薏苡仁汤加减内外合治对急性痛风性关节炎湿热痹阻证炎症因子的影响

Effect of Addition and Subtraction Therapy of Yiyiren Tang with External Application Therapy on Inflammatory Factors of Patients with Acute Gouty Arthritis and Damp-heat Obstruction Syndrome

目的:观察薏苡仁汤加减内服和外敷治疗急性痛风性关节炎(AGA)湿热痹阻证的临床疗效及对炎症因子的影响。方法:将153例AGA患者随机按数字表法分为对照组77例和观察组76例。对照组采用美洛昔康片,1片/次,1次/d,饭后服用;双氯芬酸钠凝胶,适量外涂患处,适当按摩,3次/d。观察组美洛昔康片使用同对照组,并给予薏苡仁汤加减内服、外敷。两组疗程均为治疗7 d。患者每日记录疼痛视觉模拟评分(VAS),记录疼痛缓解时间和疼痛消失时间;进行治疗前后湿热痹阻证评分;检测治疗前后尿酸(UA),C-反应蛋白(CRP),红细胞沉降率(ESR),白细胞介素-1β(IL-1β),IL-6,IL-8,肿瘤坏死因子-α(TNF-α),血清环氧合酶-2(COX-2),前列腺素E2(PGE2),血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto-PGF1α)水平;进行安全性评价。结果:观察组临床疗效优于对照组(Z=2.205,P<0.05);观察组疼痛缓解时间和疼痛消失时间均短于对照组(P<0.01);观察组在治疗后1,3,5,7 d的VAS评分均低于对照组(P<0.01);治疗后观察组关节疼痛、关节压痛、关节肿胀、活动障碍等主证评分、次证评分和湿热痹阻证总分均低于对照组(P<0.01);治疗后观察组ESR,CRP,UA,IL-1β,IL-6,IL-8,TNF-α,COX-2,PGE2和TXB2水平均低于对照组(P<0.01),6-keto-PGF1α水平高于对照组(P<0.01)。结论:在美洛昔康片治疗的基础上,采用薏苡仁汤加减内服、外敷治疗AGA湿热痹阻证患者可快速缓解和消除疼痛,减轻临床主要症状,抑制炎症反应,有着较好的临床疗效,且使用安全。

Objective:To observe the clinical effect of addition and subtraction therapy of Yiyiren Tang with external application therapy in the patients with acute gouty arthritis(AGA)and damp-heat obstruction syndrome,and to investigate its effect on inflammatory factors.Method:One hundred and fifty-three patients were randomly divided into control group(77 cases)and observation group(76 cases)by random number table.Patients in control group got meloxicam tablets after the meal,1 tablet/day,1 time/day,diclofenac sodium gel,3 times/days.On the basis of meloxicam tablets,patients in observation group additionally received addition and subtraction therapy of Yiyiren Tang by oral and topical applications.The course of treatment was 7 days in both groups.Scores of visual analogue score of pain(VAS)were graded everyday,and the relief time and disappearance time of pain were recorded.Before and after treatment,scores of damp-heat obstruction syndrome were recorded.Levels of uric acid(UA),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-1 beta(IL-1β),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-alpha(TNF-α),serum cyclooxygenase-2(COX-2),prostaglandin E2(PGE2),thromboxane B2(TXB2)and 6-keto-prostatic factor F1alpha(6-keto-PGF1α)were all detected,and the safety was evaluated.Result:The clinical efficacy in observation group was better than that in control group(Z=2.205,P<0.05).The relief time and disappearance time of pain were shorter than those in control group(P<0.01).At the 1st,3rd,5th and 7th day after treatment,scores of VAS were lower than those in control group(P<0.01).After treatment,the scores of main symptoms such as joint pain,tenderness,swelling and dyskinesia,scores of the secondary symptoms and the total scores of damp-heat obstruction syndrome were all lower than those in control group(P<0.01).After treatment,levels of ESR,CRP,UA,IL-1β,IL-6,IL-8,TNF-α,COX-2,PGE2 and TXB2 were all lower than those in control group(P<0.01).Conclusion:Based on the treatment of meloxicam,addition and subtraction therapy of Yiyiren Tang by oral and topical administration methods can quickly relieve and eliminate pain,alleviate the main clinical symptoms and inhibit inflammation in patients with damp-heat obstruction syndrome,showing good clinical efficacy and safety.