祛湿除痹方联合西药治疗湿热蕴结型原发性痛风疗效观察

摘要

目的：观察祛湿除痹方联合西药治疗湿热蕴结型原发性痛风（PG）的临床效果。方法选取2015年1月至2016年1月苏州市中医院风湿病科收治的湿热蕴结型原发性痛风患者72例，采用随机数表法将患者分为对照组与观察组，每组36例。对照组患者给予西医常规治疗，观察组在西医治疗的基础上给予祛湿除痹方治疗，连续治疗28 d。观察两组患者治疗后的症状和体征改善情况，采用中医证候评分进行疗效评价；尿酸酶法检验患者血尿酸浓度；观察两组患者急性期使用糖皮质激素情况及不良反应。结果观察组患者的治疗总有效率为91.7%，明显高于对照组的72.2%，差异有统计学意义(P<0.05)；治疗前，两组患者血尿酸水平相当，差异无统计学意义(P>0.05)，治疗后，两组患者的血尿酸水平均明显低于治疗前，且观察组降低比对照组更明显，差异均有统计学意义(P<0.05)；观察组患者的急性期糖皮质激素使用率为16.7%，明显低于对照组的52.8%，差异有统计学意义(P<0.05）；不良反应以胃肠反应为主要表现，对照组不良反应发生率为38.9%，明显高于观察组的13.9%，差异有统计学意义(P<0.05)。结论祛湿除痹方联合西药治疗湿热蕴结型原发性痛风疗效显著，其不仅能降低血尿酸浓度，还可以减少糖皮质激素的使用，不良反应较少。%Objective To investigate the clinical effect of Qushichubi decoration in treatment of the damp-heat accumulation type primary gout (PG). Methods A total of 72 patients with damp-heat accumulation type PG in Depart-ment of Rheumatology in Suzhou Traditional Chinese Medicine Hospital from January 2015 from January 2016 were se-lected. They were divided into control and observation group based on the random number table, with 36 patients in each group. Patients in the control group were treated with the routine treatment of western medicine, while patients in the ob-servation group were treated with the Qushichubi decoration based on the control group. All patients were treated for 28 days. Clinical manifestations were observed, and the TCM syndrome scores were used to evaluate the effects. Serums of uric acid (UA) concentration of patients were tested by uricase method. The use of the glucocorticoids and adverse reac-tions during the acute period were observed between the two groups. Results The total effective rate of observation group was 91.7%, which was significantly higher than 72.2%in the control group, and the difference was statistically sig-nificant (P<0.05). There was no significant difference in the serum concentrations of UA before treatment between the two groups (P>0.05). After treatment, the serum UA levels of the two groups were significantly lower than before treat-ment and were lower in the observation group than the control group, and the difference was statistically significant (P<0.05). The rate of use of glucocorticoids in the control group was higher than that in the observation group (52.8% vs 16.7%), and the difference was statistically significant (P<0.05). Gastrointestinal reaction was the main performance with adverse reactions. Adverse reaction rate in control group was 38.9%, which was significantly higher than the obser-vation group of 13.9%, and the difference was statistically significant (P<0.05). Conclusion Qushichubi decoration combined with western medicine has significant effect in treatment of damp-heat accumulation type PG. It not only can decrease the UA concentration, but also can reduce the use of glucocorticoids, with less adverse reactions.