蚕矢汤加减治疗痛风性关节炎湿热蕴结证临床观察

目的:观察蚕矢汤加减及其联合秋水仙碱治疗痛风性关节炎湿热蕴结证的疗效及安全性。方法:将258例患者随机分为中药组、西药组和中西药组,每组各86例。中药组口服蚕矢汤加减,西药组口服秋水仙碱,中西药组同时口服蚕矢汤加减联合秋水仙碱,疗程均为14 d。观察治疗前后各组临床症状,血清尿酸(SUA),血沉(ESR),C-反应蛋白(CRP)和白细胞介素-6(IL-6)的变化;比较各组总有效率、不良反应发生率及随访3个月患者的复发率。结果:治疗过程中药组剔除3例,西药组剔除2例,中西药剔除5例。中西药组总有效率93.8%,优于中药组的81.9%和西药组的83.3%(P0.05),中药组与西药组比较无明显差异;中西药组各临床症状和实验室检查指标改善较中药组和西药组更为明显(P0.05),中药组与西药组比较无统计学意义;不良反应发生率中药组(3.6%)中西药组(60.5%)西药组(82.1%)(P0.05);复发率中西药组(7.4%)中药组(20.5%)西药组(26.1%)(P0.05)。结论:蚕矢汤加减治疗痛风性关节炎湿热蕴结证的疗效与西药秋水仙碱无明显差异,说明其具有有效性,且不良反应的发生率和复发率较秋水仙碱低;蚕矢汤加减联合秋水仙碱治疗痛风性关节炎湿热蕴结证具有协同增效的作用,疗效优于单用蚕矢汤加减或秋水仙碱,且可降低秋水仙碱的不良反应、复发率低。

Clinical Observation on Gouty Arthritis Syndrome of Accumulated Dampness-heat Treated with Canshitang Recipe

Objective: To explore the therapeutic effect and safety of Canshitang combined with colchicine in treatment of the gouty arthritis syndrome of accumulated dampness-heat. Method: A total of 258 patients with gouty arthritis syndrome of accumulated dampness-heat were randomly divided into the traditional Chinese medicine(TCM) group, western medicine group and the integrated Chinese and western medicine group, with 86 cases in each group. The TCM group was treated with Canshitang recipe by oral administration; the colchicine was applied by oral administration in the western medicine group, and Canshitang combined with colchicine was adopted in integrated Chinese and western medicine group, with a course of 14 d in all three groups. The changes in clinical symptoms, serum uric acid (SUA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) levels were observed before and after treatment, and the total effective rate, incidence of adverse reactions and 3-month recurrence rate were compared among these three groups. Result: The 3 cases were removed in TCM group in the treatment; 2 cases were removed in western medicine group, and 5 cases were removed in integrated Chinese and western medicine group. The total effective rate was 93.8% in integrated Chinese and western medicine group, better than 81.9% in TCM group and 83.3% in western medicine group (P<0.05); there was no significant difference between Chinese medicine group and western medicine group. After treatment, the score of the clinical symptoms, UA, ESR, CRP and IL-6 levels in integrated Chinese and western medicine group were better than those in TCM group and the western medicine group (P<0.05), but there was no significant difference between TCM group and the western medicine group. The incidence of adverse reactions was as follows, TCM group (3.6%) < integrated Chinese and western medicine group (60.5%) < western medicine group (82.1%) (P<0.05); and the recurrence rate was integrated Chinese and western medicine group (7.4%) < TCM group (20.5%) < western medicine group (26.1%) (P<0.05). Conclusion: There was no significant difference in efficacy between Canshitang treatment and colchicine in the treatment of gouty arthritis syndrome of accumulated dampness-heat, but the incidence of adverse reactions and the recurrent rate were lower than those of colchicine. Canshitang combined with colchicine had a synergistic effect for this disease, and the efficacy was superior to that of Canshitang treatment alone or colchicine alone, with lower reverse action incidence and recurrent rate.