加减木防己汤联合塞来昔布治疗湿热型急性痛风性关节炎疗效观察

Clinical Observation of Modified Mufangji Tang Combined with Celecoxib in the Treatment of Damp-heat Pattern Acute Gouty Arthritis

目的:观察加减木防己汤联合塞来昔布治疗湿热型急性痛风性关节炎的临床疗效及对血清环氧合酶2(cyclooxygenase,COX-2)、血尿酸(blood uric acid,BUA)、血沉(erythrocyte sedimentation rate,ESR)及炎性因子的影响。方法:将急性痛风性关节炎湿热型患者135例按随机数字表法分为观察组、对照1组和对照2组各45例。对照1组患者口服塞来昔布胶囊,对照2组患者口服塞来昔布胶囊与四妙散,观察组患者口服塞来昔布胶囊与加减木防己汤,疗程均为14天。观察3组患者临床症状、体征总积分(total symptom score,TSS)及中医证候积分。检测患者血清BUA、ESR、COX-2、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白细胞介素1β(interleukin-1β,IL-1β)、白细胞介素8(interleukin-8,IL-8)、IL-18、IL-4、干扰素γ(interferonγ,IFN-γ)水平。并进行安全性评价。结果:治疗后观察组TSS和中医证候积分、血清BUA、ESR、COX-2、TNF-α、IL-1β、IL-8低于2个对照组(P<0.05),且观察组、对照2组各项指标低于对照1组(P<0.05);观察组血清IL-4、IL-18、IFN-γ水平高于2个对照组(P<0.05),且观察组、对照2组各项指标高于对照1组(P<0.05)。观察组总有效率为93.02%(40/43),高于对照1组的73.17%(30/41)(P<0.05)与对照2组的83.33%(35/42)(P<0.05)。治疗后3组安全性指标检查未见异常变化;观察组复发率低于2个对照组(P<0.05)。结论:加减木防己汤联合塞来昔布在改善急性痛风性关节炎湿热型患者症状、体征方面优于单纯西药治疗及四妙散联合塞来昔布治疗,复发率低且安全性高;其作用机制可能与降低患者COX-2、BUA、ESR水平、调节炎性因子水平有关。

Objective:To observe the curative effects of modified Mufangji Tang combined with celecoxib in the treatment of damp-heat pattern acute gouty arthritis and its influence on serum cyclooxygenase-2(COX-2),blood uric acid(BUA),erythrocyte sedimentation rate(ESR)and inflammatory factors.Methods:All 135 patients with acute gouty arthritis of damp-heat pattern were divided into the observation group,the control group No 1 and the control group No 2 in light of random number table method,with 45 cases in each group.The control group No 1 took celecoxib capsules orally,the control group No 2 were treated with celecoxib capsules and Simiao powder,the observation group were given celecoxib capsules and modified Mufangji Tang,the course of the treatment was 14 days.To observe clinical symptoms,total symptom score(TSS)and TCM syndrome integrals in three groups,and to detect the levels of COX-2,BUA,ESR,TNF-α,IL-8,IL-1β,IFN-γ,IL-18 and IL-4,and perform safety evaluation.Results:After the treatment,TSS and TCM syndrome integrals,the levels of serum BUA,ESR,COX-2,TNF-α,IL-1βand IL-8 of the observation group were lower than these of two control groups(P<0.05),different indexes of the observation group and the control group No 2 were lower than these of the control group No 1(P<0.05);the levels of IL-4,IL-18 and IFN-γof the observation group were higher than these of the two control groups(P<0.05),different indexes of the observation group and the control group No 2 were higher than these of the control group No 1(P<0.05).Total effective rate of the observation group was 93.02%(40/43),higher than 73.17%(30/41)of the control group No 1(P<0.05)and 83.33%(35/42)of the control group No 2(P<0.05).After the treatment,there was no abnormal changes in the safety indexes of the three groups;the relapse rate of the observation group was lower than that of the two control groups(P<0.05).Conclusion:Modified Mufangji Tang combined with celecoxib are superior to single Western medicine therapy and Simiao powder in combination with celecoxib in improving symptoms and body signs in patients,with low recurrence rate and high safety;and its mechanism might be related to reducing the levels of COX-2,BUA and ESR,and regulating the levels of inflammatory factors.