加味四妙散对湿热痹阻型慢性痛风性关节炎炎症因子的影响及相关性分析  

Influence of Modified Wonderfully Effective Four Powder on Inflammatory Factors and Correlation Analysis in Damp-Heat Stagnation Type Chronic Gouty Arthritis

作　　者：杜明瑞[1] 赵哲 李秦 李华燕 王鑫[2] 崔炎[1] DU Mingrui;ZHAO Zhe;LI Qing;LI Huayan;WANG Xin;CUI Yan(The First Affiliated Hospital of Henan University of Chinese medicine,Zhengzhou 450000,China;Henan University of Chinese medicine,Zhengzhou 450046,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000 [2]河南中医药大学,河南郑州450046

出　　处：《中医药信息》2024年第5期56-63,共8页Information on Traditional Chinese Medicine

基　　金：河南省中医药传承与创新人才工程(仲景工程)中医药学科拔尖人才项目(CZ0325-15);河南省中医药科学研究专项课题(2018ZY2060);河南省卫生健康委员会基地专项课题(2021JDZY083)。

摘　　要：目的:通过分析慢性痛风与白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)与中医症状及临床指标间存在的关联性,探究加味四妙散治疗慢性痛风的作用机制。方法:60例符合纳入标准的湿热痹阻型慢性痛风性关节炎患者,依据随机数字表随机分为观察组和对照组各30例,同时设健康组30例。对照组给予口服非布司他治疗;观察组在对照组的基础上联合加味四妙散治疗,治疗周期为4周。观察患者一般临床资料、中医症状积分、生化学指标,同时采用酶联免疫吸附法(ELISA)测定IL-1β、TNF-α和IL-6水平,分析IL-1β、IL-6、TNF-α与中医证候积分及生化学指标的相关性。结果:与健康组相比,慢性痛风患者IL-1β、TNF-α、IL-6水平显著升高(P<0.01);慢性痛风患者关节疼痛、关节肿胀、大便黏滞及舌象与IL-1β、TNF-α和IL-6呈正相关,关节压痛、关节发热及身体倦怠与IL-1β、TNF-α呈正相关;黏腻、口苦及小便与TNF-α呈正相关,脉象与IL-1β呈正相关,IL-1β与FPG、TC、ESR、VAS评分呈正相关,TNF-α与BMI、UA、HDL、ESR、VAS评分呈正相关,与HDL呈负相关,IL-6与SBP、UA、CRP呈正相关(P<0.05,P<0.01);两组患者治疗后组内比较,IL-1β、TNF-α和IL-6水平显著降低(P<0.01),组间比较,观察组IL-1β水平较治疗组显著降低(P<0.05);与本组治疗前比较,两组患者关节疼痛,关节压痛,关节肿胀,关节发热,活动障碍,身困倦怠,黏腻、口苦,小便黄赤,舌象中医症状评分均明显降低(P<0.05,P<0.01)。与对照组治疗后比较,观察组患者关节发热,身困倦怠,黏腻、口苦,大便黏滞,小便黄赤,舌象,脉象积分均明显降低(P<0.05);与本组治疗前比较,BMI、SBP、DBP、UA、Scr、BUN、FPG、LDL、TG、TC、ESR、CRP、IL-1β、TNF-α、IL-6水平及VAS评分均明显升高(P<0.05,P<0.01);与对照组治疗后比较,观察组患者BMI、ESR、IL-1β水平及VAS评分均明显降低(P<0.05)。观察组�Objective:To explore the mechanism of modified Wonderfully Effective Four Powder(MWEFP)in the treatment of chronic gout by analyzing the correlation between chronic gout and interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),as well as traditional Chinese medicine(TCM)symptoms and clinical indicators.Methods:Sixty patients with damp-heat obstruction type chronic gouty arthritis were randomly divided into an observation group and a control group,with 30 cases in each group.Additionally,30 healthy subjects were enrolled as the healthy control group.The control group received oral administration of febuxostat,while the observation group received MWEFP in addition to the treatment in the control group,with a treatment cycle of 4 weeks.General clinical data,TCM symptom scores,and biochemical indicators were observed in all patients.Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of IL-1β,TNF-α,and IL-6,and the correlation of IL-1β,IL-6,TNF-α with TCM syndrome scores and biochemical indexes was analyzed.Results:Compared with the healthy control group,the levels of IL-1β,TNF-α,and IL-6 were significantly elevated in patients with chronic gout(P<0.01).In patients with chronic gout,joint pain,joint swelling,sticky stools,and tongue coating were positively correlated with IL-1β,TNF-α,and IL-6,while joint tenderness,joint fever,and fatigue were positively correlated with IL-1β and TNF-α.Additionally,greasy tongue coating,bitterness in the mouth,and urine were positively correlated with TNF-α.The pulse condition was positively correlated with IL-1β,and IL-1β was positively correlated with fasting plasma glucose(FPG),total cholesterol(TC),erythrocyte sedimentation rate(ESR),and visual analog scale(VAS)score.TNF-α was positively correlated with body mass index(BMI),uric acid(UA),high-density lipoprotein(HDL),ESR,VAS score,and negatively correlated with HDL.IL-6 was positively correlated with systolic blood pressure(SBP),UA,and C-reactive protein(CRP)(P<0.05,P<0.01)

关 键 词：慢性痛风性关节炎 炎症因子 加味四妙散 作用机制 

分 类 号：R259[医药卫生—中西医结合]