摘要
目的 探究非布司他联合吲哚美辛对痛风性关节炎患者血尿酸、疼痛程度及氧化应激水平的影响.方法 选取2022年1月—2023年5月新疆维吾尔自治区人民医院内分泌与代谢病科收治的痛风性关节炎患者86例,按随机数字表法分为对照组(n=43)和观察组(n=43).对照组患者接受非布司他片口服,观察组患者在此基础上联合吲哚美辛片口服,2组均持续治疗1个月.评价2组患者的临床疗效,通过视觉模拟评分法(VAS)评估患者治疗前、治疗2周及1个月时关节疼痛程度;比较2组患者治疗前后肾功能指标[血清肌酐(SCr)、血尿酸(UA)、尿素氮(BUN)]、血清炎性指标[白介素1β(IL-1β)、核苷酸寡聚化结构域样受体蛋白3(NALP3)、肿瘤坏死因子α(TNF-α)]、氧化应激指标[血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)及丙二醛(MDA)]及不良事件发生率.结果 观察组治疗总有效率高于对照组(88.37％vs.69.77％,x2/P=4.497/0.034);治疗2周后,2组患者VAS评分均低于治疗前,且观察组低于对照组(t/P=5.324/＜0.001);治疗1个月后2组患者血清UA及SCr水平较治疗前降低,且观察组低于对照组(t/P=3.081/0.003、2.692/0.009);2组血清IL-1β及NALP3水平较治疗前降低,且观察组低于对照组(t/P=5.587/＜0.001、2.465/0.016);2组血清GSH-Px及SOD水平较治疗前升高,血清MDA降低,且观察组高于/低于对照组患者(t/P=3.709/＜0.001、3.655/＜0.001、3.653/＜0.001);观察组疼痛消失时间短于对照组(t/P=4.025/＜0.001);观察组药物相关不良事件总发生率低于对照组,但差异无统计学意义(11.63％vs.18.60％,x2/P=0.816/0.366).结论 非布司他联合吲哚美辛对痛风性关节炎患者的肾功能改善具有更显著的效果,同时可有效降低患者炎性反应及氧化应激水平,有利于提高患者临床疗效且具有较好的临床安全性.
Abstract
Objective To investigate the effect of febuxostat combined with indomethacin on serum uric acid,pain and oxidative stress in gouty arthritis patients.Methods A total of 86 patients with gouty arthritis were included in our hospital.They were randomly divided into observation group(n=43)and control group(n=43).Patients in the control group received febuxostat tablets orally,and patients in the observation group received indomethacin tablets orally on this basis.All patients continued treatment for 1 month.Visual analogue scale(VAS)was used to assess the degree of joint pain before treatment,2 weeks and 1 month after treatment.Serum creatinine(SCr),uric acid(UA),urea nitrogen(BUN)and other renal function indexes were compared between the two groups before and after treatment.Serum interleukin 1β(IL-1β),NACHT-LR-PYD-containing protein3(NALP3),tumor necrosis factor-α(TNF-α)and other inflammatory markers;Glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)in serum were related to oxidative stress.Clinical efficacy and adverse event incidence were evaluated.Results The total effectiveness rate of the observation group stood at 88.37％,outshining the control group's rate of 69.77％(x2/P=4.497/0.034).Following a 2-week treatment period,both groups witnessed a decrease in average VAS scores compared to pre-treatment levels(t/P=5 324/＜0.001).Moreover,the observation group displayed lower average serum levels of UA and Scr in comparison to the control group(t/P=3.081/0.003,2.692/0.009).In addition,the observation group exhibited reduced average serum levels of IL-1β and NALP3 post-treatment,surpassing both pre-treatment levels and those of the control group(t/P=5.587/＜0.001,2.465/0.016).Conversely,the average serum levels of GSH-Px and SOD saw an increase compared to pre-treatment levels and exceeded those of the control group.Meanwhile,the average serum MDA levels decreased,falling below the control group's levels(t/P=3.709/＜0.001,3.655/＜0.001,3.653/＜0.001).Additionally,the observation group experienced a shorter average pain disappearance time than the control group(t/P=4.025/＜0.001).Furthermore,the total occurrence of drug-related adverse events was lower in the observation group,albeit the variance was not deemed statistically significant in comparison to the control group(11.63％vs 18.60％,x2/P=0.816/0366).Conclusion Febuxostat combined with indomethacin has more significant effect on renal function improvement in patients with gouty arthritis.Meanwhile,the combination therapy can effectively reduce the inflammatory level and oxidative stress level of patients,which is conducive to improving the clinical efficacy of patients and has good clinical safety.It has certain clinical application value for patients with gouty arthritis.
基金项目
新疆维吾尔自治区自然科学基金资助项目(2020D01C130)
维普
万方数据