目的 比较不同剂量非布司他与别嘌呤醇对痛风患者疗效及对NACHT-LRR-PYD结构域蛋白3(NALP3)、白细胞介素-1β(IL-1β)水平的影响.方法 将90例痛风患者按照随机数字表法分为非布司他1组、非布司他2组、别嘌醇组,每组30例,分别给予非布司他40 mg/d、非布司他80 mg/d、别嘌醇300 mg/d口服治疗.于治疗前及治疗后4周、12周、24周比较3组的尿酸、IL-1β、NALP3水平;于治疗后4周及24周比较3组的尿酸达标率.结果 治疗后各时间点,3组尿酸水平均低于治疗前,非布司他2组及别嘌醇组的尿酸水平均低于非布司他1组(P<0.05).治疗后4周、24周,非布司他2组的尿酸水平均低于别嘌醇组,非布司他2组与别嘌醇组尿酸达标率均高于非布司他1组(均P<0.05).治疗后各时间点,3组的IL-1β水平均较前下降(P<0.05),但3组IL-1β比较,差异无统计学意义(P>0.05).治疗后各时间点,3组的NALP3水平均较前下降(P<0.05);治疗后12周、24周,别嘌醇组、非布司他1组、非布司他2组的NALP3水平依次降低(P<0.05).结论 不同剂量非布司他与别嘌醇均能降低痛风患者的血尿酸水平并改善炎症状态,但高剂量的非布司他效果更佳.%Objective To compare the efficacy as well as the influence on the levels of uric acid,NACHT,LRR and PYD domains-containing protein 3(NALP3) and interleukin-1β(IL-1β) between different doses of febuxostat and allopurinol in the patients with gout.Methods Ninety patients with gout were divided into febuxostat group 1,febuxostat group 2 and allopurinol group using the random number table method,with 30 cases in each group.The febuxostat group 1,febuxostat group 2 and allopurinol group were orally administered febuxostat at a dose of 40 mg/d,febuxostat 80 mg/d and allopurinol 300 mg/d,respectively.Before treatment and at 4,12 and 24 weeks after treatment,the levels of uric acid,IL-1β and NALP3 were compared among the three groups.After 4 and 24 weeks of treatment, the qualified rate of uric acid were compared among the three groups.Results At each time point after treatment,the level of uric acid was lower than the level before treatment among the three groups,and the level of uric acid in the febuxostat group 2 and allopurinol group was lower than that in the febuxostat group 1(all P<0.05).After 4 and 24 weeks of treatment,the levels of uric acid in the febuxostat group 2 were lower than those in the allopurinol group,and the qualified rates of uric acid in the febuxostat group 2 and allopurinol group was higher than those in the febuxostat group 1(P<0.05).At each time point after treatment,the IL-1β level in each group was lower than the level before treatment(P<0.05),but there were no significant differences in IL-1β among the three groups(P>0.05).At each time point after treatment,the NALP3 level in each group was lower than the level before treatment(P<0.05);after 12 and 24 weeks of treatment,the NALP3 levels decreased in the order of the allopurinol group,the febuxostat group 1 and the febuxostat group 2(P<0.05). Conclusion Either different doses of allopurinol or febuxostat can reduce the level of serum uric acid and improve the inflammation state in gout patients,and the high-dose febuxostat achieves the better efficacy.
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