三棱针放血联合中药口服治疗慢性肾脏病3~4期痛风发作临床观察

Clinical Observation on Three-edged Needle Bloodletting Combined with Oral Administration of Chinese Medicine in the Treatment of Gout Attack in Stage 3~ 4 of Chronic Kidney Disease

目的观察三棱针放血联合中药口服治疗慢性肾脏病3~4期痛风发作湿热蕴结型的临床疗效。方法选取60例慢性肾脏病3~4期痛风发作湿热蕴结型患者,随机分为2组。观察组30例在一般治疗基础上,三棱针放血后口服慢肾痛风方进行治疗,对照组30例在一般治疗的基础上口服非布司他联合秋水仙碱片,疗程均为2周,观察用药前后2组患者临床症状、体征、24 h尿蛋白量、观察期内完全缓解的天数、观察期内完全缓解例数、血尿酸、血肌酐、尿素氮、eGFR、CRP变化情况。结果观察组总有效率为100%,对照组总有效率为86.67%,观察组优于对照组,差异无统计学意义(P> 0.05),观察组愈显率86.67%优于对照组53.33%,有统计学差异(P <0.05);在临床症状、体征、观察期内完全缓解的天数、观察期内完全缓解例数等方面观察组均明显优于对照组(P <0.05)。2组治疗后血尿酸、CRP均有改善,与治疗前比较差异有统计学意义,治疗后观察组CRP降低优于对照组,差异有统计学意义,观察组血肌酐、血尿素氮、24 h尿蛋白定量、eGFR均有改善,但差异无统计学意义。结论三棱针放血联合中药口服可有效缓解慢性肾脏病3~4期痛风发作,缩短痛风发作时间,改善炎症状态,降低血尿酸,安全性好,并可能对残余肾功能有保护作用。

Objective To observe the clinical effect of three-edged needle bloodletting combined with oral administration of Chinese medicine in the treatment of chronic kidney disease stage 3 ~ 4 gout attack damp heat accumulation type. Methods 60 patients with chronic kidney disease stage 3 ~ 4 gout attack dampness heat accumulation type were randomly divided into two groups. On the basis of general treatment,30 cases in the observation group were treated with Manshen Tongfeng decoction after bleeding with three-edged needle,while 30 cases in the control group were treated with febuxostat combined with colchicine tablets on the basis of general treatment. The clinical symptoms,signs,24 hour urine protein volume,days of complete remission,number of cases with complete remission and hematuria,acid,serum creatinine,urea nitrogen,EGFR,CRP changes were observed before and after treatment. Results The total effective rate of the observation group was 100%,the total effective rate of the control group was 86. 67%,the observation group was better than the control group,but the difference was not significant(P > 0. 05). The effective rate of the observation group was 86. 67%,which was better than 53. 33% of the control group,and there had significant difference(P < 0. 05). The clinical symptoms,signs,days of complete remission in the observation period,the number of cases of complete remission in the observation period were significantly better than those of the control group(P < 0. 05).After treatment,the levels of serum uric acid and CRP were improved in both groups,with significant difference compared with those before treatment. After treatment,the decrease of CRP of the observation group was better than that of the control group,and the difference was significant. The serum creatinine,blood urea nitrogen,24-hour urinary protein and EGFR in the observation group were improved,but the difference was not significant. Conclusion Three-edged needle bloodletting combined with oral administration of Chinese medicine can effectively relieve gout attack in stage 3 ~ 4 of chronic kidney disease,shorten the onset time of gout,improve the inflammatory state,reduce blood uric acid,with good safety,and may have protective effect on residual renal function.