自拟痛风方联合塞来昔布治疗湿热夹瘀型痛风性关节炎临床研究

Clinical observation of Tongfeng decoction combined with celecoxib for the acute gouty arthritis with damp-heat and blood stasis type

目的 评价自拟痛风方联合塞来昔布治疗湿热夹瘀型痛风性关节炎的疗效。方法 将符合入选标准的193例痛风性关节炎患者按随机数字表法分为对照组96例、治疗组97例。对照组在西医常规疗法基础上加服塞来昔布，治疗组在对照组基础上加服自拟痛风方。2组均连续治疗14 d。分别于治疗前后进行关节功能评分，采用关节疼痛积分量表评价关节疼痛程度，采用简明健康状况调查表（36-item Short Form Health Survey, SF-36）评价患者生活质量；以全自动生化分析仪检测血尿酸（blood uric acid, BUA）、ESR，采用ELISA法检测血清D-二聚体（D-dimer, DD）、IL-1、CRP水平，评价临床疗效。结果 治疗组总有效率为93.8%（91/97）、对照组为74.0%（71/96），2组比较差异有统计学意义（χ2=14.109，P＜0.01）。治疗后，治疗组关节疼痛评分[（1.1±0.4）分比（2.4±0.8）分，t=13.984]、关节功能评分[（0.7±0.6）分比（1.3±0.9）分，t=5.451]均低于对照组，生活质量评分[（39.7±9.3）分比（32.5±8.6）分，t=5.623]高于对照组（P＜0.01）。治疗后，治疗组BUA[（302.47±50.72）mmol/L比（395.21±69.63）mmol/L，t=10.584]、ESR[（11.63±4.05）mm/h比（24.87±10.49）mm/h，t=11.589]及血清DD[（0.43±0.21）mg/L比（0.95±0.71）mg/L，t=6.914]、IL-1[（12.03±2.62）ng/L比（19.31±3.25）ng/L，t=17.140]、CRP[（6.11± 2.40）mg/L比（11.84±5.49）mg/L，t=9.411]水平均低于对照组（P＜0.01）。结论 自拟痛风方联合塞来昔布可改善湿热夹瘀型痛风性关节炎患者的关节功能和生活质量，降低BUA及炎性细胞因子水平。

Objective To explore clinical efficacy and safety of Tongfeng decoction combined with celecoxib for the acute gouty arthritis of damp-heat with blood stasis type. Methods According to the random indicator method, 193 of patients with acute gouty arthritis of damp-heat with blood stasis type in our hospital from 2014 January to January 2017 were divided into control group （n=96） and treatment group （n=97）. Patients of control group were treated with celecoxib, while treatment group were treated with Tongfeng decoction combined with celecoxib. The two groups were treated for 14 days. Clinical curative effect was evaluated after treatment. The joint pain score, joint function score and quality of life score of the two groups before and after treatment were compared. The BUA, ESR, DD, IL-1 and CRP of the two groups before and after treatment were compared. The adverse reactions of the two groups during the treatment were compared. Results Total effective rate of observation group was 93.81% （91/97）, which was significantly higher than the control group 73.96% （71/96）, and the difference was statistically significant （χ2=14.109, P〈0.01）. After treatment, the joint pain （1.1 ± 0.4 vs. 2.4 ± 0.8, t=13.984）, joint function score （0.7 ± 0.6 vs. 1.3 ± 0.9, t=5.451） in the treatment group were lower than those in the control group （P〈0.05）. The quality of life score （39.7 ± 9.3 vs. 32.5 ± 8.6, t=5.623） in the treatment group were higher than that in the control group （P〈0.05）. After treatment, the BUA （302.47 ± 50.72 mmol/L vs. 395.21 ± 69.63 mmol/L, t=10.584）, ESR （11.63 ± 4.05 mm/h vs. 24.87 ± 10.49 mm/h, t=11.589）, DD （0.43 ± 0.21 mg/L vs. 0.95 ± 0.71 mg/L, t=6.914）, IL-1 （12.03 ± 2.62 ng/L vs. 19.31 ± 3.25 ng/L, t=17.140） and CRP （6.11 ± 2.40 mg/L vs. 11.84 ± 5.49 mg/L, t=9.411） in the treatment group were lower than those in the control group （P〈0.05）. There was no significantly difference of the adverse reaction rates of the two groups during treatment （χ2=0.216, P=0.642）. Conclusions Tongfeng decoction combined with celecoxib for treatment of acute gouty arthritis of damp-heat with blood stasis type showed a good efficacy and low adverse reactions, and it can improve the joint function and quality of life, reduce the BUA.