阳痛方联合塞来昔布治疗急性痛风性关节炎湿热蕴结型的疗效研究

Observation on curative effect of Yangtong Prescription combined with celecoxib in the treatment of acute gouty arthritis with damp-heat accumulation

目的探讨观察阳痛方外敷对湿热蕴结型急性痛风性关节炎(AGA)的治疗效果。方法以2020年9月—2021年7月上海市第六人民医院金山分院肾内科收治的60例AGA患者为研究对象,随机分为对照组和治疗组,每组30例。对照组患者口服塞来昔布胶囊(200 mg/次,2次/d,连服3 d后改为200 mg/次,1次/d,续服4 d),治疗组在对照组的基础上联合阳痛方外敷,两组连续治疗7 d。对比两组治疗前后视觉模拟评分法(VAS)评分、疾病相关因子[尿酸(UA)、血沉(ESR)、C反应蛋白(CRP)]、相关炎症介质[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)]水平变化、治疗安全性、中医疗效、西医疗效。结果与对照组比较,治疗组VAS评分降低,血清UA、ESR、CRP水平及TNF-α、IL-1β、IL-6水平降低,差异有统计学意义(P<0.05);两组均未见肝肾功能障碍、血尿粪常规异常或心电图异常,两组不良反应发生率比较无明显差异(P>0.05);治疗组中医证候总有效率(96.67%)及西医总有效率(93.33%)较对照组(70.0%、73.33%)升高,差异有统计学意义(P<0.05)。结论阳痛方外敷治疗湿热蕴结型AGA效果显著、安全性高,可有效缓解患者关节疼痛。

Objective To study the therapeutic effect of Yangtong Prescription on acute gouty arthritis(AGA)of dampheat accumulation type.Methods A total of 60 AGA patients admitted to the hospital from September 2020 to July 2021 were selected as the research objects and were randomly divided into the control group and the treatment group,with 30 cases in each group.The patients in the control group were given oral celecoxib capsules(200 mg/time,2 times/d,for 3 days,then changed to 200 mg/time,1 time/d,continued for 4 days).On the basis of the control group,the treatment group was combined with external application of Yangtong Prescription,and the two groups were treated for 7 days.The lesion joint pain(VAS)score,disease-related factors[uric acid(UA),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)],and related inflammatory mediators[TNF-α,interleukin-1β(IL),interleukin-6(IL-6)]and treatment safety were compared between the two groups before and after the treatment,efficacy of traditional Chinese medicine syndromes,and efficacy of western medicine.Results Compared with the control group,the VAS score of the treatment group was decreased,and the difference was statistically significant(P<0.05);Compared with the control group,the serum levels of UA,ESR,CRP,TNF-α,IL-1β,and IL-6 in the treatment group were decreased,and the difference was statistically significant(P<0.05);There was no liver and kidney dysfunction,abnormal blood,urine and stool routine or abnormal electrocardiogram in the two groups,and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The total effective rate of TCM syndrome(96.67%)and the total effective rate of western medicine(93.33%)in the treatment group were higher than those in the control group(70.0%,73.33%)(P<0.05).Conclusion The external application of Yangtong Prescription is effective in treating damp-heat accumulation type AGA and has high safety.It is beneficial to alleviate joint pain of patients for reason with down-regulates the expression of TNF-αinflammatory mediators.