加味大柴胡汤治疗痛风湿热蕴结证临床研究  

Clinical Study of Jiawei Dachaihu Decoction Treating Gout of Damp Heat Accumulation

作　　者：刘喆[1] 张泽 丁繁荣 庞爱梅[1] 吕伟华 姜萍[1] LIU Zhe;ZHANG Ze;DING Fanrong;PANG Aimei;LYU Weihua;JIANG Ping(Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011,China;Master Graduate Student of Grade 2015,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Master Graduate Student of Grade 2017,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;The Third People＇s Hospital of Haiyang City,Haiyang 265100,China)

机构地区：[1]山东中医药大学附属医院,山东济南250011 [2]山东中医药大学2015年级,山东济南250355 [3]山东中医药大学2017年级,山东济南250355 [4]海阳市第三人民医院,山东烟台265100

出　　处：《山东中医杂志》2018年第9期730-733,共4页Shandong Journal of Traditional Chinese Medicine

基　　金：山东省中医药科技发展计划项目(编号:2015-089)

摘　　要：目的：观察加味大柴胡汤治疗痛风湿热蕴结证的临床疗效,并初步探讨其作用机制。方法：选取70例痛风湿热蕴结证患者,采用随机数字表法分为对照组（30例,基础治疗并口服双氯芬酸钠肠溶缓释胶囊75 mg,日一次。连续7 d）和观察组（40例,在对照组治疗基础上加用加味大柴胡汤,水煎日一剂,分两次口服,连续7 d）,治疗前后分别观察中医证候疗效、关节疼痛积分、疼痛缓解时间、C反应蛋白（CRP）、血清尿酸（SUA）、红细胞沉降率（ESR）、NOD样受体蛋白3（nod-like receptor protein 3,NALP3）、半胱氨酸天冬氨酸蛋白酶（caspase-1）、白介素6（IL-6）。结果：治疗后观察组中医证候总有效率89.5%,对照组75.0%（χ2=66.00,P〈0.01）。与本组治疗前相比,观察组治疗后VAS评分、ESR、CRP、SUA、IL-6均明显降低（P〈0.01或P〈0.05）,NALP3、Caspase-1水平均升高（P〈0.01）。与对照组相比,观察组干预后在VAS评分、疼痛缓解时间、CRP、SUA、IL-6均降低（P〈0.01或P〈0.05）,NALP3、Caspase-1水平均升高（P〈0.01）。结论 ：加味大柴胡汤可改善痛风湿热蕴结证的临床症状,其机制是通过对NALP炎性体及IL-6等炎症因子作用而实现。Objective：to observe the efficacy of Jiawei Dachaihu Decoction in treating gout of damp heat.Methods：Seventy patients with gout of damp heat accumulation were randomly divided into the control group（30 patients） and treatment group（40 patients）. Both groups were treated with conventional treatment and oral administration of diclofenac sodium dual release enteric-coated capsules,75 mg,once a day,and the treatment group were further treated with Jiawei Dachaihu Decoction,two times orally,for one week. The efficacy on traditional Chinese traditional（TCM） syndromes,joint pain scores,the time of pain relieving,laborato ry indexes like C-reaction protein（ CRP）, serum uric acid（ SUA）, erythrocyte sedimentation rate（ ESR）,nod-like receptor protein 3（NALP3）,cysteine-asparate protease-1（caspase-1） and interleukin-6（IL-6） were observed before and after treatment. Results：The efficacy on TCM syndromes after the treatment in the treatment group（89.5%） was higher than that in the control group（75%）（χ^2=66.00,P〈0.01）. Compared with before treatment in the same group,visual analogue scale（VAS） score,levels of ESR,CRP,SUA,IL-6 in both groups were significantly decreased（P〈0.01,P〈0.05,respectively）,while levels of NALP3,caspase-1 increased（P〈0.01）. Compared with the control group,VAS score,time of pain relieving,CRP,SUA,IL-6 in the treatment group decreased obviously（P〈0.01,P〈0.05,respectively）,while levels of NALP3,caspase-1 increased（P〈0.01）. Conclusion：Jiawei Dachaihu Decoction could improve symptoms of gout of damp heat accumulation,and the mechanism was to affect the NALP inflammasome and inflammatory cytokines like IL-6.

关 键 词：加味大柴胡汤 痛风 湿热蕴结 NALP3 

分 类 号：R259.897[医药卫生—中西医结合]