Clinical Efficacy of Addition and Subtraction Treatment of Pingweisan Combined with Guizhi Shaoyao Zhimu Tang for Chronic Gouty Arthritis

LI Jian; ZHANG Jie-ying; SUN Peng; CHEN Shuang

doi:10.13422/j.cnki.syfjx.2018010180

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Clinical Efficacy of Addition and Subtraction Treatment of Pingweisan Combined with Guizhi Shaoyao Zhimu Tang for Chronic Gouty Arthritis

更新时间：2024-01-04

- Clinical Efficacy of Addition and Subtraction Treatment of Pingweisan Combined with Guizhi Shaoyao Zhimu Tang for Chronic Gouty Arthritis
- Chinese Journal of Experimental Traditional Medical Formulae Vol. 24, Issue 1, Pages: 180-185(2018)
- 作者机构：
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- DOI：10.13422/j.cnki.syfjx.2018010180
  CLC： R259
- Published：2018
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LI Jian, ZHANG Jie-ying, SUN Peng, et al. Clinical Efficacy of Addition and Subtraction Treatment of Pingweisan Combined with Guizhi Shaoyao Zhimu Tang for Chronic Gouty Arthritis[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(1): 180-185.
DOI：

LI Jian, ZHANG Jie-ying, SUN Peng, et al. Clinical Efficacy of Addition and Subtraction Treatment of Pingweisan Combined with Guizhi Shaoyao Zhimu Tang for Chronic Gouty Arthritis[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(1): 180-185. DOI： 10.13422/j.cnki.syfjx.2018010180.

摘要

目的：观察平胃散合桂枝芍药知母汤加减治疗慢性痛风性关节炎（脾虚痰浊阻滞证）的临床疗效及对白细胞介素-1β（IL-1β），IL-8，IL-17和肿瘤坏死因子-α（TNF-α）等炎症因子的影响。方法：将148例患者随机按数字表法分为对照组和观察组各74例。对照组采用别嘌醇片，100 mg/次，3次/d，饭后服用；血尿酸正常后，以100~200 mg维持。急性发作期采用尼美舒利缓释片，0.2 g/次，1次/d，口服。观察组采用平胃散合桂枝芍药知母汤加减，1剂/d。两组疗程均为6个月；疗程结束后进行6个月随访。记录治疗48周内的急性痛风发作次数；治疗前、治疗后2，4，6个月各测量1次血尿酸水平，并计算尿酸达标率；进行治疗前后主要症状、体征和脾虚痰浊阻滞证评分；检测治疗前后IL-1β，IL-8，IL-17和TNF-α水平，并进行安全性评价。结果：观察组临床疗效总有效率为91.55%，对照组为79.71%，观察组高于对照组（χ2=4.105，P<0.05）；在48周内观察组急性痛风发作（1.78±0.89）次，少于对照组的（3.67±1.35）次（P<0.01）；治疗后观察组患者骨破坏和关节腔狭窄评分均低于对照组（P<0.05）；在治疗后4个月和6个月，观察组血尿酸水平均低于对照组（P<0.01）；治疗后6个月，观察组血尿酸达标率为85.92%，高于对照组的69.57%（χ2=5.426，P<0.05）；治疗后观察组患者压痛、屈伸不利及脾虚痰浊阻滞证评分均低于对照组（P<0.01）；治疗后观察组患者血清IL-1β，IL-8，IL-17和TNF-α水平均低于对照组（P<0.01）；观察组不良反应发生情况少于对照组。结论：与西医常规治疗相比较，平胃散合桂枝芍药知母汤治疗慢性痛风性关节炎脾虚痰浊阻滞证患者能减少痛风发作次数，降低尿酸水平和提高血尿酸达标率，减轻临床症状，并能减轻炎症因子反应，临床疗效优于单纯的西医治疗。

Abstract

Objective:To observe the clinical efficacy of addition and subtraction treatment of Pingweisan combined with Guizhi Shaoyao Zhimu Tang for chronic gouty arthritis with spleen deficiency syndrome

and investigate its effect on levels of interleukin-1β (IL-1β)

IL-8

IL-17 and tumor necrosis factor-α (TNF-α). Method:One hundred and forty-eight patients were randomly divided into control group and observation group by random number table

74 cases in each group. Patients in control group got allopurinol tablets after meal

100 mg/time

3 times/day. After the blood uric acid was normal

100-200 mg for maintaining. And in acute episode

nimesulide sustained release tablets were given

0.2 g/time

1 time/day. Patients in observation group got addition and subtraction treatment of Pingweisan combined with Guizhi Shaoyao Zhimu Tang

1 dose/day. The treatment course was 6 months for both groups. Besides

6 months' follow-up and number of acute gout attacks were recorded. Before treatment and at the 2th

4th

6th month after treatment

levels of blood uric acid were detected. Uric acid compliance rate was calculated

and scores of the main symptoms

signs and spleen deficiency phlegm block were graded.In addition

levels of IL-1β

IL-8

IL-17

TNF-α and safety were evaluated. Result:The total effective rate was 91.55% in observation group

higher than 79.71% in control group (χ2=4.105

P<0.05). The number of attacks for acute gout was (1.78±0.89) in observation group

less than (3.67±1.35) in control group (P<0.01) during 48 weeks. Scores of bone destruction and joint stenosis in observation group were lower than those in control group (P<0.05). Level of blood uric acid was lower than that in control group at the 4th and 6th month after treatment (P<0.01). Compliance rate of blood uric acid was 85.92% in observation group

higher than 69.57% in control group (χ2=5.426

P<0.05). Scores of tenderness

flexion and discomfort and spleen deficiency phlegm block and levels of IL-1β

IL-8

IL-17 and TNF-α in observation group were all lower than those in control group (P<0.01)

and the adverse reactions were also less than those in control group. Conclusion:As compared with routine treatment of western medicine

addition and subtraction treatment of Pingweisan combined with Guizhi Shaoyao Zhimu Tang can reduce the number of gout attacks

reduce uric acid levels and improve blood uric acid compliance rate

and relieve clinical symptoms and inflammation in patients with chronic gouty arthritis and spleen deficiency syndrome. The clinical efficacy was better than western medicine treatment program.

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