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赖宇文, 杜根发, 夏威夷, 邱宏韬, 林青, 李田珂, 盛朝辉.黄柏骨伤散治疗湿热型痛风性关节炎患者的临床效果及对血清UA、COX-2、CRP、TNF-α、IL-1水平的影响[J].湖南中医药大学学报,2026,46(5):957-963[点击复制] |
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| 黄柏骨伤散治疗湿热型痛风性关节炎患者的临床效果及对血清UA、COX-2、CRP、TNF-α、IL-1水平的影响 |
| 赖宇文,杜根发,夏威夷,邱宏韬,林青,李田珂,盛朝辉 |
| (深圳市宝安区中医院, 广东 深圳 518133) |
| 摘要: |
| 目的 探讨黄柏骨伤散对湿热型痛风性关节炎患者的临床治疗效果及对血清尿酸（UA)、环氧化酶-2（COX-2）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1)水平的影响。方法 前瞻性选取深圳市宝安区中医院2023年1月至2025年4月收治的210例湿热型痛风性关节炎患者为研究对象，依据随机数字表法分为对照组和观察组，每组105例。两组均给予生活指导和降UA药物（非布司他40~80 mg/次，别嘌醇100~300 mg/次，苯溴马隆50 mg/次，1次/d）治疗；在此基础上，对照组予以依托考昔片治疗，60 mg/次，1次/d，连续治疗14 d；观察组在对照组基础上予以黄柏骨伤散外敷治疗，1次/d，每次贴敷时间4~6 h，连续治疗14 d。在治疗前、治疗7 d、治疗14 d，采用视觉模拟量表（VAS）评分评估患者疼痛程度；量角器测量两组患者膝关节关节活动度（ROM）；记录两组患者中医证候积分；高效液相色谱法测定患者血清UA水平；ELISA测定患者血清IL-1、TNF-α、COX-2、CRP水平；魏氏法测定患者红细胞沉降率（ESR）水平；在治疗前、治疗14 d采用生活质量综合评定问卷-74（GQOLI-74）评估患者生活质量；比较患者治疗后的临床疗效；记录患者治疗期间不良事件的发生情况及随访3个月的复发情况。结果 与治疗前比较，治疗7、14 d两组患者ROM均增大（P<0.05），VAS评分、ESR水平、中医证候积分及血清UA、IL-1、TNF-α、CRP、COX-2水平均降低（P<0.05)；与治疗7 d比较，治疗14 d两组患者ROM均增大（P<0.05），VAS评分、ESR水平、中医证候积分及血清UA、IL-1、TNF-α、CRP、COX-2水平均降低（P<0.05）；与对照组比较，观察组患者治疗7、14 d ROM均增大（P<0.05），VAS评分、ESR水平、中医证候积分及血清UA、IL-1、TNF-α、CRP、COX-2水平均降低（P<0.05）。与治疗前相比，治疗14 d两组患者GQOL-74中躯体功能、心理功能、社会功能、物质生活状态及总体生活质量评分均升高（P<0.05）；且观察组患者GQOL-74中躯体功能、心理功能、社会功能、物质生活状态及总体生活质量评分均高于对照组（P<0.05）。观察组治疗总有效率（94.29%）高于对照组（87%）（P<0.05）。结论 黄柏骨伤散治疗湿热型痛风性关节炎患者的临床效果良好且安全性高，可有效改善患者临床症状，抑制炎症反应，降低UA水平，从而提高患者生活质量。 |
| 关键词: 痛风性关节炎|黄柏骨伤散|湿热型|尿酸|疼痛 |
| DOI：10.3969/j.issn.1674-070X.2026.05.012 |
| 投稿时间：2026-03-03 |
| 基金项目:深圳市宝安区医疗卫生科研项目（2024JD124）；2024年度广东省医学科研基金立项项目（A20241096）。 |
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| Clinical efficacy of Huangbai Gushang Powder in treating gouty arthritis with damp-heat pattern and its effects on serum levels of UA, COX-2, CRP, TNF-α, and IL-1 |
| LAI Yuwen, DU Genfa, XIA Weiyi, QIU Hongtao, LIN Qing, LI Tianke, SHENG Zhaohui |
| (Shenzhen Bao'an Traditional Chinese Medicine Hospital, Shenzhen, Guangdong 518133, China) |
| Abstract: |
| Objective To explore the clinical efficacy of Huangbai Gushang Powder in treating patients with gouty arthritis of damp-heat pattern and its effects on serum levels of uric acid (UA), cyclooxygenase-2 (COX-2), C-reactive protein (CRP), tumor necrosis factor (TNF-α), and interleukin-1 (IL-1). Methods A prospective study was conducted on 210 patients with damp-heat type gouty arthritis admitted to Shenzhen Bao'an Traditional Chinese Medicine Hospital from January 2023 to April 2025. The patients were randomly divided into control group and observation group using a random number table method, with 105 patients in each group. Both groups received lifestyle guidance and UA-lowering medication (febuxostat 40-80 mg/time, allopurinol 100-300 mg/time, benzbromarone 50 mg/time, once daily). On this basis, the control group was treated with etoricoxib tablets (60 mg/time, once daily) for 14 consecutive days. The observation group received additional topical application of Huangbai Gushang Powder (once daily, each application lasting 4-6 hours) for 14 consecutive days. Before treatment, at 7 days and 14 days of treatment, pain severity was assessed using visual analogue scale (VAS); knee joint range of motion (ROM) was measured with a goniometer; TCM pattern scores were recorded; serum UA levels were measured by high-performance liquid chromatography; serum levels of IL-1, TNF-α, COX-2, and CRP were determined by ELISA; erythrocyte sedimentation rate (ESR) was measured by the Westergren method. Before treatment and at 14 days of treatment, quality of life was assessed using the Generic Quality of Life Inventory-74 (GQOLI-74). Clinical efficacy after treatment was compared between groups. Adverse events during treatment and recurrence within three months of follow-up were recorded. Results Compared with before treatment, ROM increased (P<0.05), while VAS scores, ESR levels, TCM pattern scores, and serum levels of UA, IL-1, TNF-α, CRP, and COX-2 decreased (P<0.05) in both groups at 7 days and 14 days of treatment. Compared with 7 days of treatment, ROM increased (P<0.05), while VAS scores, ESR levels, TCM pattern scores, and serum levels of UA, IL-1, TNF-α, CRP, and COX-2 decreased (P<0.05) in both groups at 14 days of treatment. Compared with the control group, the observation group showed increased ROM (P<0.05) and decreased VAS scores, ESR levels, TCM pattern scores, and serum levels of UA, IL-1, TNF-α, CRP, and COX-2 (P<0.05) at both 7 and 14 days of treatment. Compared with before treatment, scores for physical function, psychological function, social function, material living status, and overall quality of life in the GQOL-74 increased in both groups at 14 days of treatment (P<0.05); these scores were significantly higher in the observation group than in the control group (P<0.05). The total clinical effective rate in the observation group (94.29%) was higher than that in the control group (87%) (P<0.05). Conclusion Huangbai Gushang Powder demonstrates favorable clinical efficacy and high safety in treating patients with damp-heat type gouty arthritis. It can effectively alleviate the clinical symptoms, inhibit inflammatory response, reduce UA levels, and thereby improve patients' quality of life. |
| Key words: gouty arthritis|Huangbai Gushang Powder|damp-heat pattern|uric acid|pain |
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