清热利湿除痹方治疗急性痛风性关节炎患者的疗效及对炎症因子的影响

Clinical Efficacy of Qingre Lishi Chubi Decoction in the Treatment of Patients with Acute Gouty Arthritis and Its Effect on Inflammatory Factors

目的 观察清热利湿除痹方治疗急性痛风性关节炎的临床疗效及对患者血清炎症因子表达的影响。方法 将70例急性痛风性关节炎患者分为观察组、对照组,两组患者均进行饮食、生活方式非药物指导治疗,并予非布司他40 mg/d、塞来昔布胶囊0.2 g/d口服,观察组在对照组治疗基础上加用清热利湿除痹方口服,疗程为7 d。观察治疗前后炎症因子水平[包括肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、转化生长因子-β(TGF-β)、白细胞介素-4(IL-4)]、血尿酸(BUA)、24 h尿酸排出量(24 h UUA)、C反应蛋白(CRP)、血沉(ESR)、11点疼痛程度数字等级量表(PINRS)、关节疼痛视觉模拟评分(VAS)、中医证候积分,并对两组治疗临床疗效、不良反应发生率、复发率比较。结果 70例患者中纳入69例进行疗效分析,对照组中脱落1例。观察组总有效率为85.71%,高于对照组的64.71%(P<0.05);与对照组比较,观察组治疗后中医证候积分、VAS、PINRS评分明显低于对照组(P<0.01);与对照组比较,观察组治疗后CRP、ESR、TNF-α、IL-1、IL-6指标明显降低(P<0.01),BUA指标降低(P<0.05),24 h UUA、TGF-β、IL-4水平明显升高(P<0.01);治疗后观察组3个月内复发率低于对照组(P<0.05);两组安全性指标未见异常,无不良反应事件发生。结论 清热利湿除痹方可通过调控炎症因子显著改善急性痛风性关节炎(风湿热痹证)患者的临床症状,且安全性较高、复发率较低。

Objective:To study the clinical efficacy of Qingre Lishi Chubi Decoction in the treatment of acute gouty arthritis and its effect on the expression of serum inflammatory factors in patients.Methods:A total of 70 patients with acute gouty arthritis were divided into observation group and control group.Both groups were treated with non-drug guidance of diet and lifestyle,as well as conventional drug treatment of febuxostat 40 mg/d and cele⁃coxib capsule 0.2 g/d orally.The observation group was treated with Qingre Lishi Chubi Decoction orally on the ba⁃sis of the control group.The course of treatment was 7 days.The levels of inflammatory factors[including tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6),transforming growth factor-β(TGF-β),in⁃terleukin-4(IL-4)],blood uric acid(BUA),24-hour uric acid output(24 h UUA),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),11-point pain digital rating scale(PINRS),visual analogue scale(VAS)of joint pain and TCM syndrome scores were observed before and after treatment.The clinical efficacy,incidence of adverse reactions and recurrence rate of the two groups were compared.Results:Among the 70 patients,69 cases were included in the efficacy analysis,and 1 case was lost in the control group.The total effective rate of the obser⁃vation group(85.71%)was higher than that of the control group(64.71%)(P<0.05).Compared with the control group,the scores of TCM syndromes,VAS and PINRS in the observation group were significantly lower than those in the control group(P<0.01).Compared with the control group,the levels of CRP,ESR,TNF-α,IL-1 and IL-6 in the observation group were significantly decreased after treatment(P<0.01),the BUA index was decreased(P<0.05),and the levels of 24 h UUA,TGF-βand IL-4 were significantly increased(P<0.01).After treatment,the recurrence rate of the observation group within 3 months was lower than that of the control group(P<0.05).There were no abnormalities in the safety indicators of the two groups,and no adverse events occurred.Conclusion:Qin⁃gre Lishi Chubi Decoction can significantly improve the clinical symptoms of patients with acute gouty arthritis of rheumatic fever syndrome by regulating inflammatory factors,with high safety and low recurrence rate.