降尿酸药物的心血管安全性研究进展
Progress in Research on the Cardiovascular Safety Profile of Uric Acid-Lowering Drugs
摘要: 高尿酸血症(hyperuricemia, HUA)是一种常见的代谢性疾病，不仅可引起痛风性关节炎，还与心血管疾病(cardiovascular diseases, CVD)、慢性肾病和代谢综合征等疾病的发生和发展密切相关。尿酸降到合理水平有益于降低CVD风险，但降尿酸药物黄嘌呤氧化酶抑制剂(xanthine oxidase inhibitors, XOi)的心血管安全性仍存在争议，尿酸转运蛋白1 (urate transporter 1, URAT1)抑制剂Dotinurad因在心血管安全性方面的良好表现，可能为其带来应用优势。本综述阐述了XOi和URAT1抑制剂对心血管系统的影响，重点探讨了其对高尿酸血症及高尿酸血症合并CVD患者的心血管安全性。尽管XOi对心血管系统表现出一定的保护作用，但对于合并CVD的高尿酸血症患者的应用中，表现出的心血管安全性仍存较大争议。URAT1抑制剂Dotinurad在心血管安全性方面展现出良好的应用前景，但其长期应用的安全性仍需进一步研究验证。本综述旨在通过总结降尿酸药物的心血管作用机制及相应的临床研究证据，以期作为对高尿酸血症及高尿酸血症合并CVD患者治疗策略的有益探索。
Abstract: Hyperuricaemia (HUA) is a common metabolic disorder that not only causes gouty arthritis but also is closely associated with the onset and progression of cardiovascular disease (CVD). Existing evidence suggests that lowering uric acid levels to an appropriate level may reduce CVD risk. Febuxostat does not increase the risk of death or serious adverse events, and it is safe for use in patients with low CVD risk, although caution is needed in its use high-risk CVD patients. Recent studies have demonstrated that abrupt discontinuation of febuxostat or rapid reduction in uric acid levels can increase the risk of cardiovascular events, highlighting the importance of a rational and appropriate treatment approach for lowering uric acid levels. Moreover, the initiation of uric acid-lowering therapy in asymptomatic HUA patients or those with HUA and comorbid CVD but without gout remains a subject of ongoing debate. URAT1 inhibitors, such as dotinurad, have shown promise in reducing CVD risk, but more studies are needed to validate their long-term safety and mechanisms of action. The aim of this review was to summarize the cardiovascular mechanisms of action and clinical evidence related to uric acid-lowering drugs, focusing on xanthine oxidase inhibitors (XOis) and URAT1 inhibitors, to gain deeper insights into their cardiovascular safety profile in patients with HUA and HUA combined with CVD, with the goal of contributing to the exploration of therapeutic strategies for these patients.
文章引用：伍子行, 冯桂波. 降尿酸药物的心血管安全性研究进展[J]. 临床医学进展, 2026, 16(4): 3789-3796. https://doi.org/10.12677/acm.2026.1641646

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