Hyperuricemia (HUA) poses a significant public health challenge, and prolonged use of conventional urate-lowering drugs may result in drug dependence and adverse effects, including hepatic and renal damage. In recent years, probiotics have emerged as a promising focus for uric acid (UA) regulation due to their favorable safety profile. This randomized, double-blind, placebo-controlled trial evaluated the regulatory effects of Lactobacillus rhamnosus CCFM1131 in patients with HUA. Participants were randomly assigned to receive either 6×10⁹ CFU of L. rhamnosus CCFM1131 powder (n=55) or placebo (n=52) daily for 8 weeks. Following intervention, the CCFM1131 group exhibited significantly reduced serum UA concentrations and suppressed xanthine oxidase (XOD) activity compared to the placebo group (P < 0.05). Gut microbiota analysis demonstrated increased abundance of beneficial genera such as Bifidobacterium and Lactobacillus. Additionally, untargeted metabolomics further revealed competitive depletion of intestinal purine bases and elevated levels of taurine and hippuric acid, suggesting enhanced intestinal barrier function and UA excretion. Concurrently, serum levels of bile acids including glycocholic acid and glycochenodeoxycholic acid decreased, contributing to improved hepatic lipid metabolism and reduced cytotoxicity. In summary, L. rhamnosus CCFM1131 modulates HUA through a triple mechanism—attenuating endogenous UA synthesis, modulating host metabolism, and promoting UA excretion—via remodeling of the gut microbiota. These findings provide both theoretical rationale and experimental support for applying probiotics in the clinical management of HUA.