四妙汤加味配合中药外敷治疗痛风性关节炎的临床研究

Clinical observation on treating gouty arthritis with modified Simiao decoction and external application of traditional Chinese medicine

目的：探讨四妙汤加减配合中药外敷治疗痛风性关节炎的临床疗效。方法收集2010年1月至2013年8月本院就诊痛风性关节炎患者76例，按病例尾号随机分为两组各38例，两组患者治疗期间均进食低热量饮食，并加大日饮水量（＞2000 ml），戒烟酒，禁食高嘌呤食物。对照组急性期口服秋水仙碱片、吲哚美辛肠溶片，缓解期口服双氯芬酸钠缓释片。治疗组在对照组治疗基础上加用四妙汤加味并配合外敷自拟消肿止痛散治疗。治疗7d后观察并记录患者治疗前后的中医症状积分、关节炎症状积分、症状缓解时间，红细胞沉降率（ESR）、C反应蛋白（CRP）、血尿酸（UA）、白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18）。结果两组治疗后CRP、ESR[治疗组分别为（22.06±10.31）mg/L、（25.18±17.80）mm/h，对照组分别为（14.11±7.32） mg/L、（24.16±22.09） mm/h]均较同组治疗前降低[治疗组分别为（82.16±21.37）mg/L、（72.13±32.36）mm/h，对照组分别为（52.46±22.26）mg/L、（62.72±33.31）mm/h， P＜0.01]，治疗组ESR低于对照组（P＜0.05）。两组治疗后IL-1？、IL-18[治疗组为（55.26±16.31）pg/ml、（187.32±50.38）pg/ml，对照组为（57.25±18.21）pg/ml、（178.49±52.60）pg/ml]均较同组治疗前[治疗组分别为（106.11±41.02）pg/ml、（398.15±132.52）pg/ml，对照组分别为（109.23±40.12）pg/ml、（397.16±141.21）pg/ml]明显降低（P＜0.01）。治疗后治疗组完全缓解时间为（4.02±2.08）d，对照组为（4.95±2.68）d，两组完全缓解时间比较，差异有统计学意义（P＜0.05）。结论四妙汤加减配合中药外敷可减少中医症状积分、关节炎症状积分，缩短症状缓解时间；降低ESR、CRP、UA水平，增强机体免疫力。

Objective To evaluate the effects of treating gouty arthritis with modified Simiao decoction and external application of traditional Chinese medicine. Methods 76 patients with gouty arthritis of our hospital from January 2010 to August 2013 were recruited and randomly divided into a treatment group and a control group, 38 patients in each group. Patients in both groups were given low caloric diet, large amount of water（〉2 000 ml）, and forbidden to smoking, alcohol, sea food, animal splanchna and bean products. The control group was treated with oral intake of colchicines and indometacin in acute stage and oral intake of diclofenc in stable stage, while the treatment group was further added modified Simiao decoction and external application of traditional Chinese medicine on the basis of the control group. TCM symptom score, arthritis symptom score, symptomatic relief time, ESR, CRP, UA, IL-1βand IL-18 were observed after 7 days treatment. Results CRP, ESR decreased after the treatment[The treatment group respectively（22.06±10.31）mg/L, （25.18±17.80）mm/h,the control group respectively（14.11±7.32）mg/L, （24.16±22.09）mm/h]in both groups compared with the values before the treatment[The treatment group respectively（82.16±21.37）mg/L, （72.13± 32.36）mm/h,the control group respectively（52.46±22.26）mg/L, （62.72±33.31）mm/h, P〈0.01],while the decrease after of ESR in the treatment group was much obvious than the control group（P〈0.05）. IL-1β, IL-18 decreased after the treatment[The treatment group respectively（55.26±16.31）pg/ml, （187.32±50.38）pg/ml;the control group respectively（57.25±18.21）pg/ml, （178.49±52.60）pg/ml] in both groups compared with the values before the treatment[The treatment group respectively（106.11±41.02）pg/ml, （398.15±132.52）pg/ml.The control group respectively（109.23±40.12）pg/ml, （397.16±141.21）pg/ml, P〈0.01]. The symptomatic relief time was（4.02±2.08）d and（4.95±2.68）d in the treatment group and the control group respectively, showing statistical difference between the two groups（P〈0.05）. Conclusion Modified Simiao decoction combined with external application of Chinese medicines reduced TCM symptom score and arthritis symptom score, increase symptomatic relief time, decrease ESR, CRP and UA level, and enhance body immunity.