当归拈痛汤合三妙丸对湿热蕴结型痛风性关节炎的疗效观察

Efficacy of Danggui Zhantong Tang Combined with Sanmiao Wan in Treatment of Damp-heat Accumulation Type Gouty Arthritis

目的:探讨当归拈痛汤合三妙丸对湿热蕴结型急性痛风性关节炎的临床疗效及对Diekkopf-1(DKK-1)和抗酒石酸酸性磷酸酶5 b(TRAP5 b)含量的影响。方法:将122例湿热蕴结型急性痛风性关节炎患者按数字表法随机分为治疗组和对照组各61例;两组患者均给予常规处理治疗;对照组患者给予秋水仙碱片(初始剂量为1 mg,随后0.5 mg·h-1,症状缓解后0.5 mg/次,3次/d)和美洛昔康分散片(7.5 mg/次,2次/d);治疗组在对照组治疗的基础上服用当归拈痛汤(1剂/d,分2次煎煮)合三妙丸(9 g/次,2次/d)内服治疗。两组疗程均为1周。比较两组治疗前后临床症状和体征、血尿酸(BUA)含量、疼痛视觉模拟评分(VAS)和中医证候(STCM)积分;检测两组治疗前后血清DKK-1和TRAP5 b水平。结果:治疗组总有效率为95.09%,对照组为80.33%,治疗组优于对照组(P<0.05);治疗组治疗后各症状和体征评分均明显低于对照组(P<0.01);治疗组治疗后BUA水平和VAS,STCM评分均明显低于对照组,比较差异有统计学意义(P<0.01);治疗组治疗后DKK-1和TRAP5 b水平均明显低于对照组,比较差异均有统计学意义(P<0.05)。结论:在常规处理和西医治疗基础上,当归拈痛汤合三妙丸能有效控制急性痛风性关节炎(湿热蕴结证)的临床症状体征,减轻疼痛,降低BUA含量,改善中医证候,其作用可能与其降低血清DKK-1和TRAP5b水平相关。

Objective： To investigate the clinical effect of Danggui Zhantong Tang combined with Sanmiao Wan to treat damp-heat accumulation type gouty arthritis and its influence on Dickkopf-1（ DKK-1） and tartrate-resistant acid phosphatase 5 b（ TRAP5 b） contents. Method： One hundred and twenty-two cases with damp-heat accumulation type gouty arthritis were randomly divided into the treatment group and control group according to method of random digits table 61 patients. Conventional treatment was given to all patients in both groups. Control group was orally given with colchicines tablets（ with 1 mg dose at the initial and 0. 5 mg·h- 1until symptoms relieved, and then 0. 5 mg / time, tid） and meloxicam dispersible tablets（ 7. 5 mg / time, bid）.Treatment group was added with Danggui Zhantong decoction（ 1 dose / d,bid） combined with Sanmiao pills（ 9 g /time,tid） based on the treatment in control group. Course of treatment lasted for 1 week for both groups. Clinical symptoms and signs,blood uric acid（ BUA） levels,visual analogue scale（ VAS） scores,and syndrome of traditional Chinese medicine（ STCM） scores were compared between two groups before and after treatment. Serum DKK-1 and TRAP5 b levels were detected in two groups before and after treatment. Result： The total effective rate was 95. 08% in treatment group,higher than 80. 33% in control group（ P〈0. 05）. Symptoms and signs scores in treatment group after treatment were significantly lower than those in control group（ P〈0. 01）. After treatment,BUA leves,VAS score,and STCM score in treatment group were significantly lower than those in control group,with statistically significant difference（ P〈0. 01）. After treatment,DKK-1 and TRAP5 b levels in the treatment group were significantly lower than those in control group,with statistically significant difference（ P〈0. 05）.Conclusion： Based on conventional processing and treatment with western medicine,Danggui Zhantong decoction combined with Sanmiao pills can effectively control the clinical symptoms and signs of acute gouty arthritis（ dampheat accumulation type）,relieve pain,reduce BUA level,improve STCM,and its mechanisms may be associated with reducing DKK-1 and TRAP5 b levels in serum.