加味四妙散汤剂结合解毒散外敷治疗急性痛风性关节炎60例临床观察

Efficacy of Jiawei Simiao Powder (加味四妙散) Decoction Combined with Jiedu Powder (解毒散) External Application on Acute Gouty Arthritis: A Clinical Observation of 60 Cases

目的:评价解毒散及加味四妙散治疗急性痛风性关节炎的临床疗效,并探讨其早期肾保护作用。方法:将120例急性痛风性关节炎(湿热蕴结证)患者随机分为治疗组(口服加味四妙散及解毒散外敷)、对照组(口服醋氯芬酸肠溶片及解毒散外敷),各60例;疗程为1周,1周后观察记录治疗前后痛风症状积分,以及治疗前后血尿酸浓度(UA)、血沉(ESR)、超敏C反应蛋白(hs-CRP)、尿白蛋白/尿肌酐(ACR)、尿β2-微球蛋白(β2-MG)、胱抑素c(Cys c)等指标的变化。结果:治疗后,两组患者的症状积分均较治疗前降低(P<0.05),且两组的降低作用相当(P>0.05);治疗后,两组患者的UA、ESR、CRP均较治疗前降低(P<0.05),治疗组治疗后UA低于对照组(P<0.05),但对照组ESR、CRP低于治疗组(P<0.05);治疗后,治疗组的ACR、β2-MG、Cys c与治疗前相当(P>0.05),对照组的ACR、β2-MG、Cys c较治疗前升高(P<0.05),且治疗组优于对照组(P<0.05)。治疗后两组临床疗效相当(P>0.05)。结论:与口服醋氯芬酸肠溶片相比,口服加味四妙散治疗急性痛风性关节炎临床疗效一样显著,能够明显改善患者疼痛症状,降低炎性指标,且更能降低患者的血尿酸值,对肾脏功能的影响小,能更好的保护肾功能。

Objective: To evaluate the clinical efficacy of Jiedu powder combined with Jiawei Simiao powder for the treatment of acute gouty arthritis, and to explore their early renal protective effect. Methods: A total of 120 patients with acute gouty arthritis differentiated as damp-heat accumulation syndrome were randomly assigned to the treatment group(oral administration of Jiawei Simiao powder and external application of Jiedu powder) and the control group(oral aceclofenac enteric coated tablets and external application of Jiedu powder), 60 cases in each group. The treatment for the two groups lasted one week. The score of gout symptoms and the levels of blood uric acid(UA), erythrocyte sedimentation rate(ESR), high sensitivity C-reactive protein(hs-CRP), urinary albumin/creatinine(ACR), urinary 2-microglobulin(β2-MG) and cystatin C(Cys C) were observed and recorded in the two groups before and after treatment. Results: After treatment, the symptom scores were obviously decreased in the two groups in comparison with those before treatment(P<0.05), and the effect of the two groups was similar(P>0.05). After treatment, the levels of UA, ESR and CRP obviously decreased in the two groups in comparison with those before treatment(P<0.05);The treatment group showed lower UA than the control group(P <0.05),while the control group showed lower ESR and CRP than the treatment group(P <0.05). A fter treatment, the ACR, β2-MG and Cys C in the treatment group were similar to those before treatment(P>0.05), while the control group showed higher ACR, β2-MG and Cys C than before treatment(P<0.05);The treatment group showed better indexes than the control group(P<0.05). After treatment, the clinical effects of the two groups were similar(P>0.05). Conclusion: The clinical effect of Jiawei Simiao powder in the treatment of acute gouty arthritis is as significant as that of aceclofenac enteric coated tablets. It can obviously relieve the pain symptoms of patients,reduce the inflammatory index and reduce the blood uric acid value, with little effect on renal function. It can better protect renal function.