| Objective 1.Analyze the clinical characteristics of gout patients;2.Evaluation the efficacy and safety of febuxostat in the treatment of gout nephropathy,and its effect on renal function.Methods 1.Retrospective analysis of 274 gout patients who were treated in the Endocrinology Department of Wuhan fourth hospital from January 2015 to December 2018.The clinical characteristics,complications and laboratory examination results were analyzed statistically and comprehensively.2.135 gout patients with chronic kidney diesase from the inpatients and outpatients of Wuhan fourth hospital from January 2014 to Aprial 2019,treated with febuxostat 20mg/d at least 3 months,were involved in the study.They were invided into 3 groups:66 cases in CKD（chronic kidney disease）of stage 2[eGFR（estimated glomerular filtration rate）>60 and≤90ml·min-1·1.73m-2],57 cases in CKD of stage 3(eGFR>30 and≤60ml·min-1·1.73m-2)and 12 cases in CKD of stage 4(eGFR>15 and≤30ml·min-1·1.73m-2).Collect at baseline and laboratory indexes included serum uric acid,serum creatinine,estimated glomerular filtration and other indexes after 3months febuxostat treatment.SPSS17.0 statistical software was used to compare the indexes changes betwen the treatment of febuxostat before and after.Meanwhile,the changes of liver function and myocardial enzyme were observed.Results Analysis of clinical characteristics:1)There were 268 males（97.81%）and 6（2.19%）females in 274 cases.31.02%age of patients was 41-50 years old.The average course of disease was 8.42±3.66 years.21.90%of the patients had gouty stone and 15.69%had chronic kidney disease.The overweight rate was 52.46%,and the obesity rate was 36.43%.55.47%,44.16%,9.85%and 6.20%of them were complicated with hyperlipidemia,hypertension,cardiovascular disease and diabetes.2)They were invided in to 2 groups:156 cases in the young group（aged<45）and 118cases in the middle-aged and old group（aged≧45）.The combined rate of hypertension,cardiovascular disease and diabetes in the middle-aged and old group was higher than that in the young group（p<0.05）.The incidence of gout stone in the middle-aged and old group was higher than that in the young group（p<0.05）.3)Gout with CKD group had 51.16%hypertension,25.58%cardiovascular disease and13.95%diabetes mellitus,witch were higher than gout without CKD group（p<0.05）.2.Evaluation the treatment effecy of febusxotat:After at least of 3 months of the20mg every day febusxotat treatment,1)the levels of serum uric acid,in the stage of CKD2（568.94±94.60μmol/L vs 355.56±90.26μmol/L,p<0.001）,CKD3（540.78±91.30μmol/L vs 354.82±95.23μmol/L,p<0.001）and CKD4（613.83±98.89μmol/L vs 351.42±81.37μmol/L,p<0.001）were significant decline,and the difference is statistically significant;2)the levels of estimated glomerular filtration rate,in the stage of CKD2(74.18±7.27ml·min-1·1.73m-22 vs84.42±13.11ml·min-1·1.73m-2,p<0.001),CKD3(50.02±8.05ml·min-1·1.73m-2vs60.45±11.30ml·min-1·1.73m-2,p<0.001)and CKD4(24.14±4.69ml·min-1·1.73m-2vs41.96±3.61ml·min-1·1.73m-2,p<0.001)were significant rise,and the difference is statistically significant;3)the levels of serum creatinine,in the stage of CKD2（98.58±9.29μmol/L vs 89.02±12.20μmol/L,p<0.001）,CKD3（131.08±22.59μmol/L vs 111.46±20.45μmol/L,p<0.001）and CKD4（240.75±58.16μmol/L vs192.59±72.56μmol/L,p<0.01）were significant decline,and the difference is statistically significant.4)There was no change of liver function and myocardial enzyme during the treatment of febuxostat.Conclusions 1.Gout usually occurs between 41 and 50 years old.More commen in men.The clinical characteristics are long course of disease,high incidence of gouty stone and complications.There are more complications in middle-aged and old gout patients,and comprehensive management of treatment should be emphasized.2.febusxotat can reduce the serum uric acid level of hyperuricemia safely and effectively,and improve the renal function of gout patients with chronic kidney disease in stage 2-4 to a certain extent.3.There were no adverse reactions such as abnormal liver function and acute cardiovascular events in the course of febuxostat treatment. |
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