[1]张睿,刘帅辉,于珮.痛风合并慢性肾脏疾病的药物治疗[J].国际内分泌代谢杂志,2016,36(02):82-88.[doi:10.3760/cma.j.issn.1673-4157.2016.02.003]
　Zhang Rui,Liu Shuaihui,Yu Pei..Drug therapy of gout combined with chronic kidney disease[J].International Journal of Endocrinology and Metabolism,2016,36(02):82-88.[doi:10.3760/cma.j.issn.1673-4157.2016.02.003]
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痛风合并慢性肾脏疾病的药物治疗()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
36
期数:
2016年02期
页码:
82-88
栏目:
高尿酸血症/痛风相关代谢性疾病专栏
出版日期:
2016-03-20

文章信息/Info

Title:
Drug therapy of gout combined with chronic kidney disease
作者:
张睿; 刘帅辉; 于珮
300070 天津医科大学代谢病医院肾透析科,天津医科大学代谢病医院内分泌研究所,卫生部激素与发育重点实验室, 天津市代谢性疾病重点实验室
Author(s):
Zhang Rui;  Liu Shuaihui;  Yu Pei.
Department of Kidney Dialysis, Key Laboratory of Hormones and Development(Ministry of Health),Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 3
关键词:
痛风;  高尿酸血症;  慢性肾脏疾病;  药物治疗
Keywords:
Gout;  Hyperuricemia;  Chronic kidney disease;  Drug therapy
DOI:
10.3760/cma.j.issn.1673-4157.2016.02.003
摘要:
慢性肾脏疾病(CKD)正困扰越来越多的痛风患者,是痛风最常见的合并症。然而,目前痛风和CKD的随机对照试验比较有限,并且指南并没有明确的痛风合并CKD患者的用药指导。痛风的治疗主要是控制痛风发作以及降尿酸治疗。非甾体类抗炎药物和秋水仙碱是急性痛风发作的一线治疗药物。然而,对于CKD患者,非甾体类抗炎药物因肾损伤并不被推荐。同样,秋水仙碱的毒性在CKD患者中是加剧的,其剂量应根据肾功能情况酌减。类固醇激素的使用也需要权衡利弊,因此免疫治疗可能成为未来治疗手段的重要方面。别嘌呤醇、非布司他、促尿酸排泄药物及聚乙二醇重组尿酸酶用于控制急性发作后的高尿酸血症。然而,因CKD患者需要限制别嘌呤醇剂量,从而影响了其疗效。聚乙二醇重组尿酸酶有待进一步研究,非布司他未曾在肌酐清除率<30 ml/min的患者中研究。
Abstract:
Chronic kidney disease(CKD)is the most common comorbidity of gout that increasingly plagues patients these years. However, data from randomized controlled trials in patients with gout and CKD are limited, and there is no explicit treatment guidance in guidelines for management of patients with gout and CKD. The goals of gout treatment are to control pain and lower the level of serum urate. Though nonsteroidal anti-inflammatory drugs(NSAIDs)and colchicine are used to treat acute gout flares as the fisrt line medications, NSAIDs are not recommended in patients with CKD for the kidney injury. Similarly, the toxicity of colchicine is increased in patients with CKD that means the dosage should be decreased moderately based on the level of kidney function. We should also weigh the advantages and disadvantages for steroid hormone therapy, which suggests changes in immunotherapy might be necessary. Allopurinol, febuxostat, uricosuric agents and pegloticase are all effective agents for the hyperuricemia secondary to acute gout flares. Nevertheless, in patients with CKD, the efficacy of allopurinol is unsatisfied due to its limited dosage, and the pegloticase requires further study, while little research has been done on febuxostat in patients with creatinine clearance rate less than 30 ml/min.

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备注/Memo

备注/Memo:
基金项目:天津市科委科技支撑计划重点项目(13ZCZDSY01300); 天津市卫计委重点攻关项目(15KG101)
更新日期/Last Update: 2016-03-20