杨阳 李金田 李娟 李博宽 魏腾飞 田萍

【摘 要】目的：系統评价白虎加桂枝汤加减治疗急性痛风性关节炎的有效性与安全性。方法：计算机检索中国知网（CNKI）、维普（VIP）、万方（Wanfang）、Pubmed、Cochrane Library、Web of Science等数据库发表的白虎加桂枝汤加减治疗急性痛风性关节炎的随机对照试验，检索时间为数据库建立至2019年12月1日。根据Cochrane系统评价手册，采用RevMan 5.3软件对总有效率、血尿酸和不良反应发生率等进行Meta分析。结果：最终纳入12篇文献，共1109例患者，试验组564例，对照组545例。Meta分析结果显示，与常规西药疗法比较，白虎加桂枝汤加减治疗急性痛风性关节炎在总有效率

（RR = 1.16，95%CI = [1.10，1.23]，P < 0.000 01），血尿酸（MD = -56.01，95%CI = [-75.89，-36.41]，P < 0.000 01）方面疗效显著，不良反应发生率（RR = 0.31，95%CI = [0.19，0.49]，P < 0.000 01）更低，差异均有统计学意义。根据GRADE评价标准，总有效率和不良反应发生率2个结局指标证据为中质量，血尿酸变化的结局指标证据为低质量。结论：白虎加桂枝汤加减治疗急性痛风性关节炎有效性和安全性优于西药常规疗法，但此结论仍需要开展多中心、高质量的随机对照试验进一步验证。

【关键词】 急性痛风性关节炎;白虎加桂枝汤;加减;疗效;Meta分析

Efficacy of Modified Baihu Jia Guizhi Tang（白虎加桂枝汤）in the Treatment of Acute Gouty Arthritis：

A Systematic Review

YANG Yang，LI Jin-tian，LI Juan，LI Bo-kuan，WEI Teng-fei，TIAN Ping

【ABSTRACT】Objective：To systematically evaluate the efficacy and safety of Modified Baihu Jia Guizhi Tang（白虎加桂枝汤）in the treatment of acute gouty arthritis.Methods：The randomized controlled trials of treating acute gouty arthritis with Baihu Jia Guizhi Tang collected in CNKI，VIP，Wanfang，PubMed，Cochrane Library and Web of Science from the establishment of the databases to December 2019 were searched by computer.According to the Cochrane System Review Manual，software Revman 5.3 was used for meta-analysis of the total effective rate，serum uric acid and incidence of adverse reactions.Results：Twelve articles were included，including 1109 patients（564 patients in the experimental group and 545 patients in the control group）.Meta-analysis results showed that compared with conventional western medicine therapy，modified Baihu Jia Guizhi Tang had a significant effect on total effective rate（RR = 1.16，95%CI = [1.10，1.23]，P < 0.000 01），

serum uric acid（MD = -56.01，95%CI = [-75.89，-36.41]，P < 0.000 01）and the incidence of adverse reactions（RR = 0.31，95%CI = [0.19，0.49]，

P < 0.000 01）was lower，with the difference being statistically significant.According to the GRADE evaluation standard，the total effective rate and the incidence of adverse reactions were of medium quality，and the change of serum uric acid was of low quality.Conclusion：The efficacy and safety of modified Baihu Jia Guizhi Tang in the treatment of acute gouty arthritis is better than that of conventional western medicine，but this conclusion still needs to be further verified by multi-center，high-quality randomized controlled trials.

【Keywords】 acute gouty arthritis;Baihu Jia Guizhi Tang（白虎加桂枝汤）;modified;efficacy;Meta-analysis

急性痛风性关节炎属于代谢性风湿病范畴，为人体关节、软骨或其他组织产生的一种单钠尿酸盐沉积现象，从而导致的炎性反应。近年来，随着人们生活方式的改变，如不良饮食习惯，长期紧张、焦虑等不良情绪刺激，急性痛风性关节炎的患病率有所上升并呈年轻化趋势。其早期临床表现为受累关节红肿热痛，进而出现关节畸形、功能障碍，最终导致多系统损害，患者的生活质量严重降低[1]。因此，寻找一种有效且安全的治疗手段十分重要，而中医药治疗急性痛风性关节炎具有一定的临床优势。

中医学认为，急性痛风性关节炎属“痹病”“历节病”“白虎历节”“浊瘀痹”等范畴，其病机多为湿热之邪造成筋脉阻滞进而出现气血运行不畅，故治以清利湿热、荣筋止痛为主。……