加味四妙丸联合青敷贴敷治疗慢性肾脏病急性痛风性关节炎临床研究
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摘要
目的:观察加味四妙丸联合青敷贴敷治疗慢性肾脏病急性痛风性关节炎的临床疗效。方法:选取53例符合要求的患者,随机分为治疗组32例和对照组21例。在低嘌呤饮食、碱化尿液、酌情使用非甾体类抗炎药及延缓肾功能进展等西医治疗基础上,治疗组予内服加味四妙丸联合青敷贴敷治疗,对照组予内服加味四妙丸。以1周为1个观察周期,观察3～4个周期,于治疗前后记录关节疼痛及功能评分(VAS视觉疼痛评分、关节肿痛指数、关节功能评分)、物理指标(肿痛关节周径、肿痛关节皮温)、炎症指标(超敏C反应蛋白、白细胞计数、中性粒细胞百分比)、肾功能指标(血尿酸、尿素氮、肌酐)及安全性指标(血清门冬氨酸氨基转移酶、血清丙氨酸氨基转移酶、血小板计数)。结果:①总有效率治疗组96.86%,对照组90.48%,两组疗效相当(P> 0.05);②平均疗程治疗组(7.81±3.27) d,对照组(11.33±6.04) d,治疗组疗程短于对照组(P<0.05);③两组治疗后关节疼痛及功能评分均较治疗前下降(P<0.01),且治疗组优于对照组(P<0.05);④两组治疗后物理指标均较治疗前下降(P<0.01),治疗组优于对照组(P<0.01);⑤两组治疗后炎症指标、血小板计数、血尿素氮均较治疗前改善(P<0.01,P<0.05)。结论:加味四妙丸联合青敷贴敷治疗能较好地缓解慢性肾脏病急性痛风性关节炎患者关节肿痛症状,缩短疗程,安全性较好。
Objective:To observe the clinical efficacy of Jiawei Simiao pill combined with Qingfu pasting in the treatment of acute gouty arthritis. Methods:Fifty three patients meeting the criteria were randomly divided into the treatment group(32 patients) and the control group(21 patients). Besides the low-purine diet,alkalizing urine,applying non-steroidal anti-inflammatory drugs depending on the disease condition,and delaying the progression of renal failure and other western medicine routine treatment,the treatment group was treated with Jiawei Simiao pill combined with Qingfu pasting,and the control group was only given oral administration of Jiawei Simiao pill.One week was used as an observation period,and patients were observed for 3 to 4 periods. Joint pain and functional scores(visual pain score(VAS),joint swelling and pain index,joint function score) and physical indexes(circumference and skin temperature of the swelling and painful joint),inflammation index(high-sensitivity C-reactive protein,white blood cell count,percentage of neutrophils),renal function index(serum uric acid,urea nitrogen,creatinine) and safety indicators(serum aspartate aminotransferase,serum gluten transaminase,platelet count) were recorded before and after treatment. Results:①Total effective rate was 96.86% in the treatment group and 90.48% in the control group,with no statistical difference(P> 0.05);②The average course lasted in the treatment group for 7.81±3.27 days,while in the control group lasted for 11.33±6.04 days,and the treatment group was shorter than the control group on treatment course(P<0.05). ③On pain and functional scores after treatment the two groups were lower than before treatment(P<0.01),and the treatment group was superior to the control group(P<0.05). ④On the physical indexes after treatment both groups were lower than before treatment(P<0.01),and the treatment group was better than the control group(P<0.01). ⑤The inflammation index,platelet count and blood urea nitrogen were improved after treatment(P<0.01,P<0.05). Conclusion:Jiawei Simiao pill combined with Qingfu pasting can obviously alleviate the symptoms of joint swelling and pain in patients with chronic kidney disease accompanied with acute gouty arthritis,and shorten the course of treatment with high safety.
Objective:To observe the clinical efficacy of Jiawei Simiao pill combined with Qingfu pasting in the treatment of acute gouty arthritis. Methods:Fifty three patients meeting the criteria were randomly divided into the treatment group(32 patients) and the control group(21 patients). Besides the low-purine diet,alkalizing urine,applying non-steroidal anti-inflammatory drugs depending on the disease condition,and delaying the progression of renal failure and other western medicine routine treatment,the treatment group was treated with Jiawei Simiao pill combined with Qingfu pasting,and the control group was only given oral administration of Jiawei Simiao pill.One week was used as an observation period,and patients were observed for 3 to 4 periods. Joint pain and functional scores(visual pain score(VAS),joint swelling and pain index,joint function score) and physical indexes(circumference and skin temperature of the swelling and painful joint),inflammation index(high-sensitivity C-reactive protein,white blood cell count,percentage of neutrophils),renal function index(serum uric acid,urea nitrogen,creatinine) and safety indicators(serum aspartate aminotransferase,serum gluten transaminase,platelet count) were recorded before and after treatment. Results:①Total effective rate was 96.86% in the treatment group and 90.48% in the control group,with no statistical difference(P> 0.05);②The average course lasted in the treatment group for 7.81±3.27 days,while in the control group lasted for 11.33±6.04 days,and the treatment group was shorter than the control group on treatment course(P<0.05). ③On pain and functional scores after treatment the two groups were lower than before treatment(P<0.01),and the treatment group was superior to the control group(P<0.05). ④On the physical indexes after treatment both groups were lower than before treatment(P<0.01),and the treatment group was better than the control group(P<0.01). ⑤The inflammation index,platelet count and blood urea nitrogen were improved after treatment(P<0.01,P<0.05). Conclusion:Jiawei Simiao pill combined with Qingfu pasting can obviously alleviate the symptoms of joint swelling and pain in patients with chronic kidney disease accompanied with acute gouty arthritis,and shorten the course of treatment with high safety.
引文
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[12]谷数珍.鬼箭羽醇提取物的抑菌、抗炎作用研究[J].湖北民族学院学报·医学版,2006,23(1):17-19.
[13]聂新政,林志健,王雨,等.秦艽化学成分及药理作用研究进展[J].中草药,2017,48(3):597-607.
[14]王慧,陈雪,邱洪,等.络石藤的研究概况[J].中国医药指南,2012,10(15):93-94.
[15]金莲花.豨签草的药理作用与临床应用[J].吉林中医药,2006,26(10):68.
[16]傅兴圣,陈菲,刘训红,等.大黄化学成分与药理作用研究新进展[J].中国新药杂志,2011,20(16):1534-1538.
[17]胡俊青,胡晓.黄柏化学成分和药理作用的现代研究[J]当代医学,2009,15(7):139-141.
[18]卢嘉,金丽,金永生,等.中药杭白芷化学成分的研究[J]第二军医大学学报,2007,28(3):294-298.
[19]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[20]崔语涵,安潇,王海峰,等.姜黄化学成分研究[J].中草药,2016,47(7):1074-1078.
[21]JOHNSON RJ,NAKAGAWA T,JALAL D,et al.Uric acid and chronic kidney disease:which is chasing which[J].JNephrol Dial Transplant 2013,28(9):2221-2228.
[2]赵友红.痛风性关节炎急性期中医治疗之规律性研究[J]内蒙古中医药,2011,30(23):4-6.
[3]Kidney Disease:Improving Global Outcomes(KDIGO)CKDWork Group.KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease[J].Kidney Int suppl,2013,3:1-150.
[4]WALLACE SL,ROBINSON H,MASI AT,et al.Preliminary criteria for the classification of the acute arthritis of primary gout.Arthritis Rheum[J].Arthritis and Rheumatism,1977,20(3):895-900.
[5]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:3.
[6]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:51.
[7]WOODFORDE JM,MERSKEY H.Some relationships between subjective measures of pain[J].J Psychosom Res,1972,16(3):173-178.
[8]中华人民共和国卫生部药政局.新药西药临床研究指导原则汇编[M].北京:中华人民共和国卫生部药政局,1993:110.
[9]时乐,徐立,尹莲.加味四妙丸康痛风作用有效部位群的研究[J].南京中医药大学学报,2008,24(6):386-387.
[10]薛震,李帅,王素娟,等.山慈菇Creamstra appendiculata化学成分[J].中国中医药杂志,2005,30(7):511-513.
[11]陶小军,闫宇辉,徐志立,等.薏苡仁油抗炎消肿作用研究[J].辽宁中医药大学学报,2015,17(1):45-46.
[12]谷数珍.鬼箭羽醇提取物的抑菌、抗炎作用研究[J].湖北民族学院学报·医学版,2006,23(1):17-19.
[13]聂新政,林志健,王雨,等.秦艽化学成分及药理作用研究进展[J].中草药,2017,48(3):597-607.
[14]王慧,陈雪,邱洪,等.络石藤的研究概况[J].中国医药指南,2012,10(15):93-94.
[15]金莲花.豨签草的药理作用与临床应用[J].吉林中医药,2006,26(10):68.
[16]傅兴圣,陈菲,刘训红,等.大黄化学成分与药理作用研究新进展[J].中国新药杂志,2011,20(16):1534-1538.
[17]胡俊青,胡晓.黄柏化学成分和药理作用的现代研究[J]当代医学,2009,15(7):139-141.
[18]卢嘉,金丽,金永生,等.中药杭白芷化学成分的研究[J]第二军医大学学报,2007,28(3):294-298.
[19]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[20]崔语涵,安潇,王海峰,等.姜黄化学成分研究[J].中草药,2016,47(7):1074-1078.
[21]JOHNSON RJ,NAKAGAWA T,JALAL D,et al.Uric acid and chronic kidney disease:which is chasing which[J].JNephrol Dial Transplant 2013,28(9):2221-2228.