Effects of Rebixiao Granules (热痹消颗粒剂) on Blood Uric Acid in Patients with Repeatedly Attacking Acute Gouty Arthritis

Objective: To observe the clinical effect of Rebixiao granule (热痹消颗粒剂, RBXG) in treating repeatedly attacking acute gouty arthritis and through experimental study on blood uric acid to explore RBXG’s therapeutic mechanism. Methods: Ninety repeatedly attacking acute gouty arthritis patients were divided into the treated group ( n =60) and control group ( n =30). The treated group was treated with RBXG, and the control group was treated with Futalin tablets (diclofenac sodium). The baseline treatment including good rest, low purine diet, sufficient water drinking and urine alkalization, etc. was then given to both groups. Hypoxanthine 600 mg/kg and niacin 100 mg/kg was applied to hyperuricemic mice by gastrogavage to establish the animal models. Results: The clinical effective rate of the treated group was 95.0% and that of the control 90.0%. Good therapeutic effects were won, insignificant difference ( P >0.05)was shown between the two groups. However, the cure rate of the treated group was 26.7% while that of the control group was 10.0%, with significant difference ( P <0.01) shown between them. The treated group had its blood uric acid lowered, which was significantly different ( P <0.05) from that of the control group. The animal experiment indicated that all the three groups treated with different dosages of RBXG, as well as the Ash bark and Smilax glabra rhizome groups had their blood uric acid content reduced in the hyperuricemic mice. Conclusion: RBXG has a quicker initiation and better treatment effects than sole anti-inflammatory and analgesic agents on the treatment of repeatedly attacking acute gouty arthritis, showing no obvious toxic or adverse reactions and therefore good for long-term administration and likely to be a safe TCM preparation to control the symptoms and reduce the onsets of repeatedly attacking of acute gouty arthritis. The animal experiment shows that both the compound preparation and part of the single ingredients in the recipe have the function of reducing blood uric acid. However, the compound recipe has better therapeutic effects, proving to be superior to single drugs.

Effect of Simiao Liangxue Granule on Acute Gouty Arthritis in Rats

[Objectives]To study the anti-inflammatory effect of Simiao Liangxue granule on the rats with acute gouty arthritis(AGA).[Methods]A total of 60 male SD rats were randomly divided into 6 groups with 10 rats in each group.The rats in the colchicine group were intragastrically administered with 0.65 mg/kg colchicine,and the rats in low,medium and high dose groups of Simiao Liangxue granule were intragastrically administered with Simiao Liangxue granule with mass concentration of 0.4,0.8 and 1.6 g/kg,respectively.The rats in the normal control group and the model group were given the same amount of normal saline for 7 d,and the acute gouty arthritis model was prepared 1 h after administration on the 5th d.At the end of the experiment,the degree of joint swelling and joint inflammation index,the content of interleukin-1β,tumor necrosis factor-a and cyclooxygenase-2 in articular cartilage,and the content of interleukin-8,NO and UA in serum of rats were measured,and the histomorphological observation was performed.[Results]Compared with the normal control group,the joints of rats were swollen to different degrees,the inflammation score was significantly increased,and the content of IL-1β,TNF-αand COX-2 in the soft tissue of the joints was significantly increased in each group(P<0.05);compared with the model group,the joint swelling degree and inflammation score of rats in the colchicine group and Simiao Liangxue granule group were significantly decreased,the content of IL-1β,TNF-αand COX-2 in the joint soft tissue was also significantly decreased(P<0.05),and the indexes of each dose group of Simiao Liangxue granule were similar to those of the colchicine group;compared with the normal control group,the content of IL-8,NO and UA in the joint soft tissue of rats was significantly increased in each group(P<0.05);compared with the model group,the content of all indexes in joint soft tissue of rats in normal control group,colchicine group and Simiao Liangxue granule group were significantly decreased(P<0.05);the content of various indexes in the joint soft tissue of rats in the low and medium dose groups of Simiao Liangxue granule was higher than that in the colchicine group,and decreased significantly with the increase of the dose of Simiao Liangxue granule(P<0.05);the inflammatory index decreased significantly with the increase of the dose of Simiao Liangxue granule(P<0.05);the inflammation and degeneration in each dose group of Simiao Liangxue granule were milder than those in the model group,and the symptoms were relieved to some extent with the increase of dose(P<0.05).[Conclusions]Simiao Liangxue granule has the effect of anti-inflammation and detumescence,and its mechanism may be related to the content of factors that reduce inflammation including IL-1β,TNF-α,C0X-2,IL-8,NO and UA.

A network pharmacology approach to explore action mechanisms of Si Miao decoction for treating acute gouty arthritis

Objective:To Find the core targets and drug action mechanism of Si Miao decoction for the treatment of acute gouty arthritis.Methods:Through the TCMSP database,the chemical composition of all the drugs in Si Miao decoction was obtained.The Perl script was compiled and the UniProt database was searched to determine the corresponding target of the chemical composition.Then,the disease databases such as OMIM,DisGeNET,and GeneCards were searched in order to determine acute gouty arthritis Related targets.Finally,screen common targets for drugs and diseases,use the STRING database and Cytoscape software to build a network control map of drugs-chemical components-targets-disease.Use R language software to screen common targets and find the four best The core targets of San for the treatment of acute gouty arthritis.The GO and KEGG analysis of the core targets were performed to clarify the core targets and mechanism of Si Miao decoction for the treatment of gout.Results:There are 64 effective chemical components in Si Miao decoction,197 genetic targets,600 disease targets,and 58 common targets.It is predicted that IL6,VEGFA,IL1B,JUN,PTGS2,and CCL2 may be treated by Si Miao decoction for gout The core target of arthritis.GO enrichment analysis identified 85 entries,of which biological processes mainly included the regulation of cytokine activity,protease activation,nucleic acid expression,etc.;KEGG pathway enrichment analysis identified 135 signaling pathways,of which signaling pathways involved the IL-17 signaling pathway,TNF signaling pathway,Th17 cell differentiation and other pathways.Conclusion:Si Miao decoction acts on acute gouty arthritis by regulating the occurrence of inflammation,and has significant anti-inflammatory and immune effects.The formula is rigorous and scientific,and it is worthy of clinical application.

Study on anti-inflammatory mechanism and effects of Flemingia Roxb.exAit extract intervene acute gouty arthritis in rats

Objective:To investigate the effect and anti-inflammatory mechanism the effect of Flemingia Roxb.exAit extract on acute gouty arthritis.Methods:Sixty SD rats were randomly divided into 6 groups by weight,control and model group,(100、150、200 mg/kg)of Flemingia Roxb.exAit extract group and colchicine group.The rats of each group were given by intragastric for 7 days of continuous administration,meanwhile,there were given 0.9%NaCl solution instead as control and model group.The acute gouty arthritis model was constructed through right ankle joint cavity injection of sodium urate crystal solutionon day 5 after 1 h,but rats in the negative control group were injected with 0.9%NaCl solution into the articular cavity of the right foot.The general condition of rats and the degree of joint swelling,and the gait was observed after constructed model.To detected the joint fluid IL-1β、TNF-α、IL-6 indicators,and the expression of NLRP3,Caspase-1 protein in ankle joint tissue for 2 hours after the last administration.Results:Groups of Flemingia Roxb.exAit extract could markedly reduce the joint swelling on acute gouty arthritis rat model,improve gait in a dose-dependent manner,high dose group of Flemingia Roxb.exAit extract did particularly well(Pjoint swelling<0.01;Pgait<0.05),close to the therapeutic effect colchicine group.Further mechanism studies show that the joint fluid IL-1β、TNF-α、IL-6 level was reduced by Flemingia Roxb.exAit extract group,the expressions of NLRP3、Caspase-1 protein of Flemingia Roxb.exAit extract group was decreased observbly than model group,but the most obvious is that high dose group as well as colchicine group(PNALP3<0.01;PCaspase-1<0.01).Conclusion:Flemingia Roxb.exAit extract has the effect of treating acute gouty arthritis and its mechanism may be related toinhibiting NLRP3 inflammasome activation and inhibiting inflammatory response.

桂枝芍药知母汤治疗痛风性关节炎急性期疗效及对患者可调节相关因子与嘌呤受体水平变化的影响

目的:观察桂枝芍药知母汤联合非布司他、塞来昔布治疗痛风性关节炎(GA)急性期的效果,为临床治疗提供参考。方法:选取GA患者110例,根据随机原则分为对照组(西药)和观察组(桂枝芍药知母汤+西药),每组55例。记录两组治疗前及治疗3、7 d后血尿酸(UA)、血沉(ESR)、白细胞介素-1β(IL-1β)、Diekkopf-1(DKK-1)、白细胞介素-18(IL-18)、嘌呤能受体(P2X7R)水平及中医证候积分的变化,统计两组疗效和不良反应。结果:治疗7 d后,观察组总有效率为90.91%(50/55),明显高于对照组的76.36%(42/55),差异有统计学意义(P<0.05)。治疗3、7 d后,两组皮色皮温、全身症状及关节相关积分较治疗前下降,观察组低于对照组,且两组治疗7 d后低于治疗3 d后(P<0.05)。治疗3、7 d后,两组UA、IL-1β、DKK-1、IL-18、P2X7R、ESR较治疗前下降,观察组低于对照组,且两组治疗7 d后上述因子低于治疗3 d后(P<0.05)。观察组不良反应发生率为9.09%(胸闷1例、胃肠道症状4例),与对照组的20.00%(胸闷2例、胃肠道症状8例和皮疹1例)比较,差异无统计学意义(P>0.05)。结论:桂枝芍药知母汤联合西药治疗GA急性期可减轻症状,提高疗效,可能与调节相关因子的表达水平有关。

miR-185-5p通过靶向抑制IL-1β减轻急性痛风性关节炎的炎症反应

目的 探索白细胞介素1β(IL-1β)在急性痛风性关节炎(AGA)的关节损伤过程中与miR-185-5p的关系。方法 采用实时荧光定量PCR检测89名AGA患者及91名健康志愿者的血清miR-185-5p的水平,采用Pearson相关系数法评估miR-185-5p的表达水平与视觉模拟(VAS)评分以及IL-1β水平之间的相关性;采用受试者工作特征(ROC)曲线评估miR-185-5p对AGA的诊断价值。采用尿酸钠(MSU)诱导THP-1细胞建立体外急性痛风性炎症细胞模型,通过体外转染miR-185-5p模拟物或抑制物增加或降低THP-1细胞miR-185-5p的表达水平后,采用ELISA检测THP-1细胞白细胞介素1β(IL-1β)、 IL-8及肿瘤坏死因子α(TNF-α)的表达水平;荧光素酶报告基因实验确定miR-185-5p与IL-1β的3′-非翻译区(3′-UTR)的相互作用。结果 与健康对照组相比,AGA患者血清miR-185-5p的水平显著降低;血清miR-185-5p的水平与VAS评分和IL-1β的表达水平均呈负相关;ROC曲线下面积为0.905,敏感性为80.17%,特异性为83.52%。下调miR-185-5p显著促进THP-1细胞IL-1β、 IL-8及TNF-α的表达,而过表达miR-185-5p则呈现相反的结果;荧光素酶报告基因实验显示IL-1β是miR-185-5p的靶基因,并且负调控IL-1β的表达。结论 miR-185-5p通过靶向抑制IL-1β减轻AGA的炎症反应。

麦粒灸对AGA及镇痛的实验研究

目的:观察麦粒灸对AGA模型大鼠镇痛作用。方法:采用尿酸钠(MSU)诱导大鼠AGA,醋酸及热板小鼠致痛。用麦粒灸灸“足三里”、“三阴交”、“太溪”、“阿是穴”给予治疗。结果:麦粒灸能明显减少小鼠扭体反应次数,且能提高小鼠痛阈值,与空白组比较,有显著性差异(P<0.01)或差异(P<0.05),局部组织K+、DA、NE、5-HT水平较模型组显著较低(P<0.01)或(P<0.05)。结论:麦粒灸治疗AGA疗效确定。

土藤草颗粒对微晶型尿酸钠致家兔急性痛风性关节炎的药效学研究

目的观察土藤草颗粒对微晶型尿酸钠(monosodium urate,MSU)致家兔急性痛风性关节炎模型的药效学作用。方法选用取雄性日本大耳白兔,随机分为正常对照组,模型对照组,阳性药秋水仙碱组(0.18 mg·kg^(-1)),土藤草颗粒高、中、低剂量组分别为600、300、150 mg·kg^(-1)。通过家兔左后肢膝关节腔内注入MSU的方式建立急性痛风性关节炎模型,给药5天后收集关节液,检测关节腔积液中的白细胞数,测定关节液中炎症细胞因子白介素-6(interleukin-6,IL-6)、白介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumour necrosis factor-α,TNF-α)、白介素-1β(interleukin-1β,IL-1β)、前列腺素E2(prostaglandin E2,PGE2)含量;采血检测血尿酸值,给药前后血清中尿素(urea,UREA)、胆固醇(cholesterol,CHO)、血肌酐(serum creatinine,Cre)、血糖(glucose,GLU)及甘油三酯(triglyceride,TG)含量。结果土藤草颗粒高、中、低剂量组给药5 d后关节腔内白细胞数均有所下降,中剂量组与模型对照组比较有显著性差异(P<0.01);高、中剂量组有降低血尿酸的趋势;土藤草颗粒对家兔血清中UREA、CHO、Cre、GLU及TG含量均无影响;与模型对照组比较,土藤草颗粒高、中、低剂量组IL-6、IL-8、TNF-α及PGE2含量均明显降低,其中高、中、低剂量组的IL-6、TNF-α含量,高、中剂量组IL-8含量及中剂量组PGE2含量与之比较有显著性差异(P<0.01);土藤草颗粒高、中、低剂量组可以一定程度上降低关节液中IL-1β含量。结论土藤草颗粒对MSU致急性关节炎家兔模型有明显的治疗作用,可以减少动物关节腔内白细胞数量、抑制炎症细胞因子的表达,降低血清中尿酸含量。

高明利教授治疗痛风性关节炎急性期的用药规律

目的:应用数据挖掘的科研方法分析高明利教授辨治痛风性关节炎急性期的药物组方原则及用药规律,为临床用药提供科学的依据。方法:收集2017年1月15日至2021年12月15日在辽宁中医药大学附属医院风湿科高明利教授门诊就诊的206例痛风性关节炎急性期患者的病例数据及首诊处方,对性别、年龄、四气五味、归经、药物功效、药物的频次进行分析;采用软件IBM SPSS Modeler 18.0、SPSS 26.0对数据进行复杂网络分析、关联规则分析及聚类分析。结果:对206例病例数据进行整理,男女比为40∶1,涉及药物135味,频次最高的药物为萆薢、泽泻、知母、薏苡仁;四气多为寒、平、温;五味多为苦、甘、辛,归经多为肾、胃、肝三经。药物类别清热药、利水渗湿药、祛风湿药应用居多。关联规则分析得出常用药对及药物组,高频药物聚类分析共聚5大类。结论:高明利教授治疗痛风性关节炎急性期以清热药、利水渗湿药及祛风湿药为基准,重用清热药与利水渗湿药,用以清热利湿、通络止痛,在性味归经上重用苦寒之品,多选择从肾经上加以干预,治疗多以清热利湿为中心,佐用健脾、活血、引经、补益、解表、散结、止痛等药物。

抗痛风胶囊对AGA大鼠血清、关节软骨和关节液中TNF-α水平的影响分析

目的：探讨抗痛风胶囊（AGC）对急性痛风性关节炎（AGA）大鼠肿瘤坏死因子（TNF-α）水平的影响。方法：选取雄性SD大鼠60只,随机分为正常组、模型组、秋水仙碱组（0.8 mg/kg）、AGC低剂量组（0.3 g/kg）和AGC高剂量组（1.2g/kg）,每组12只,采用关节腔内注射尿酸钠制备AGA模型,检测各组关节软骨、血清及关节液中TNF-α含量,观察大鼠足踝关节肿胀情况等。结果：模型组24 h、48 h步态行为学评分分别为（2.57±0.43）分和（2.11±0.50）分,明显高于其他组（P〈0.05）;秋水仙碱组、AGC低剂量组和AGC高剂量组24 h、48 h步态行为学评分均较模型组明显降低（P〈0.05）;模型组在造模2 h后开始肿胀,在12~24 h到达高峰。在造模72 h内各时间段,模型组足踝关节肿胀率均明显高于正常组,差异有统计学意义（P〈0.05）;秋水仙碱组在12、24和48 h足踝关节肿胀率明显低于模型组（P〈0.05）,AGC高剂量组在12、24、48和72h足踝关节肿胀率明显低于模型组（P〈0.05）,AGC低剂量组仅在24 h足踝关节肿胀率低于模型组（P〈0.05）;模型组关节软骨细胞TNF-α表达较正常组明显上调（P〈0.05）,而模型组与秋水仙碱组差异无统计学意义（P〉0.05）;AGC高剂量组和低剂量组关节软骨细胞TNF-α表达较模型组有明显减弱（P〈0.05）;模型组血清及关节液TNF-α含量均较正常组明显增高（P〈0.05）;秋水仙碱组、AGC低剂量组和AGC高剂量组血清及关节液TNF-α含量较模型组有所降低（P〈0.05）;AGC低剂量组和AGC高剂量组血清TNF-α分别为（0.81±0.27）ng/ml和（0.79±0.31）ng/ml,低于秋水仙碱组（P〈0.05）。结论：AGC可明显改善AGA大鼠关节症状,降低AGA大鼠关节软骨组织、血清和关节液中TNF-α水平。

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

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。

三仁汤加减联合艾瑞昔布治疗急性痛风性关节炎临床观察

目的观察三仁汤加减联合艾瑞昔布治疗急性痛风性关节炎(湿热痹阻证)临床疗效及对实验室指标的影响。方法将80例患者分为对照组与观察组各40例。对照组患者在常规治疗基础上给予艾瑞昔布片治疗,观察组在对照组治疗基础上联合三仁汤加减方治疗,均连续治疗7 d。观察两组患者治疗前后主要症状体征积分、湿热体质积分、血尿酸(UA)、血沉(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素-1β(IL-1β)水平变化,比较两组治疗后临床疗效、湿热体质改善疗效,并评价两组治疗安全性情况。结果两组治疗后关节急性红肿、关节压痛、关节疼痛及关节活动障碍度评分均降低(P<0.05),且观察组治疗后以上症状体征积分均低于对照组(P<0.05);两组治疗后身重困倦、口苦口干、心烦懈怠、大便黏滞或燥结、小便短赤积分均降低(P<0.05),且观察组均低于对照组(P<0.05);两组治疗后UA、ESR、CRP、TNF-α、IL-6、IL-1β水平均降低(P<0.05),且观察组均低于对照组(P<0.05);观察组总有效率为92.50%,明显高于对照组的75.00%(P<0.05);观察组湿热体质改善总有效率90.00%,明显高于对照组72.50%(P<0.05);两组治疗期间均未出现明显与用药相关的不良反应。结论三仁汤加减联合艾瑞昔布治疗急性痛风性关节炎(湿热痹阻证)疗效显著,能够有效缓解患者临床症状,改善湿热体质,调节理化检查指标水平,且毒副作用小,可为痛风性关节炎急性发作的中西医治疗提供新的思路。

中西医治疗急性痛风性关节炎的进展

急性痛风性关节炎(AGA)是一种临床常见疾病。近年来,随着人们生活水平的提高,急性AGA的发病率不断上升,严重影响人们的工作、学习和生活。痛风归属于中医学“痹证”“历节”的范畴,中医药治疗急性AGA具有效果显著、不良作用小、价格低廉等诸多优点,能够根据患者的具体症状、体征等辨证论治、标本兼治,减少复发概率。文章从中医内治法、中医外治法,以及西医治疗、外科治疗等方面进行综述,以期为急性AGA的治疗提供思路。

揿针疗法联合中药湿敷治疗急性痛风性关节炎临床研究

目的:观察揿针疗法联合中药湿敷治疗急性痛风性关节炎(acute gouty arthritis,AGA)的临床疗效。方法:选取2020年9月至2022年8月兴国县人民医院收治的AGA患者70例为研究对象,按照随机数字表法分为联合组和揿针组,每组35例。所有患者均给予秋水仙碱片口服治疗,待疼痛缓解或出现腹泻腹痛等症状时停用。揿针组另给予揿针疗法治疗,联合组在揿针组治疗的基础上给予中药湿敷治疗。观察两组患者治疗前后中医症状积分、疼痛视觉模拟评分(visual analogue score,VAS)、滑膜厚度、关节液深度、血尿酸(serum uric acid,SUA)、24 h尿尿酸(uric acid,UA)排出量、红细胞沉降率(erythrocyte sedimentation rate,ESR)、炎性指标[C反应蛋白(C reactive protein,CRP)、白细胞介素(interleukin,IL)-6]变化情况及临床疗效、不良反应发生情况。结果:联合组有效率为94.29%,揿针组有效率为77.14%,联合组有效率高于揿针组,差异有统计学意义(P<0.05);治疗7 d后和治疗14 d后,两组患者中医症状积分和VAS评分均低于治疗前,且联合组低于揿针组,差异有统计学意义(P<0.05);治疗14 d后,两组患者滑膜厚度、关节液深度、SUA、ESR、CRP、IL-6水平均低于治疗前,且联合组低于揿针组差异有统计学意义(P<0.05);治疗14 d后,两组患者24 h尿UA排出量高于治疗前,且联合组高于揿针组,差异有统计学意义(P<0.05);两组患者治疗期间均未见严重不良反应。结论:揿针疗法联合中药湿敷治疗AGA疗效显著,有利于缓解患者临床症状和疼痛程度,改善患者SUA、ESR及炎性指标水平。

麦粒灸对AGA模型大鼠外周炎症介质的影响

目的观察麦粒灸对AGA模型大鼠足跖肿胀度、局部组织IL-1β、TNF-α及病理改变的影响。方法40只大鼠随机分为空白组、模型组、消炎痛组、麦粒灸4组,除空白组外,将尿酸钠溶液注入到大鼠踝关节腔,形成AGA模型。用麦粒灸灸大鼠足三里、三阴交、太溪、阿是穴。结果造模后实验动物IL-1β、TNF-α高表达(P<0.01),经麦粒灸治疗后,足跖肿胀度及IL-1β、TNF-α较模型组显著降低(P<0.01)。结论麦粒灸治疗能抑制局部组织炎性介质,以减轻局部组织的炎症水肿等症状,病理观察也证明了这一结论。

五味消毒饮加减治疗急性痛风性关节炎(湿热蕴结证)的临床疗效观察

目的:探讨五味消毒饮加减治疗急性痛风性关节炎(AGA)(湿热蕴结证)的临床疗效。方法:选择2022年1月—2023年6月收治的AGA患者120例,采用随机数字表法分为对照组、观察组和联合组,每组40例。对照组予以依托考昔治疗,观察组予以五味消毒饮加减治疗,联合组予以依托考昔+五味消毒饮加减治疗,三组均连续治疗14 d。对比三组临床疗效、实验室指标、中医症候积分、关节肿痛指数及不良反应。结果:联合组治疗总有效率高于对照组和观察组,且观察组高于对照组(P<0.05);联合组治疗后白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子α(TNF-α)、尿酸水平及中医症候积分、关节肿胀指数低于对照组和观察组,且观察组低于对照组(P<0.05);三组不良反应发生率比较差异无统计学意义(P>0.05)。结论:在西药治疗基础上,联合五味消毒饮加减治疗AGA(湿热蕴结证)患者效果更佳,可有效降低炎症因子及尿酸水平,减轻关节肿痛,充分彰显中西医结合治疗优势,且中医药治疗具有毒副作用小的优势,可弥补西药不良反应多的不足,患者更易接受。

氧化与抗氧化作用在急性痛风性关节炎中的机制研究进展

急性痛风性关节炎(acute gouty arthritis,AGA)是痛风最常见的发病类型,由尿酸增多、聚集、沉降而形成的单钠尿酸盐晶体是其主要病因。氧化应激(oxidative stress,OS)反应对AGA具有重要影响,AGA发作过程中炎症反应和OS反应同时发生,两种反应均会对机体造成损伤。在治疗AGA时,西医多采用降尿酸类、免疫抑制剂类和消炎镇痛类药物,中医多采用清热、祛湿、除痹、舒筋活络等药物,两者均有一定的抗OS作用。近年来相关研究多集中于炎症反应,本文对AGA发作时体内OS反应的机制及治疗时抗OS反应的作用机理进行综述,以期为临床医生治疗AGA及新药研发提供参考。

基于数据挖掘分析针药结合治疗急性痛风性关节炎的临床规律

目的基于数据挖掘技术来分析研究针药结合治疗急性痛风性关节炎的临床治疗规律,为临床上药穴结合治疗急性痛风性关节炎提供选穴和用药的参考和借鉴。方法检索并筛选20年来使用针药结合治疗急性痛风性关节炎的相关文献,用Excel 2019建立处方数据库并对处方中药、腧穴、归经、药类进行频数分析,SPSS Statistics 26进行聚类分析,SPSS Modeler18.0进行关联规则分析。结果共纳入40个针药结合处方,其中使用频率最高的腧穴和药物分别为三阴交、薏苡仁;关联规则分析显示药穴关联性最高的是:三阴交-薏苡仁-足三里;聚类分析得出10个聚类群。结论本研究总结出针药结合治疗急性痛风性关节炎的选穴与用药中常用组合的临床规律,为临床针药结合治疗急性痛风性关节炎提供了思路。

急性痛风性关节炎的中医辨证论治

急性痛风性关节炎(acute gouty arthritis,AGA)是一类以嘌呤代谢障碍、血尿酸水平升高、尿酸盐类结晶物沉淀于关节周围组织所导致的晶体性关节炎。尿酸水平升高和炎症反应被认为是导致痛风性关节炎发展的主要因素。此病侵蚀关节,降低生活质量,对患者生命造成严重危害。目前临床常用治疗方案以口服抗痛风药及非甾体类药物为主,必要时候手术治疗,然非甾体类药物具有不良胃肠道反应,抗痛风药物肝肾损伤相对较大,部分患者不愿接受。然而,在临床实践中发现,中医在治疗该病方面历史悠久,效美价廉,且不良反应少,患者普遍易接受。为丰富临床治疗思路,使广大患者受益,本文就中医药治疗急性痛风性关节炎的病因病机及辨证论治方面做一综述,以供临床借鉴。

痛风消停汤对AGA大鼠踝关节炎性因子表达的影响

目的:研究痛风消停汤对急性痛风性关节炎(AGA)大鼠受试踝关节滑膜组织炎性因子的影响。方法:60只SD雄性大鼠随机分为正常组、模型组、秋水仙碱组,痛风消停汤低、中、高剂量组,每组10只。正常组常规喂养,其余各组采用尿酸钠(MSU)溶液注射法建立急性痛风性关节炎模型。造模前2日,正常组与模型组按20m L/kg予以生理盐水灌胃,秋水仙碱组0.3mg/kg灌胃,1日1次;痛风消停汤低、中、高剂量组分别按2g/kg、4g/kg、8g/kg体质量给予痛风消停汤灌胃,1日1次,直至造模后第7日,连续9日。实验结束后,检测血尿酸,采用ELISA法检测受试踝关节IL-1β、IL-6、TNF-α的含量,免疫组化法检测TGF-β及其受体(TGF-βR1)的表达。结果:与正常组比较,模型组大鼠血尿酸、受试踝关节滑膜组织中IL-1β、IL-6、TNF-α含量明显升高(P<0.05);与模型组比较,痛风消停汤各组大鼠血尿酸、受试踝关节滑膜组织中IL-1β、IL-6、TNF-α含量明显降低(P<0.05),而痛风消停汤各组TGF-β1及TGF-βR1的表达较其他各组明显增强(P<0.05)。结论:痛风消停汤治疗急性痛风性关节炎的机制可能与上调TGF-β1及TGF-βR1的表达、抑制IL-1β、IL-6、TNF-α的表达有关。