OBJECTIVE: To observe clinical efficacy and safety of febuxostat in the treatment of type 2 diabetic nephropathy complicated with hyperuricemia. METHODS: A total of 137 patients with type 2 diabetic nephropathy complicated with hyperuricemia selected from our hospital during Jan. 2014-Jun. 2016 were divided into group A (46 cases), B (47 cases), C (44 cases) according to random number table. On the basis of routine treatment, group A was given Allopurinol tablets orally with initial dose of 0. 05 g, bid; increasing to 0. 10 g, bid, 2 weeks later. Group B was given Benzbromarone tablets 50 mg orally, qd. Group C was given Febuxostat tablets orally with initial dose of 40 mg, qd; increasing to 80 mg, qd, 2 weeks later. All patients received treatment for consecutive 12 weeks. Clinical efficacies of 2 groups were observed, and the levels of serum uric acid (SUA), Scr and BUN were also observed before and after treatment. The occurrence of ADR was recorded. RESULTS: Four, six, three patients withdrew from the study in group A, B, C, respectively. The total response rates of group B, C (87. 8％, 85. 4％) were significantly higher than that of group A (76. 2％), with statistical significance (P＜0. 05); there was no statistical significance between group B and C (P＞0. 05). Before treatment, there was no statistical significance in the levels of SUA, Scr or BUN among 3 groups (P＞0. 05). Four weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment, with statistical significance (P＜0. 05); there was no statistical significance in other indexes among 3 groups or between before and after treatment (P＞0. 05). Twelve weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment and 4 weeks after treatment, and group B and C were significantly lower than group A; the levels of Scr in group A and C were decreased significantly compared to before treatment, while that of group B was increased significantly compared to before treatment and group B was significantly higher than group A and C, with statistical significance (P＜0. 05). There was no statistical significance in the levels of Scr or BUN among 3 groups compared to 4 weeks after treatment; there was also no statistical significance in the levels of SUA between group B and C, the levels of Scr between group A and C (P＞0. 05). Total incidence of ADR in group C (12. 20％) was significantly lower than group A and B (25. 58％, 24. 39％), with statistical significance (P＜0. 05); there was no statistical significance between group A and B (P＞0. 05). CONCLUSIONS: Febuxostat is better than allopurinol in reducing the level of SUA in type 2 diabetic nephropathy patients with hyperuricemia. It shows small effect on renal function with better safety.

Objective To retrospectively analyze the prognostic factors for diabetic ketoacidsis (DKA) in order to improve the diagnosis and treatment and decreased the mortality for DKA.Methods Clinical data of all DKA patients admitted in our department of endocrinology from January 2014 to December 2016 were collected and retrospectively analyzed.The patients were divided into the survival group and dead group.The baseline data,blood routine results,liver and renal functions,electrolyte levels,C-reactive protein (CRP) level,Scores of Glasgow coma scale (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),and prognosis of the DKA patients were analyzed.Results There were totally 70 subjects enrolled,including 36 males and 34 females,at an average age of 42.63 ± 15.67 years.When compared with the dead group,the survival group had significantly higher GCS score (14.41 ± 1.42 vs 11.36 ± 3.14) and serum phosphate (0.96 ± 0.47 vs 0.68 ± 0.60 mg/L),but obviously lower APACHE Ⅱ score (8.58 ±4.63 vs 15.73 ±4.38),white blood cells count [(22.80 ±7.67) × 109/L vs (14.82 ±9.55) × 109/L],CRP level (211.39 ± 173.93 vs 33.67 ± 45.70 mg/L),serum creatinine (136.47 ± 87.50 vs 87.28 ±43.89 μmol/L),and urea nitrogen (14.72 ± 9.23 vs 8.45 ± 5.00 mmol/L) (all P ＜ 0.05,P ＜ 0.01).The lower the GCS score was (OR =0.510,P ＜0.05) and the higher APACHE Ⅱ score (OR =1.300,P ＜0.05) and CRP level (OR =1.031,P ＜ 0.05) were,the worse the prognosis was in the DKA patients.Conclusion CRP level,GCS score and APACHE Ⅱ score are independent prognostic factors for DKA patients.