.2ml/min per 1.73m(2),and in the allopurinol group,eGFR increased 1.3+/-1.3ml/min per 1.73m(2)after 24months.Allopurinol treatment slowed down renal disease progression independently of age,gender,diabetes,C-reactive protein,albuminuria,and renin-angiotensin system blockers use.After amean follow-up time of 23.4+/-7.8months,22patients suffered acardiovascular event.Diabetes mellitus,previous coronary heart disease,and C-reactive protein levels increased cardiovascular risk.Allopurinol treatment reduces risk of cardiovascular events in 71%compared with standard therapy.

CONCLUSIONS：Allopurinol decreases C-reactive protein and slows down the progression of renal disease in patients with chronic kidney disease.In addition,allopurinol reduces cardiovascular and hospitalization ris kin these subjects.

别嘌醇在慢性肾脏病进展和心血管风险中的作用

摘要

背景和目的：高尿酸血症与高血压、炎症反应、肾脏疾病的进展和心血管疾病有关。然而，关于别嘌醇在CKD病人中的作用没有相关的数据。

设计、方法、参与者和措施：我们做了一项前瞻性、随机对照试验，有113位肾小球滤过率小于60ml/min的患者被纳入。患者被随机分为别嘌醇100mg/d治疗(57人)，和常规治疗(56人)。临床、生化和炎症有关的指标在治疗的基线、6月，12月，24月检测。本研究的目的就是：(1)肾脏疾病的进展；(2)心血管事件(3)病例的住院率。

结果：在使用别嘌醇的患者，血尿酸和C-反应安白的水平明显的下降。在24月后，对照组，eGFR下降3.3+/-1.2ml/min。别嘌醇组，eGFR增加了1.3+/-1.3ml/min。别嘌醇治疗延缓了肾脏疾病的进展，该作用是***于年龄、性别、CRP、尿蛋白、RAS阻断剂使用的。在平均随访23.4+/-7.8月，22名患者发生了心血管事件。糖尿病、既往冠心病史和CRP水平增加了心血管的风险。别嘌醇的治疗与常规治疗比较，心血管事件的风险降低了71%。

结论：别嘌醇降低了CKD患者的CRP，延缓了肾脏疾病的进展。另外，别嘌醇降低了心血管事件和住院风险。

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