{"title":"非布司他对无症状高尿酸血症心衰患者的影响:一项回顾性队列研究。","authors":"Xinguang Long, Zhaojun Wang, Wei Yuan","doi":"10.1136/bmjopen-2025-099442","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effects of uric-acid-lowering therapy with febuxostat in asymptomatic hyperuricaemic patients with heart failure.</p><p><strong>Methods: </strong>In this retrospective cohort analysis, we included consecutive hospitalised patients with heart failure and concomitant asymptomatic hyperuricaemia in Yangzhong People's Hospital from 1 April 2018 through 1 April 2022. Febuxostat was used to lower serum uric acid. The primary endpoint was defined as a composite of cardiovascular death, recurrent hospitalisation and emergency room visit for cardiovascular (CV) reasons. Additional endpoints included changes in echocardiography measures, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) distance from baseline to the most recent clinic visit. Cox analysis was used to determine HR between febuxostat and the control group after adjustment for age, sex, body mass index, serum creatinine, atrial fibrillation and coronary heart disease and the Kaplan-Meier curve was used to describe survival.</p><p><strong>Results: </strong>979 patients were included in the final analysis (505 in the febuxostat group vs 474 in the control group). In a follow-up duration of 16±9 months, uric acid was significantly lower in the febuxostat group compared with the control group (p<i><</i>0.001). There was no difference in the incidence of primary outcome between groups (HR 0.907 (95% CI 0.726 to 0.985), p<i>=</i>0.52). Changes in left ventricular ejection fraction, KCCQ scores and 6MWT distance from baseline to the latest record did not differ between groups. Subgroup analysis demonstrated no effect modification between treatment and age, sex, body mass index, atrial fibrillation and coronary heart disease. In multivariable Cox regression analysis based on cut-off value 5.35 of serum uric acid/serum creatinine ratio (SUA/sCr), SUA/sCr≥5.35 was an independent risk factor for primary outcome (HR 2.89 (95% CI 1.76 to 4.74), p<0.001).</p><p><strong>Conclusion: </strong>Uric acid lowering therapy with febuxostat fails to produce clinical benefits in heart failure patients with asymptomatic hyperuricaemia.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e099442"},"PeriodicalIF":2.4000,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of febuxostat on heart failure patients with asymptomatic hyperuricaemia: a retrospective cohort study.\",\"authors\":\"Xinguang Long, Zhaojun Wang, Wei Yuan\",\"doi\":\"10.1136/bmjopen-2025-099442\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate the effects of uric-acid-lowering therapy with febuxostat in asymptomatic hyperuricaemic patients with heart failure.</p><p><strong>Methods: </strong>In this retrospective cohort analysis, we included consecutive hospitalised patients with heart failure and concomitant asymptomatic hyperuricaemia in Yangzhong People's Hospital from 1 April 2018 through 1 April 2022. Febuxostat was used to lower serum uric acid. The primary endpoint was defined as a composite of cardiovascular death, recurrent hospitalisation and emergency room visit for cardiovascular (CV) reasons. Additional endpoints included changes in echocardiography measures, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) distance from baseline to the most recent clinic visit. Cox analysis was used to determine HR between febuxostat and the control group after adjustment for age, sex, body mass index, serum creatinine, atrial fibrillation and coronary heart disease and the Kaplan-Meier curve was used to describe survival.</p><p><strong>Results: </strong>979 patients were included in the final analysis (505 in the febuxostat group vs 474 in the control group). In a follow-up duration of 16±9 months, uric acid was significantly lower in the febuxostat group compared with the control group (p<i><</i>0.001). There was no difference in the incidence of primary outcome between groups (HR 0.907 (95% CI 0.726 to 0.985), p<i>=</i>0.52). Changes in left ventricular ejection fraction, KCCQ scores and 6MWT distance from baseline to the latest record did not differ between groups. Subgroup analysis demonstrated no effect modification between treatment and age, sex, body mass index, atrial fibrillation and coronary heart disease. In multivariable Cox regression analysis based on cut-off value 5.35 of serum uric acid/serum creatinine ratio (SUA/sCr), SUA/sCr≥5.35 was an independent risk factor for primary outcome (HR 2.89 (95% CI 1.76 to 4.74), p<0.001).</p><p><strong>Conclusion: </strong>Uric acid lowering therapy with febuxostat fails to produce clinical benefits in heart failure patients with asymptomatic hyperuricaemia.</p>\",\"PeriodicalId\":9158,\"journal\":{\"name\":\"BMJ Open\",\"volume\":\"15 7\",\"pages\":\"e099442\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-07-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjopen-2025-099442\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjopen-2025-099442","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的:探讨非布司他降尿酸治疗无症状高尿酸血症合并心衰患者的疗效。方法:在这项回顾性队列分析中,我们纳入了2018年4月1日至2022年4月1日在扬中市人民医院连续住院的心力衰竭合并无症状高尿酸血症患者。非布司他用于降低血清尿酸。主要终点被定义为心血管死亡、复发住院和心血管(CV)原因的急诊室就诊的复合。其他终点包括超声心动图测量、堪萨斯城心肌病问卷(KCCQ)评分和从基线到最近一次诊所就诊的6分钟步行测试(6MWT)距离的变化。在校正年龄、性别、体重指数、血清肌酐、心房颤动和冠心病等因素后,采用Cox分析确定非布司他与对照组的HR,采用Kaplan-Meier曲线描述生存率。结果:979例患者纳入最终分析(非布司他组505例,对照组474例)。在16±9个月的随访中,非布司他组尿酸明显低于对照组(p0.001)。各组间主要结局发生率无差异(HR 0.907 (95% CI 0.726 ~ 0.985), p=0.52)。左心室射血分数、KCCQ评分和从基线到最新记录的6MWT距离的变化在两组之间没有差异。亚组分析显示,治疗与年龄、性别、体重指数、房颤和冠心病之间没有影响。在基于血清尿酸/血清肌酐比值(SUA/sCr)截断值5.35的多变量Cox回归分析中,SUA/sCr≥5.35是主要结局的独立危险因素(HR 2.89 (95% CI 1.76 ~ 4.74))。结论:非布司他降尿酸治疗对无症状高尿酸血症心衰患者不能产生临床获益。
Effects of febuxostat on heart failure patients with asymptomatic hyperuricaemia: a retrospective cohort study.
Objectives: To investigate the effects of uric-acid-lowering therapy with febuxostat in asymptomatic hyperuricaemic patients with heart failure.
Methods: In this retrospective cohort analysis, we included consecutive hospitalised patients with heart failure and concomitant asymptomatic hyperuricaemia in Yangzhong People's Hospital from 1 April 2018 through 1 April 2022. Febuxostat was used to lower serum uric acid. The primary endpoint was defined as a composite of cardiovascular death, recurrent hospitalisation and emergency room visit for cardiovascular (CV) reasons. Additional endpoints included changes in echocardiography measures, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and 6-minute walk test (6MWT) distance from baseline to the most recent clinic visit. Cox analysis was used to determine HR between febuxostat and the control group after adjustment for age, sex, body mass index, serum creatinine, atrial fibrillation and coronary heart disease and the Kaplan-Meier curve was used to describe survival.
Results: 979 patients were included in the final analysis (505 in the febuxostat group vs 474 in the control group). In a follow-up duration of 16±9 months, uric acid was significantly lower in the febuxostat group compared with the control group (p<0.001). There was no difference in the incidence of primary outcome between groups (HR 0.907 (95% CI 0.726 to 0.985), p=0.52). Changes in left ventricular ejection fraction, KCCQ scores and 6MWT distance from baseline to the latest record did not differ between groups. Subgroup analysis demonstrated no effect modification between treatment and age, sex, body mass index, atrial fibrillation and coronary heart disease. In multivariable Cox regression analysis based on cut-off value 5.35 of serum uric acid/serum creatinine ratio (SUA/sCr), SUA/sCr≥5.35 was an independent risk factor for primary outcome (HR 2.89 (95% CI 1.76 to 4.74), p<0.001).
Conclusion: Uric acid lowering therapy with febuxostat fails to produce clinical benefits in heart failure patients with asymptomatic hyperuricaemia.
期刊介绍:
BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.