补肾健脾祛湿通络法治疗痛风患者的疗效观察

Clinical Efficacy of Bushen Jianpi Qushi Tongluo Therapies in Treatment of Gout Patients

目的观察补肾健脾祛湿通络法治疗痛风患者的疗效及对其炎症、代谢指标的调节作用。方法选取2021年2月—2023年2月期间在黑龙江省中医药科学院就诊的痛风患者132例,按随机数字表法分为对照组和观察组,每组各66例。对照组予以常规药物治疗,观察组在对照组治疗基础上予以补肾健脾祛湿通络法治疗,疗程4周。治疗前后评价中医证候评分和关节局部评分,比较两组患者治疗效果,并检测血尿酸(Serum uric acid,SUA)、血沉(Erythrocyte sedimentation rate,ESR)、血清超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、白介素-1β(Interleukin-1β,IL-1β)、白介素-6(Interleukin-6,IL-6)、白介素-18(Interleukin-18,IL-18)、肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)和脂代谢指标[甘油三酯(Triglycerides,TG)、总胆固醇(Total cholesterol,TC)、低密度脂蛋白胆固醇(Low-density lipoprotein cholesterol,LDL-C)与高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C)]。结果治疗后两组患者关节疼痛、屈伸不利、腰膝酸软、神疲乏力、肢体困重、周身浮肿、兼证积分及总积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者关节疼痛、关节压痛、关节红肿、活动障碍评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组关节局部评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者SUA、ESR水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组SUA、ESR水平低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者hs-CRP、IL-1β、IL-6、IL-18、TNF-α水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清炎症因子水平低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者TC、TG和LDL-C均较治疗前降低,且观察组TC、TG和LDL-C低于对照组,差异有统计学意义(P<0.05)。对照组治疗后HDL-C变化不明显(P>0.05),而观察组的HDL-C明显升高且高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者临床总有效率比较,差异无统计学意义(χ^(2)=2.948,P=0.086);观察组愈显率81.82%(54/66)明显高于对照组62.12%(41/66),差异有统计学意义(χ^(2)=8.667,P=0.003)。治疗期间两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论补肾健脾祛湿通络法治疗痛风可提高疗效,降低SUA水平,其机制或与调节炎症反应及代谢异常有关。

Objective To observe the efficacy of Bushen Jianpi Qushi Tongluo therapies(kidneys-tonifying,spleen-strengthening,dampness-removing,and collaterals-dredging therapies)in the treatment of gout patients and its regulatory effects on inflammation and metabolic indicators.Methods A total of 132 gout patients treated at the Heilongjiang Academy of Chinese Medicine Sciences from February 2021 to February 2023 were selected and randomly divided into a control group and an observation group according to a random number table,with 66 patients in each group.The control group received conventional drug treatment,while the observation group received Bushen Jianpi Qushi Tongluo therapies in addition to the conventional treatment for a duration of 4 weeks.The traditional Chinese medicine(TCM)syndrome scores and local joint scores were evaluated before and after treatment.The treatment effects of both groups were compared,and serum uric acid(SUA),erythrocyte sedimentation rate(ESR),serum hypersensitive C-reactive protein(hs-CRP),interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-18(IL-18),tumor necrosis factor-α(TNF-α),and lipid metabolism indicators[triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)]were measured.Results After treatment,the scores for joint pain,difficulty in flexion and extension,soreness and weakness in the waist and knees,fatigue,heaviness in the limbs,generalized edema,scores of concomitant symptoms,and total scores in both groups were significantly lower than those before treatment(P<0.05).The TCM syndrome scores in the observation group were significantly lower than those in the control group(P<0.05).The scores for joint pain,joint tenderness,joint redness and swelling,and mobility impairment were significantly lower in both groups after treatment(P<0.05),with the observation group showing lower local joint scores than the control group(P<0.05).The levels of SUA and ESR in both groups decreased significantly after treatment(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).The levels of hs-CRP,IL-1β,IL-6,IL-18,and TNF-αin both groups significantly decreased after treatment(P<0.05),with the observation group showing lower serum inflammatory factor levels than the control group(P<0.05).TC,TG,and LDL-C levels in both groups decreased significantly after treatment,with the observation group showing lower levels than the control group(P<0.05).There was no significant change in HDL-C levels in the control group after treatment(P>0.05),whereas HDL-C levels in the observation group increased significantly and were higher than those in the control group(P<0.05).There was no statistically significant difference in the overall clinical efficacy rate between the two groups(χ^(2)=2.948,P=0.086).However,the cure and improvement rate in the observation group was 81.82%(54/66),significantly higher than 62.12%(41/66)in the control group(χ^(2)=8.667,P=0.003).The incidence of adverse reactions during treatment did not differ significantly between the two groups(P>0.05).Conclusion Bushen Jianpi Qushi Tongluo therapies can improve the efficacy of gout treatment and lower SUA levels,potentially through the regulation of inflammatory responses and metabolic abnormalities.