Dang Wan-Tai, Zhou Jing-Guo, Xie Wen-Guang, Qing Yu-Feng, Pan Shu-Yue, Zhang Meng-Yun, Pu Meng-Jun
Institute of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Sichuan 637000, China.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Oct;33(10):1323-7.
To understand the difference in clinical indicators of gout patients of different Chinese medical syndromes and its clinical significance.
Form November 2011 to December 2012, syndrome typed were 257 male gout in-/outpatients from Affiliated Hospital of Chuanbei Medical College. Another 50 healthy male subjects were recruited as the control. Their clinical and laboratory data were collected. All were excluded from infections and other inflammatory diseases.
Four syndrome types existed in gout patients, i.e., intermingled phlegm-stasis blood syndrome (IPSBS), obstruction of dampness and heat syndrome (ODHS), Pi-deficiency induced dampness syndrome (PDIDS), qi-blood deficiency syndrome (QBDS). Of them, 53 acute phase gout patients suffered from IPSBS, 41 from ODHS, 25 from QBDS, and 17 from PDIDS; 41 non-acute phase gout patients suffered from QBDS, 40 from PDIDS, 24 from ODHS, and 16 from IPSBS. Statistical analysis of clinical data showed that, when compared with the normal control group, there was statistical difference in blood routines (WBC, GR, LY, MO) and blood biochemical indices (UA, Ur, Cr, ALT, AST, ALB, GLOB, TG, HDL-C, VLDL-C, apoA, apoB100) of gout patients of different syndromes (P < 0.05, P < 0.01). There was also statistical difference or correlation among different syndromes (P < 0.05).
In the acute phase gout patients, IPSBS and ODHS were dominated, while in the non-acute phase gout patients, QBDS and PDIDS were often seen. In patients of IPSBS and ODHS, inflammation and immune response were more obvious, indicating that better efficacy might be achieved by clearing heat and removing blood stasis associated anti-inflammatory and immune regulation therapies. In patients of QBDS and PDIDS, impaired renal functions were more significant, indicating that better efficacy might be achieved by invigorating Pi and tonifying Shen dominated treatment.
了解痛风患者不同中医证型的临床指标差异及其临床意义。
选取2011年11月至2012年12月在川北医学院附属医院就诊的257例男性痛风患者进行辨证分型,另选取50例健康男性作为对照,收集其临床及实验室资料,所有研究对象均排除感染及其他炎性疾病。
痛风患者存在4种证型,即痰瘀互结证、湿热痹阻证、脾虚湿阻证、气血亏虚证。其中急性期痛风患者53例为痰瘀互结证,41例为湿热痹阻证,25例为气血亏虚证,17例为脾虚湿阻证;非急性期痛风患者41例为气血亏虚证,40例为脾虚湿阻证,24例为湿热痹阻证,16例为痰瘀互结证。临床资料统计分析显示,不同证型痛风患者血常规(白细胞、中性粒细胞、淋巴细胞、单核细胞)及血液生化指标(尿酸、尿素、肌酐、谷丙转氨酶、谷草转氨酶、白蛋白、球蛋白、甘油三酯、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B100)与正常对照组比较,差异有统计学意义(P<0.05,P<0.01)。不同证型间比较差异亦有统计学意义(P<0.05)。
痛风急性期患者以痰瘀互结证、湿热痹阻证为主,非急性期患者以气血亏虚证、脾虚湿阻证多见。痰瘀互结证、湿热痹阻证患者炎症及免疫反应较明显,提示清热化瘀兼抗炎及免疫调节治疗可能疗效更佳;气血亏虚证、脾虚湿阻证患者肾功能损害较显著,提示健脾补肾为主的治疗可能疗效更佳。