加味甘草附子汤联合雀啄灸治疗寒湿痹阻型痛风性关节炎临床研究

Clinical Study on Modified Gancao Fuzi Decoction Combined with Bird-Pecking Moxi⁃ bustion in the Treatment of Gouty Arthritis of Cold-Damp Blockage Type

摘要:

目的：观察加味甘草附子汤与雀啄灸并治寒湿痹阻型痛风性关节炎的临床疗效。方法：共纳入2023年1月1日—2025年1月31日龙岩市中医院诊治的68例痛风性关节炎患者，按随机数字表法分为治疗组和对照组各34例。对照组给予依托考昔片口服；治疗组在对照组基础上联合加味甘草附子汤、雀啄灸治疗。疗程均为1 周，比较2 组临床疗效及不良反应发生情况，以及治疗前后中医证候评分、疼痛视觉模拟评分法（VAS） 评分、实验室血清学指标［血尿酸（BUA）、红细胞沉降率（ESR）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）］ 水平。结果：治疗后，治疗组总有效率为94.12%（32/34），对照组为73.53%（25/34），组间比较，差异有统计学意义（P＜0.05）。治疗后，2组中医证候评分均较治疗前降低，且治疗组评分低于对照组，差异有统计学意义（P＜0.05）。治疗1、7天，2组VAS评分均较治疗前降低，且治疗组在相同时间点VAS评分均低于对照组，差异有统计学意义（P＜0.05）。治疗后，2组BUA、ESR、CRP、IL-6、TNF-α水平均较治疗前下降（P＜0.05），且治疗组5项指标水平均低于治疗组（P＜0.05）。治疗期间，治疗组未出现与治疗相关的不良反应；对照组出现轻症消化道不良反应1例。结论：加味甘草附子汤联合雀啄灸治疗寒湿痹阻型痛风性关节炎，综合疗效优于单用依托考昔方案，可有效改善关节肿痛等临床症状，降低血尿酸及炎症因子水平，且安全性良好。

Abstract:

Abstract： Objective： To observe the clinical efficacy of modified Gancao Fuzi Decoction combined with birdpecking moxibustion in the treatment of gouty arthritis of cold-damp blockage type. Methods： A total of 68 patients with gouty arthritis diagnosed and treated at Longyan Hospital of Traditional Chinese Medicine from January 1，2023 to January 31，2025 were enrolled in this study. They were randomly divided into the treatment group and the control group using the random number table method， with 34 cases in each group. The control group received Etoricoxib Tablets； while the treatment group received modified Gancao Fuzi Decoction and bird-pecking moxibustion in addition to the treatment given to the control group. The treatment duration was one week for both groups. The clinical efficacy and incidence of adverse reactions were compared between the two groups， as well as the changes in traditional Chinese medicine syndrome scores， Visual Analogue Scale （VAS） scores for pain， and laboratory serum markers [blood uric acid （BUA）， erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor-alpha （TNF- α）] before and after treatment. Results： After treatment， the total effective rate was 94.12% （32/34） in the treatment group and 73.53% （25/34） in the control group， with a statistically significant difference between the two groups （P＜0.05）. After treatment，traditional Chinese medicine syndrome scores decreased in both groups compared with those before treatment，and the scores in the treatment group were lower than those in the control group （P＜0.05）. On day one and day seven of treatment，VAS scores decreased in both groups compared with those before treatment， and the treatment group had lower VAS scores than the control group at the same time points （P＜0.05）. After treatment， the levels of BUA， ESR， CRP， IL-6， and TNF-α decreased in both groups compared with those before treatment （P＜0.05）， and the levels of BUA， ESR， CRP， IL-6， and TNF-α in the treatment group were lower than those in the control group （P＜0.05）. During treatment，no treatment-related adverse reactions occurred in the treatment group；one case of mild gastrointestinal adverse reaction was reported in the control group. Conclusion： Modified Gancao Fuzi Decoction combined with bird-pecking moxibustion for gouty arthritis of cold-damp blockage type shows better comprehensive efficacy than extoricoxib alone， effectively improving clinical symptoms such as joint swelling and pain，reducing BUA levels and inflammatory factor levels，and has a good safety profile.