针药并用治疗脾虚湿阻型老年痛风的疗效观察及对血清嘌呤能受体和趋化因子CC基序配体2水平的影响

Observation on the efficacy of combined acupuncture and medicine for senile gout of spleen deficiency with dampness pattern and its effect on serum purinergic receptors and chemokine C-C motif ligand 2

目的 观察针刺联合化湿降浊汤治疗脾虚湿阻型老年痛风的临床疗效及其对患者血清嘌呤能受体(purinergic 2X7 receptor,P2X7R)和趋化因子CC基序配体2(chemokine C-C motif ligand 2,CCL2)水平的影响。方法 将96例脾虚湿阻型老年痛风患者按随机数字表法分为对照组(48例)和研究组(48例)。对照组予一般治疗,研究组在对照组基础上予针刺联合口服化湿降浊汤治疗。比较两组临床疗效和不良反应发生情况。观察两组治疗前后临床整体症状量表(total symptom scale,TSS)评分、疼痛数字评价量表(numerical rating scale,NRS)评分和滑膜厚度的变化。比较两组治疗前后血清P2X7R、CCL2、尿酸(uric acid,UA)、红细胞沉降率(erythrocyte sedimentation rate,ESR)和T淋巴细胞亚群水平的变化。结果 研究组总有效率高于对照组(P<0.05)。治疗后,两组血清P2X7R和CCL2水平降低(P<0.05),且研究组低于对照组(P<0.05)。治疗后,两组UA、ESR和CD8^(+)T细胞水平以及TSS评分、NRS评分和滑膜厚度较治疗前降低(P<0.05),而CD3^(+)T细胞、CD4^(+)/CD8^(+)水平较治疗前高(P<0.05),且研究组UA、ESR和CD8^(+)T细胞水平以及TSS评分、NRS评分、滑膜厚度均低于对照组(P<0.05),CD3^(+)T细胞、CD4^(+)/CD8^(+)水平高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P<0.05)。结论 针刺联合化湿降浊汤治疗脾虚湿阻型老年痛风的临床疗效优于一般治疗,可降低滑膜厚度,缓解疼痛,有效调节T淋巴细胞亚群的水平。

Objective To observe the clinical efficacy of acupuncture plus Hua Shi Jiang Zhuo Tang for senile gout of spleen deficiency with dampness pattern and its effect on serum purinergic 2X7 receptor(P2X7R) and chemokine C-C motif ligand 2(CCL2) levels in the patients.Method Ninety-six patients with senile gout of spleen deficiency with dampness pattern were allocated,using a random number table,to a control group(48 cases) and a study group(48cases).The control group received general treatment and the study group received acupuncture plus oral administration of Hua Shi Jiang Zhuo Tang in addition.The clinical therapeutic effects and the occurrences of adverse reactions were compared between the two groups.The total symptom scale(TSS) score,the pain numerical rating scale(NRS) score and synovial thickness were observed in the two groups before and after treatment.P2X7R,CCL2,uric acid(UA),erythrocyte sedimentation rate(ESR) and T lymphocyte subgroup levels were compared between the two groups before and after treatment.Result The total efficacy rate was higher in the study group than in the control group(P<0.05).After treatment,serum P2X7R and CCL2 levels decreased in the two groups compared with before(P<0.05) and were lower in the study group than in the control group(P<0.05).After treatment,serum UA,ESR,CD8^(+) T cell levels,the TSS score,the NRS score and synovial thickness decreased(P<0.05) and CD3^(+) T cell and CD4^(+)/CD8^(+) increased(P<0.05) in the two groups compared with before and UA levels,ESR,CD8^(+) T cell levels,the TSS score,the NRS score and synovial thickness were lower(P<0.05) and CD3^(+) T cell and CD4^(+)/CD8^(+) were higher(P<0.05) in the study group than in the control group.There was no statistically significant difference in the occurrence of adverse reactions between the two groups(P<0.05).Conclusion Acupuncture plus Hua Shi Jiang Zhuo Tang is more effective than general treatment in clinical treatment of senile gout of spleen deficiency with dampness pattern.It can reduce synovial thickness,relieve pain and effectively regulate T lymphocyte subgroup levels.