【摘要】：目的:觀(guān)察土萆寧痛湯對(duì)濕熱蘊(yùn)結(jié)型急性痛風(fēng)性關(guān)節(jié)炎的臨床療效及安全性,以便臨床推廣應(yīng)用。方法:嚴(yán)格遵循試驗(yàn)設(shè)計(jì),選取96例急性痛風(fēng)性關(guān)節(jié)炎患者,且中醫(yī)辨證為濕熱蘊(yùn)結(jié)型,采用隨機(jī)數(shù)字表法將患者分為土萆寧痛湯組(治療組)48例和依托考昔組(對(duì)照組)48例。對(duì)照組給予基礎(chǔ)治療并口服依托考昔片120mg,每日1次;治療組予基礎(chǔ)治療并口服土萆寧痛湯,每日1劑,早晚各服一次。兩組療程均為7天,治療期間觀(guān)察記錄兩組患者癥狀體征改善情況及實(shí)驗(yàn)室指標(biāo)變化情況,評(píng)估臨床總體療效及安全性。采用SPSS22.0對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)綜合療效評(píng)價(jià):治療組47例,其中治愈14例、顯效26例,有效5例,無(wú)效2例,總有效率達(dá)95.7%,對(duì)照組46例,其中治愈2例、顯效29例,有效11例,無(wú)效4例,總有效率達(dá)91.3%,治療組療效更為顯著(P0.01)。(2)癥狀體征改善情況對(duì)比:兩組治療方案均能有效改善患者的關(guān)節(jié)疼痛積分、關(guān)節(jié)壓痛積分、關(guān)節(jié)紅腫積分、關(guān)節(jié)受限積分及癥狀體征積分(P0.01),在改善患者關(guān)節(jié)紅腫、關(guān)節(jié)受限及癥狀體征積分方面,治療組療效更佳(P0.05)。(3)實(shí)驗(yàn)室指標(biāo)變化情況對(duì)比:兩組治療方案均能降低患者ESR、CRP水平(P0.01),且兩組療效相當(dāng)(P0.05)。治療組能有效降低患者BUA水平(P0.01),但對(duì)照組無(wú)降低BUA作用(P0.05)。(4)緩解時(shí)間對(duì)比:在關(guān)節(jié)疼痛緩解時(shí)間上比較,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),在關(guān)節(jié)紅腫緩解時(shí)間上比較,治療組顯著短于對(duì)照組(P0.01)。(5)安全性評(píng)價(jià):治療組不良反應(yīng)發(fā)生率為2.13%,對(duì)照組不良反應(yīng)發(fā)生率為15.22%,顯著高于治療組(P0.05)。結(jié)論:土萆寧痛湯治療急性痛風(fēng)性關(guān)節(jié)炎具有良好療效,其抗炎鎮(zhèn)痛作用與依托考昔相當(dāng),在改善關(guān)節(jié)紅腫癥狀方面優(yōu)于依托考昔,并具有降低血尿酸的作用,不良反應(yīng)少,療效確切,值得臨床上推廣。
[Abstract]:Objective: to observe the clinical efficacy and safety of Tubibinitong decoction in treating acute gouty arthritis with damp-heat accumulation. Methods: according to the experimental design, 96 cases of acute gouty arthritis were selected, and the TCM syndrome differentiation was dampness and heat accumulation type. The patients were randomly divided into Tubibiningtong decoction group (48 cases) and etacoxib group (control group) 48 cases. The control group was given basic treatment and oral etacoxib 120 mg once a day, while the treatment group was given basic treatment and oral Tubibiotong decoction, 1 dose daily, once in the morning and evening. The two groups were treated for 7 days. The improvement of symptoms and signs and the changes of laboratory indexes were observed and recorded during the treatment period to evaluate the overall clinical efficacy and safety. All the data were analyzed by SPSS 2. 0. Results: (1) Comprehensive evaluation of curative effect: in the treatment group, 14 cases were cured, 26 cases were effective, 5 cases were effective, 2 cases were ineffective, and the total effective rate was 95.7%. In the control group, 46 cases were cured, 29 cases were markedly effective, 11 cases were effective, 4 cases were ineffective. The total effective rate was 91.3%. The curative effect of the treatment group was more significant (P0.01). (2) than that of the control group (P0.01). (2). The two treatment schemes could effectively improve the joint pain score, the joint tenderness score and the joint redness score. The joint limited score and symptom and sign score (P0.01) were used to improve the patients' joint redness, joint limitation and symptom and sign score. The therapeutic effect of the treatment group was better (P0.05). (3) compared with the laboratory index: the two groups of treatment can reduce the level of ESR-CRP (P0.01), and the two groups have the same curative effect (P0.05). Treatment group can effectively reduce the Bua level (P0.01), but the control group did not reduce Bua effect (P0.05). (4) remission time comparison: in the joint pain relief time comparison, the two groups have no statistical significance (P0.05), in the joint redness relief time comparison, The safety evaluation of the treatment group was significantly shorter than that of the control group (P0.01). (5): the incidence of adverse reactions was 2.13 in the treatment group and 15.22 in the control group, which was significantly higher than that in the treatment group (P0.05). Conclusion: Tubibiningtong decoction has good curative effect on acute gouty arthritis, its anti-inflammatory and analgesic effect is equal to that of etacoxib, it is superior to etacoxime in improving the symptoms of joint redness and swelling, and it has the effect of reducing blood uric acid, and has fewer adverse reactions. The curative effect is definite, worth popularizing clinically.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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