水晶丹外敷治疗难治性痛风急性发作的临床观察

Clinical Observation on External Application of Shuijingdan in Treating Acute Attack of Refractory Gout

目的探索水晶丹外敷治疗难治性痛风急性发作的疗效与机制。方法选取2021年6月至2022年12月四川省医学科学院·四川省人民医院(电子科技大学附属医院)中西医骨伤科门诊收治的58例难治性痛风急性发作患者,随机分为对照组和试验组,对照组给予依托考昔+健康教育,试验组在对照组治疗基础上加水晶丹外敷治疗。分别于干预前和干预后第1、3、5天通过测皮温、膝关节周径、视觉模拟评分量表(VAS)评分、美国特种外科医院(HSS)量表观察其临床疗效;通过测滑膜液细胞因子IL-1β、TNF-α、TGF-β1浓度探究其抗炎机制。结果与对照组比较,试验组皮温、膝关节周径和VAS评分均明显较低(P<0.05),HSS量表评分较高(P<0.05),滑膜液IL-1β、TNF-α浓度均明显较低(P<0.05),TGF-β1浓度升高(P<0.05)。结论水晶丹外敷能通过抑制细胞致炎因子IL-1β、TNF-α浓度以及提高抗炎因子TGF-β1浓度表达途径来治疗难治性痛风急性发作。

Objective To explore the efficacy and mechanism of external application of Shuijingdan in the treatment of acute attack of refractory gout.Methods A total of 58 patients with acute attacks of refractory gouty knees admitted to the outpatient clinic of the Department of Orthopaedics and Traumatology of Traditional Chinese and Western Medicine of Sichuan Academy of Medical Sciences(also known as Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science And Technology of China)from June 2021 to December 2022 were selected.They were randomly divided into a control group and an experimental group.The control group was given etoricoxib and health education,while the experimental group was additionally given external application of Shuijingdan on the basis of the treatment in the control group.The clinical efficacy was observed by measuring skin temperature,knee joint circumference,Visual Analogue Scale(VAS)score and Hospital for Special Surgery(HSS)scale score before intervention and on the 1st,3rd and 5th day of intervention,respectively.The anti-inflammatory mechanism was explored by measuring the concentrations of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and transforming growth factor-β1(TGF-β1)in the synovial fluid.Results Compared with the control group,the experimental group exhibited lower skin temperature,knee joint circumference and VAS score(P<0.05),higher HSS scale score(P<0.05),lower concentrations of IL-1βand TNF-α(P<0.05),and higher concentration of TGF-β1 in the synovial fluid(P<0.05).Conclusion External application of Shuijingdan can treat acute attack of refractory gout by inhibiting the concentrations of inflammatory cytokines IL-1βand TNF-αand increasing the concentration of anti-inflammatory cytokine TGF-β1.