世界中医药

目的：分析电针治疗湿热蕴结型痛风性膝关节炎的临床疗效，及对NOD样受体蛋白3(NLPR3)炎性小体的影响。方法：选取2016年1月至2018年1月延安市中医医院收治的湿热蕴结型痛风性膝关节炎患者86例作为研究对象，按照随机数字表法随机分为观察组和对照组，每组43例。2组患者均予以常规西药予以消炎止痛治疗及日常生活饮食指导、活动锻炼指导。观察组在常规治疗基础上再予以针刺双侧足三里、三阴交、丰隆及患侧阿是穴，采用低频脉冲治疗仪刺激双侧膝周的梁丘、犊鼻、血海、内膝眼穴位。2组患者均连续治疗2周为1个疗程。比较2组患者治疗前、后膝关节疼痛评分（VAS）、肿胀评分、功能活动度变化、血清NLRP3、PYCARD、CASPl基因mRNA表达、血清炎性反应指标（IL-1B、IL-2、IL4、IL-6、IL-10、TNF-α）。完成治疗后对2组患者进行疗效评价。收集治疗期间2组患者药物不良反应并比较。结果：1）治疗2周后，2组患者治疗后VAS、肿胀评分、膝关节活动较治疗前明显降低，且观察组明显低于对照组(P<0.05)。2）治疗后2组患者血清炎性反应因子IL-1B、IL-2、IL4、IL-6、IL-10、TNF-α较治疗前降低，且观察组明显低于对照组（P<0.05）。3）治疗后，2组患者血清NLRP3基因mRNA表达均较治疗前明显升高，且观察组高于对照组，PYCARD、CASPl基因mRNA表达均较治疗前明显降低，且观察组低于对照组（P<0.05）；4）2组患者完成治疗后，观察组患者临床总有效率均明显高于对照组（P<0.05）；5）2组患者治疗过程中药物不良反应发生率比较，差异无统计学意义（P>0.05）。结论：电针辅助消炎止痛药物可更有效提升湿热蕴结型痛风性膝关节炎患者NLPR3基因mRNA表达水平，降低血清炎性反应水平，促进患者临床症状改善，提高临床疗效，其安全可靠，具有较高的临床价值。

English Summary:

To analyze the clinical effects of electroacupuncture on gouty knee arthritis of damp-heat accumulation syndrome and its influence on inflammatory body of NOD-like receptor protein 3(NLPR3).Methods:From January 2016 to January 2018，86 patients with gouty knee arthritis of damp-heat accumulation syndrome who met the inclusion criteria in Yan'an Hospital of TCM were selected as the subjects.According to the order of visiting，they were divided into a control group and an observation group，with 43 cases in each group.Both groups were given routine western medicine to treat inflammation and relieve pain，daily life diet guidance，exercise guidance.On the basis of routine treatment，the observation group was given acupuncture at bilateral Zusanli(ST36)，Sanyinjiao(SP6)，Fenglong(ST40)and the affected side Ashi points，and low-frequency pulse therapy apparatus was used to stimulate the Liangqiu(ST34)，Dubi(ST35)，Xuehai(SP10)and Neixiyan(EX-LE4)around the knee.Both groups of patients were treated for 2 weeks for a course of treatment.The knee pain score(VAS)，swelling score，functional activity，serum NLRP3，PYCARD，CASPl gene mRNA expression，serum inflammatory markers(IL-1B，IL-2，IL-4，IL-6，IL-10，TNF-α)were compared between the 2 groups before and after treatment.After completion of treatment，the clinical efficacy of the 2 groups was evaluated.The adverse drug reactions/side effects of the 2 groups were collected and compared.Results:1)After 2 weeks of treatment，VAS，swelling score and knee joint activity of the 2 groups were significantly decreased，and the study group was significantly lower than the control group(P<0.05).2)After treatment，the levels of serum inflammatory factors IL-1B，IL-2，IL-4，IL-6，IL-10 and TNF-α in the 2 groups were significantly decreased than before treatment，and the observation group was significantly lower than those in the control group(P<0.05). 3)After treatment，the expression of NLRP3 gene mRNA in serum of the 2 groups was significantly increased than that before treatment，and the observation group was higher than the control group.The expression of PYCARD and CASPl gene mRNA in the observation group was significantly decreased than that before treatment，and the observation group was lower than the control group(P<0.05).4)After treatment，the clinical total effective rate of the observation group was significantly higher than the control group(P<0.05).5)There was no significant difference in the rate of adverse drug reactions/side effects between the 2 groups(P>0.05).Conclusion:Electroacupuncture assisted anti-inflammatory and analgesic drugs can effectively improve the expression of NLPR3 gene mRNA in patients with gouty knee arthritis of damp-heat accumulation syndrome，reduce the level of serum inflammation，promote the improvement of clinical symptoms and improve the clinical efficacy，which is safe and reliable，and has high clinical value.

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