【摘要】：目的：本課題通過(guò)觀察降尿酸方治療肝郁脾虛型高尿酸血癥的臨床癥狀及實(shí)驗(yàn)室指標(biāo)變化,評(píng)價(jià)其臨床效果,揭示在中醫(yī)理論指導(dǎo)下,通過(guò)辨證施治,以疏肝健脾、利濕化瘀為法組方的降尿酸方治療肝郁脾虛型高尿酸血癥的臨床療效及其作用機(jī)制,一方面為高尿酸血癥提供有效的治療途徑和方法,另一方面為開(kāi)發(fā)治療高尿酸血癥中藥打下基礎(chǔ)。方法：本課題在循證醫(yī)學(xué)原則指導(dǎo)下,采取單盲、隨機(jī)、平行對(duì)照的設(shè)計(jì)實(shí)驗(yàn)方案。將符合診斷標(biāo)準(zhǔn)的56例病例(均來(lái)自于襄陽(yáng)市中醫(yī)醫(yī)院內(nèi)分泌科2015年6月至2016年3月期間的門(mén)診或住院患者)按照隨機(jī)分組的原則,分為治療組(中藥治療組)和對(duì)照組(西藥治療組),以下簡(jiǎn)稱(chēng)為治療組和對(duì)照組。其中治療組男24例,女7例,平均年齡為(39.5±13.6)歲,血尿酸(sUA)(514.3±63.20)umol/L;對(duì)照組男19例,女6例,平均年齡為(39.34±12.9)歲,血尿酸(510.74±62.50)umol/L。兩組間一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。治療組口服降尿酸方(柴胡10g,郁金15g,蒼術(shù)10g,澤瀉15g,生薏苡仁20g,粉萆參20g,茯苓15g,生黃芪15g,丹參15g,川牛膝15g,澤蘭15g,車(chē)前子15g,威靈仙10g,桃仁18g。襄陽(yáng)市中醫(yī)醫(yī)院制劑室提供),每次10粒,每天3次；對(duì)照組口服別嘌醇片(廣州白云山制藥股份有限公司廣州白云山制藥總廠,國(guó)藥準(zhǔn)字H44021492),每次100mg,每天2次。兩組均予以基礎(chǔ)治療,清淡低嘌呤飲食,足量飲水。30天為1個(gè)療程。觀察兩組治療前后臨床癥狀體征積分及治療期間血尿酸、血脂、血糖、肝腎功能、尿常規(guī)、血常規(guī)等療效指標(biāo)及安全性指標(biāo)的變化。實(shí)驗(yàn)結(jié)束后所有測(cè)定數(shù)據(jù)均以均數(shù)±標(biāo)準(zhǔn)差((?)±s)表示,自身前后對(duì)照采用t檢驗(yàn),兩組間比較采用x~2檢驗(yàn)。應(yīng)用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)數(shù)據(jù)處理分析,從而得出研究結(jié)果。結(jié)果：治療組愈顯率為73.3%,總有效率為86.20%。對(duì)照組愈顯率為65.3%,總有效率為為77.03%(P0.05)。治療組不良反應(yīng)率為12.90%,對(duì)照組不良反應(yīng)率為28.00%。統(tǒng)計(jì)學(xué)比較,兩組高血尿酸治愈率(x~2值2.093),P0.05,治療組與對(duì)照組療效相當(dāng)。兩組總有效率及愈顯率(x~2值9.451),P0.05,治療組優(yōu)于對(duì)照組療效。提示在改善臨床癥狀及體征的改善方面,治療組明顯優(yōu)于對(duì)照組。兩組不良反應(yīng)發(fā)生率及安全性指標(biāo)觀察提示降尿酸方藥物不良反應(yīng)較低,安全性較好。結(jié)論：降尿酸方組在降低患者的血尿酸方面與對(duì)照組相當(dāng),但在改善患者的臨床癥狀及體征方面,其治療效果明顯優(yōu)于對(duì)照組。降尿酸方以中醫(yī)理論為指導(dǎo),在調(diào)理臟腑功能,通過(guò)辨證施治,以疏肝健脾、化瘀利濕為法,能夠顯著降低血尿酸,且無(wú)明顯毒副作用,臨床療效確切,臨床癥狀緩解較明顯,有較高的臨床臨床實(shí)用價(jià)值,可作為臨床新藥進(jìn)一步加以研究開(kāi)發(fā)。
[Abstract]:Objective: To observe the clinical symptoms and laboratory indexes of Jianguric acid prescription in treating hyperuricemia of liver depression and spleen deficiency type, evaluate its clinical effect, and reveal the clinical effect of Jianguric acid prescription in treating hyperuricemia of liver depression and spleen deficiency type by syndrome differentiation and treatment under the guidance of traditional Chinese medicine theory. The mechanism of action, on the one hand, provides an effective treatment for hyperuricemia and methods, on the other hand, lays the foundation for the development of traditional Chinese medicine for the treatment of hyperuricemia.Methods: Under the guidance of evidence-based medicine, the subject adopted a single blind, randomized, parallel control design experimental scheme. According to the principle of random grouping, the outpatients and inpatients in the Department of Endocrinology of the Municipal Hospital of Traditional Chinese Medicine from June 2015 to March 2016 were divided into treatment group (Chinese medicine treatment group) and control group (western medicine treatment group), hereinafter referred to as treatment group and control group. 0) umol/L; 19 males and 6 females in the control group, with an average age of (39.34 + 12.9) years, serum uric acid (510.74 + 62.50) umol/L. There was no significant difference between the two groups in general data (P 0.05), with comparability. Shen 15g, Sichuan Achyranthes Bidentata 15g, Zelan 15g, Cheqianzi 15g, Wellingxian 10g, Taoren 18g, Xiangyang Hospital of Traditional Chinese Medicine Preparation Room, 10 tablets each time, three times a day; the control group was orally administered allopurinol tablets (Guangzhou Baiyunshan Pharmaceutical General Factory, Guangzhou Baiyunshan Pharmaceutical Co., Ltd., the Chinese character H44021492), 100 mg each time, twice a day. The clinical symptoms and signs integral before and after treatment and the changes of blood uric acid, blood lipids, blood glucose, liver and kidney function, urine routine, blood routine and other therapeutic and safety indexes were observed in both groups. Results: The more obvious rate of the treatment group was 73.3%, the total effective rate was 86.20%. The more obvious rate of the control group was 65.3%, the total effective rate was 77.03%(P 0.05). The adverse reaction rate of the treatment group was 12.90%, and the adverse reaction rate of the control group was 86.20%. The response rate was 28.00%. Statistical comparison showed that the cure rate of hyperuricemia in the two groups (x~2 value 2.093), P 0.05, the treatment group and the control group had the same curative effect. The total effective rate and recovery rate of the two groups (x~2 value 9.451), P 0.05, the treatment group was better than the control group. The observation of birth rate and safety index indicated that the side effect of Jianguric acid prescription was lower and its safety was better. Conclusion: The Jianguric acid prescription group was similar to the control group in reducing serum uric acid, but its curative effect was better than the control group in improving clinical symptoms and signs. The function of zang-fu organs can be treated according to syndrome differentiation, with the methods of soothing the liver and strengthening the spleen, removing blood stasis and eliminating dampness, which can significantly reduce serum uric acid without obvious toxic and side effects. The clinical curative effect is definite and the clinical symptoms are relieved obviously. It has higher clinical practical value and can be further studied and developed as a new clinical drug.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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