陈杰 郑颖 廖琳 刘文瑞 郭玥 段连香 路建饶 叶景华

【摘 要】目的：觀察塞来昔布联合二黄膏外敷治疗瘀热阻滞型急性痛风性关节炎的临床疗效。方法：将140例急性痛风性关节炎患者按照随机数字表法分为治疗组和对照组，每组70例。在基础治疗的同时，对照组予塞来昔布胶囊每次200 mg，每日2次，口服;治疗组予塞来昔布胶囊每日200 mg，每日1次，口服，同时加用二黄膏局部外敷疼痛部位。2组均以7 d为1个疗程。在0，3，7 d采用疼痛视觉模拟评分法（VAS）评价疼痛情况，治疗前后检测红细胞沉降率（ESR）、单核细胞趋化蛋白-1（MCP-1）、巨噬细胞迁移抑制因子（MIF）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、前列腺素E2（PGE2）、白三烯B4（LTB4）水平。结果：共有128例完成研究，其中治疗组65例，对照组63例。治疗组临床治愈36例，显效21例，有效5例，无效3例，总有效率为95.38%;对照组临床治愈14例，显效18例，有效18例，无效13例，总有效率为79.36%。2组比较，差异有统计学意义（P < 0.05）。2组在治疗3，7 d时VAS评分较治疗前均有改善（P < 0.05），且治疗组优于对照组（P < 0.05）。治疗7 d后，2组ESR、MCP-1、MIF、IL-6、TNF-α、PGE2、LTB4较治疗前均有改善（P < 0.05），且治疗组改善程度优于对照组（P < 0.05）。结论：联合使用二黄膏局部外敷可以减少急性痛风性关节炎发作时塞来昔布的用量，同时提高缓解率，缩短疼痛缓解时间，减轻炎症反应，疗效优于单用双倍剂量的塞来昔布，且简单易用，值得临床推广。

【关键词】 痛风性关节炎;急性期;二黄膏;塞来昔布;瘀热阻滞型;临床疗效

Clinical Observation on Celecoxib Combined with Erhuang Ointment（二黄膏）in the Treatment of 65 Casesof Acute Gouty Arthritis of Static Heat Obstructing Type

CHEN Jie，ZHENG Ying，LIAO Lin，LIU Wen-rui，GUO Yue，DUAN Lian-xiang，LU Jian-rao，YE Jing-hua

【ABSTRACT】Objective：To observe the clinical efficacy of celecoxib combined with Erhuang ointment（二黄膏）in the treatment of acute gouty arthritis of static heat obstructing type.Methods：One hundred and forty patients with acute gouty arthritis were randomly divided into a treatment group and a control group，70 cases in each.On the basis of treatment，the control group was given celecoxib capsules（200 mg），twice a day;the treatment group was given them（200 mg），once a day，and external application of Erhuang ointment，7 days as a course of treatment for both groups.Visual analogue scale（VAS）was used to evaluate pain at the first，third and seventh days.Levels of erythrocyte sedimentation rate（ESR），monocyte chemoattractant protein-1（MCP-1），macrophage migration inhibitory factor（MIF），interleukin-6（IL-6），tumor necrosis factor-α（TNF-α），prostaglandin E2（PGE2）and leukotriene B4（LTB4）were detected before and after treatment.Results：A total of 128 cases completed in the study，including 65 cases in the treatment group and 63 cases in the control group.In the treatment group，36 cases were recovered，21 cases were markedly effective，5 cases were effective and 3 cases were ineffective，with a total effective rate of 95.38%;in the control group，14 cases were recovered，18 cases were markedly effective，18 cases were effective and 13 cases were ineffective，with a total effective rate of 79.36%.The difference between the two groups was statistically significant（P < 0.05）.The VAS scores of the two groups were improved at the 3 and 7 days after treatment（P < 0.05），and the treatment group was better than the control group（P < 0.05）.

After 7 days of treatment，ESR，MCP-1，MIF，IL-6，TNF-α，PGE2 and LTB4 were improved in both groups（P < 0.05），and the improvement degree in the treatment group was better than that in the control group（P < 0.05）.Conclusion：Combined use of Erhuang ointment can reduce the dosage of celecoxib in acute gouty arthritis attack，improve the remission rate，shorten the pain relief time，and reduce the inflammatory reaction.The curative effect of the combination is better than single use of double dose of celecoxib，simple，easy to use and worthy of clinical promotion.

【Keywords】 gouty arthritis;acute stage;Erhuang ointment（二黄膏）;celecoxib;static heat obstructing type;clinical efficacy

痛风（gout）是尿酸盐沉积在关节所致的晶体相关性关节病，与嘌呤代谢紊乱和（或）尿酸排泄减少所致的高尿酸血症直接相关[1]。急性痛风性关节炎（acute gouty arthritis，AGA）是痛风最常见的首发症状，临床表现以关节红肿热痛，以及活动受限为主，严重者可出现关节畸形、肾脏损害等病症。上海市名中医叶景华教授出生于中医世家，早年毕业于上海中医学院，师从名医丁济万，他一直倡导中医外治技术在杂病中的应用，对于瘀热阻滞型AGA，创制二黄膏局部外敷，疗效显著。……