Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, NC 27705, United States.
Curr Vasc Pharmacol. 2018;16(6):583-588. doi: 10.2174/1570161115666170919183657.
Xanthine oxidase inhibitors are commonly used to lower uric acid levels in patients with gout. Due to their effects on endothelial function, they have also been investigated for possible benefits for patients with cardiovascular disease.
To assess the efficacy and safety of xanthine oxidase inhibitors in the treatment of patients with history of stroke.
MEDLINE (1946-June 2017) and EMBASE (1947-June 2017) were queried using the search terms: "allopurinol" OR "febuxostat" OR "xanthine oxidase inhibitor" OR "xanthine oxidase/ antagonists and inhibitors" AND "stroke" OR "cerebral infarction" OR "cerebrovascular accident". Studies appropriate to the objective were evaluated, including five randomized, placebo-controlled, double-blind trials investigating the effect of allopurinol in patients with history of stroke. No articles evaluating the use of febuxostat in this setting were identified.
In patients with history of stroke, treatment with allopurinol resulted in improvements in several markers of endothelial function, inflammatory markers, and scores on the Modified Rankin Scale. Study durations ranged from 6 weeks to 1 year, and studies used varying doses of allopurinol. Allopurinol was well tolerated in most studies, with some reports of gastrointestinal adverse effects, headache and rash.
Based on the reviewed literature, allopurinol appears to be a promising therapy to improve vascular function and reduce disability in patients who have had a stroke. The benefits seen are in combination with current standard of care treatments with aspirin and lipid-lowering therapy. Larger trials are necessary to better understand the role of allopurinol in patients with history of stroke.
黄嘌呤氧化酶抑制剂常用于降低痛风患者的尿酸水平。由于它们对内皮功能的影响，它们也被研究用于可能对心血管疾病患者有益。
评估黄嘌呤氧化酶抑制剂治疗有中风病史患者的疗效和安全性。
使用搜索词“别嘌醇”或“非布司他”或“黄嘌呤氧化酶抑制剂”或“黄嘌呤氧化酶/拮抗剂和抑制剂”和“中风”或“脑梗死”或“脑血管意外”，在 MEDLINE（1946 年 6 月至 2017 年）和 EMBASE（1947 年 6 月至 2017 年）中进行检索。评估了符合目标的研究，包括五项随机、安慰剂对照、双盲试验，研究了别嘌醇对有中风病史患者的影响。未发现评估非布司他在这种情况下使用的文章。
在有中风病史的患者中，别嘌醇治疗可改善内皮功能、炎症标志物和改良 Rankin 量表评分的几个标志物。研究持续时间从 6 周到 1 年不等，并且研究使用了不同剂量的别嘌醇。大多数研究中别嘌醇的耐受性良好，一些研究报告有胃肠道不良反应、头痛和皮疹。
基于已审查的文献，别嘌醇似乎是一种很有前途的治疗方法，可改善血管功能并降低中风患者的残疾程度。所观察到的益处是与阿司匹林和降脂治疗等当前标准治疗相结合的。需要更大规模的试验来更好地了解别嘌醇在有中风病史的患者中的作用。
