Ito Hiroyuki, Antoku Shinichi, Abe Mariko, Omoto Takashi, Shinozaki Masahiro, Nishio Shinya, Mifune Mizuo, Togane Michiko, Nakata Masaya, Yamashita Tatsuya
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan.
Intern Med. 2016;55(22):3247-3256. doi: 10.2169/internalmedicine.55.6791. Epub 2016 Nov 15.
Objective The effects of febuxostat therapy on hyperuricemia in patients with and without type 2 diabetes were compared in this retrospective observational study after pair-matching using the propensity scores. Methods In total, 160 patients with hyperuricemia were studied as the treated set, and the 155 subjects in whom the administration of febuxostat was not discontinued during the observation period were investigated in the full analysis. The study subjects were divided into two groups based on the style of initiation of febuxostat: initial and switching therapy from allopurinol administration. Results The reduction in the serum uric acid (sUA) levels at six months after the initiation of febuxostat administration did not significantly differ between the patients with and without diabetes in both the initial (206±114 and 226±113 μmol/L in patients with and without diabetes, respectively) and switching (154±91 and 129±90 μmol/L in patients with and without diabetes, respectively) therapy groups. The eGFR values were significantly increased compared to the baseline levels only in the patients without diabetes. The changes in the eGFR values were significantly associated with the presence of diabetes and sUA at baseline in a multivariate analysis. The frequency of adverse events was not significantly different between the patients with and without diabetes. Conclusion Although febuxostat exerted a similar sUA-lowering effect against hyperuricemia in patients with type 2 diabetes compared to those without, the renoprotective effect was attenuated in those with diabetes compared to nondiabetic subjects.
目的 在这项回顾性观察研究中，使用倾向得分进行配对后，比较了非布司他治疗对2型糖尿病患者和非2型糖尿病患者高尿酸血症的影响。方法 共研究160例高尿酸血症患者作为治疗组，对155例在观察期内未停用非布司他的受试者进行全面分析。根据非布司他的起始方式将研究对象分为两组：初始治疗组和从别嘌醇转换治疗组。结果 在初始治疗组（糖尿病患者和非糖尿病患者分别为206±114和226±113 μmol/L）和转换治疗组（糖尿病患者和非糖尿病患者分别为154±91和129±90 μmol/L）中，非布司他给药6个月后血清尿酸（sUA）水平的降低在糖尿病患者和非糖尿病患者之间均无显著差异。仅在非糖尿病患者中，估算肾小球滤过率（eGFR）值较基线水平显著升高。多因素分析显示，eGFR值的变化与糖尿病的存在及基线sUA显著相关。糖尿病患者和非糖尿病患者不良事件的发生率无显著差异。结论 尽管与非2型糖尿病患者相比，非布司他对2型糖尿病患者高尿酸血症的降sUA作用相似，但与非糖尿病患者相比，糖尿病患者的肾脏保护作用减弱。
