臭氧自血疗法治疗急性痛风性关节炎的疗效及安全性研究

Efficacy and Safety of Ozoned Autohemotherapy in the Treatment of Acute Gouty Arthritis

目的：探索臭氧自血疗法（O3-AHT）联合依托考昔治疗急性痛风性关节炎的疗效及安全性。方法选取2013年10月—2015年10月在首都医科大学宣武医院疼痛科就诊且符合纳入与排除标准的急性痛风性关节炎患者41例为研究对象。采用随机数字表法将患者分为试验组（21例）和对照组（20例）。试验组给予O3-AHT联合依托考昔治疗，对照组给予单纯依托考昔治疗。记录并比较两组治疗前及治疗1~7 d 时疼痛强度评分〔疼痛数字评价量表（NRS）评分〕，治疗前及治疗7 d 时关节肿胀程度、关节压痛评分，治疗7 d 时患者对治疗的总体反应（PGART）评分，治疗前及治疗7 d 时白介素1β（IL-1β）、肿瘤坏死因子α（TNF-α）水平。记录治疗期间发生的不良反应。结果治疗方法与治疗时间存在交互作用（P ＜0.05）；NRS 评分组间比较，差异有统计学意义（P ＜0.05）；NRS 评分时间间比较，差异有统计学意义（ P ＜0.05）。试验组治疗1~4 d 时 NRS 评分均低于对照组（ P ＜0.05）；两组治疗1~7 d时 NRS 评分均低于治疗前（P ＜0.05）。两组治疗前关节肿胀程度、关节压痛评分，治疗7 d 时关节压痛评分， PGART 评分比较，差异无统计学意义（P ＞0.05）；试验组治疗7 d 时关节肿胀程度评分低于对照组（P ＜0.05）。两组治疗7 d 时关节肿胀程度、关节压痛评分均低于治疗前（P ＜0.05）。两组治疗前IL-1β、TNF-α水平，治疗7 d 时TNF-α水平比较，差异无统计学意义（P ＞0.05）；试验组治疗7 d 时 IL-1β水平低于对照组（P ＜0.05）。两组治疗7 d 时IL-1β、TNF-α水平均低于治疗前（P ＜0.05）。两组患者均未出现消化道出血、心脑血管意外、溶血等严重不良反应。两组患者胃肠道反应发生率比较，差异无统计学意义（P =0.306）。结论 O3-AHT联合依托考昔治疗急性痛风性关节炎能够加速对炎症的控制，加快对疼痛的缓解，且不会增加不良反应发生率，是安全有效的治疗手段。

Objective To evaluate the efficiency and safety of ozoned autohemotherapy（ O3-AHT）combined with etoricoxib in the treatment of acute gouty arthritis. Methods From October 2013 to October 2015,we enrolled 41 patients with acute gouty arthritis who received treatment in the Department of Pain Management of Xuanwu Hospital Capital Medical University and accorded with inclusion and exclusion criteria. Using random number table method,we divided the patients into trial group （n = 21）and control group（n = 20）. Trial group was given O3-AHT combined with etoricoxib,and control group was given etoricoxib solely. Pain intensity score（NRS score）before treatment and on day 1 - 7,the scores of joint swelling degree and joint tenderness before treatment and on day 7,the score of comprehensive reaction of the patients（PGART）on day 7,and the levels of IL-1β and TNF-α before treatment and on day 7 were recorded and compared. All adverse reactions during treatment＆amp;nbsp;were recorded. Results Interaction existed between treatment methods and time（P 〈 0. 05）;differences in NRS score between the two groups were significant（P 〈 0. 05）;differences in NRS score among different time points were significant（P 〈 0. 05）. Trial group was lower than control group in NRS score on day 1 - 4（P 〈 0. 05）;the two groups had lower NRS score on day 1 -7 during treatment than that before treatment（P 〈 0. 05）. The two groups were not significantly different in the scores of joint swelling degree and joint tenderness before treatment,joint tenderness score on day 7 and PGART score（P 〉 0. 05）;trial group was lower than control group in the score of joint swelling degree on day 7（P 〈 0. 05）. The two groups had lower scores of joint swelling degree and joint tenderness on day 7 than those before treatment（ P 〈 0. 05）. The two groups were not significantly different in the levels of IL-1β and TNF-α before treatment and the level of TNF-α on day 7（P 〉 0. 05）;trial group was lower than control group in the level of IL-1β on day 7（P 〈 0. 05）. The two groups had lower levels of IL-1β and TNF-α on day 7 than those before treatment（P 〈 0. 05）. Severe adverse reactions like hemorrhage of digestive tract,cardio - cerebral vascular events and hemolysis did not occurred in patients of the two groups. The two groups were not significantly different in the incidence of gastrointestinal reactions（P = 0. 306）. Conclusion O3-AHT combined with etocoxib can accelerate the inflammation control and pain remission in the treatment of acute gouty arthritis, and cause no increase in the incidence of adverse reactions. Therefore,it is a safe and effective treatment measure.