【摘要】 目的 探讨化浊解毒通络法内外合治痛风性关节炎患者的临床疗效及对其炎症介质表达的影响。方法 选取2019年7月—2021年12月期间唐山市中医医院收治的痛风性关节炎患者120例作为研究对象，按随机数字表法分为对照组和试验组，每组各60例。对照组给予常规西医治疗，治疗期间注重饮食调节；试验组在对照组基础上配合化浊解毒通络法内外合治，两组患者均治疗2周。观察比较两组患者临床疗效、治疗前后主要症状评分、生化指标[血尿酸(Uric acid, UA)、C反应蛋白(C-reactive protein, CRP)、血沉(Erythrocyte sedimentation rate, ESR)]、炎症介质[白细胞介素-1β(Interleukin-1β,IL-1β)、白细胞介素-4(Interleukin-4,IL-4)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]表达变化，客观评价两组患者治疗安全性。结果 (1)临床疗效：治疗后试验组临床总有效率96.67%(58/60)高于对照组84.48%(49/58),差异有统计学意义(P<0.05)。(2)主要症状评分：治疗后两组患者主要症状评分均较治疗前降低，差异有统计学意义(P<0.05);且试验组明显低于对照组，差异有统计学意义(P<0.05)。(3)生化指标：治疗后两组患者血清UA、CRP、ESR水平均较治疗前降低，差异有统计学意义(P<0.05);且试验组明显低于对照组，差异有统计学意义(P<0.05)。(4)炎症介质：治疗后两组患者血清IL-1β、TNF-α水平较治疗前降低，IL-4水平较治疗前升高，差异有统计学意义(P<0.05);且试验组IL-1β、TNF-α水平低于对照组，IL-4水平高于对照组，差异有统计学意义(P<0.05)。(5)治疗安全性：治疗期间，两组患者不良反应发生率比较，差异无统计学意义(P>0.05)。且均为未影响治疗的轻度不良反应，未发生各项常规、肝肾功能及心电图异常。结论 化浊解毒通络法内外合治痛风性关节炎效果显著、安全性高，有利于缓解关节疼痛、肿胀，改善关节功能，且可能与下调尿酸与炎症介质表达有关。更多还原

【Abstract】 Objective To investigate the clinical efficacy of internal and external combined treatment with the turbidity-dispelling, toxin-removing and collaterals-dredging method in patients with gouty arthritis and its influence on the expression of inflammatory mediators.Method A total of 120 patients with gouty arthritis treated in Tangshan Hospital of Traditional Chinese Medicine from July 2019 to December 2021 were selected and randomly divided into a control group and an experimental group, with 60 patients in each group.The control group was treated with conventional western medicine, with a focus on dietary regulation during the treatment period.The experimental group received internal and external combined treatment with turbidity-dispelling, toxin-removing and collaterals-dredging method in addition to the conventional treatment.Both groups underwent a 2-week treatment period.The clinical efficacy, changes in main symptom scores, biochemical indicators[serum uric acid(UA),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)],and the expression of inflammatory mediators [interleukin-1β(IL-1β),Interleukin-4(IL-4),tumor necrosis factor-α(TNF-α)] between the two groups were observed and compared before and after treatment, and the safety of treatment in both groups were objectively assessed.Result(1)Clinical efficacy: After treatment, the experimental group had a significantly higher clinical effective rate of 96.67%(58/60)compared to the control group, which had a rate of 84.48%(49/58)(P < 0.05).(2)Scores of main symptoms: After treatment, the scores of main symptoms in both groups were lower than that before treatment, with a statistically significant difference(P<0.05),and the score in the experimental group was lower than that in the control group, with a statistically significant difference(P<0.05).(3)Biochemical indexes: After treatment, the levels of serum UA,CRP and ESR in the two groups were lower than those before treatment, with a statistically significant difference(P<0.05),and the levels in the experimental group were lower than those in the control group, with a statistically significant difference(P<0.05).(4)Inflammatory mediators: After treatment, the serum IL-1β andTNF-α levels in both groups were significantly lower compared with those before treatment, while the level of IL-4 was significantly higher, with a statistically significant difference(P<0.05);the experimental group had lower levels of IL-1β and TNF-α and higher level of IL-4 compared to the control group, with a statistically significant difference(P<0.05).(5)Treatment safety: During the treatment period, there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Moreover, these adverse reactions were mild and did not affect the treatment, and there were no abnormalities in routine tests, liver and kidney functions and electrocardiograms.Conclusion The internal and external combined treatment with the turbidity-dispelling, toxin-removing and collaterals-dredging method is significantly effective and safe in the treatment of gouty arthritis, which is conducive to relieving joint pain and swelling, improving joint function, and may be related to down-regulation of uric acid and expression of inflammatory mediators.更多还原