双醋瑞因联合不同剂量依托考昔治疗急性重度痛风性关节炎 的回顾性临床观察

Retrospective Clinical Observation of Diacerein Combined with Different Doses of Etoricoxib in the Treatment of Acute Severe Gouty Arthritis

目的:观察双醋瑞因联合不同剂量依托考昔治疗急性重度痛风性关节炎的疗效和安全性。方法:采用回顾性研究方法,收集我院门诊100例首次就诊原因为急性重度痛风性关节炎发作的患者,根据治疗方式分为以下4组:双醋瑞因胶囊50 mg,po,qd联合不同剂量依托考昔片(A组120 mg、B组90 mg、C组60 mg、D组30 mg,po,qd)。比较4组患者7 d后临床症状评分、血清白细胞介素-1(IL-1)和肿瘤坏死因子(TNF-α)以及肝肾功能指标变化情况,观察各组疼痛缓解时间和不良反应发生情况。结果:治疗后,各组患者的临床症状评分均较前明显改善(P<0.05),且A、B两组症状评分显著优于C、D两组,疼痛缓解时间也明显短于C、D两组(P<0.05);而A、B两组间差异无统计学意义(P>0.05)。4组血清IL-1、TNF-α水平也较治疗前下降(P<0.05),但组间比较差异无统计学意义(P>0.05)。治疗前后各组血肌酐、尿酸和ALT水平无明显变化(P>0.05)。A组心血管事件发生率与不良反应总发生率均明显高于其他3组(P<0.05),B、C、D 3组不良反应发生率差异无统计学意义(P>0.05)。结论:双醋瑞因联合90mg依托考昔可迅速改善急性重度痛风性关节炎症状,不良反应少。抗炎机制可能为下调炎症介质的表达。

Objective: To observe the efficacy and safety of diacerein combined with different doses of etoricoxib in the treatment of acute severe gouty arthritis. Methods: A retrospective study was conducted to collect 100 cases of patients in our hospital clinic with first visit due to an attack of acute severe gouty arthritis. They were divided into four groups according to the treatment. Group A, B, C and D were given diacerein 50 mg once a day combined with etoricoxib 120 mg, 90 mg, 60 mg and 30 mg once daily, respectively. The symptom volume score, levels of serum interleukin-1(IL-1) and tumor necrosis factor-α(TNF-α), liver and kidney function indexes, pain relief time and adverse reactions were compared among the four groups after 7 days. Results: After treatment, the clinical symptom score of patients in each group was significantly improved(P<0.05), and groups A and B were obviously better than groups C and D, and the pain relief time was remarkably shorter than that of groups C and D(P<0.05);there was no significant difference between group A and group B(P>0.05). The levels of IL-1 and tumor necrosis factor-α were notably decreased in all treatments(P<0.05), while no difference was found among the four groups(P>0.05). There were no differences in liver function, uric acid and alanine aminotransferase in all groups(P>0.05). Group A was with higher incidence of cardiovascular events and total adverse reactions than other groups(P<0.05), while no apparently differences in adverse reactions were found among B,C,D(P>0.05). Conclusion: Diacerein combined with 90 mg etoricoxib can rapidly relieve the symptoms of acute severe gouty arthritis with fewer adverse reactions, and the anti-inflammatory mechanism may be related to the expression down-regulation of inflammatory mediators.