世界中医药

目的：探讨大黄牡丹汤加味治疗慢性肾脏病（CKD）高尿酸血症患者的临床效果。方法：采用回顾性分析方法，选取2019年10月至2022年6月在秦皇岛市中医医院接受别嘌醇片治疗的CKD高尿酸血症患者42例作为对照组；选取同期接受大黄牡丹汤加味联合别嘌醇片治疗的CKD高尿酸血症患者46例作为观察组，疗程均为8周。比较2组24 h尿蛋白定量、24 h尿酸水平，临床疗效，血肌酐（SCr）、血尿素氮（BUN）、肾小球滤过率（GFR）、尿酸（UA）等肾功能指标，中医证候积分，不良反应的发生情况。结果：观察组和对照组的总有效率分别为91.30%（42/46）和66.66%（28/42）；肾功能指标SCr分别为（98.21±14.01）μmol/L和（121.52±29.14）μmol/L，BUN分别为（7.56±0.63）mmol/L和（9.24±0.98）mmol/L，血清UA分别为（681.43±106.73）和（549.63±87.49）μmol/L，GFR分别为（28.97±9.23）mL/（min·1.732）和（24.56±8.44）mL/（min·1.732），差异有统计学意义（P<0.05）；尿酸代谢指标分别为24 h尿蛋白定量分别为（1.01±0.87）g和（1.94±1.12）g，24 h尿酸水平分别为（398.31±32.47）μmol/L和（456.32±40.58）μmol/L，差异有统计学意义（P<0.05）；TNF-α水平分别为（45.27±5.93）μg/L和（88.62±8.71）μg/L，IL-6水平分别为（41.73±6.21）ng/L和（82.56±8.98）ng/L，CRP水平分别为（7.97±0.38）mg/L和（14.22±1.89）mg/L，差异有统计学意义（P<0.05）；2组中医证候积分均改善，且观察组比对照组低，差异均有统计学意义（均P<0.05）。观察组和对照组均无药物不良反应发生。结论：CKD高尿酸血症患者经大黄牡丹汤加味联合别嘌醇片治疗比单纯别嘌醇片治疗疗效更佳，且安全性高。

English Summary:

To explore the clinical efficacy of modified Dahuang Mudan decoction in the treatment of hyperuricemia in patients with chronic kidney disease(CKD).Methods:Retrospective analysis was performed，42 cases of hyperuricemia with CKD treated with allopurinol tablets in Qinhuangdao Traditional Chinese Medicine Hospital from October 2019 to June 2022 were included as the control group; 46 cases of hyperuricemia with CKD who received the treatment of modified Dahuang Mudan Decoction combined with allopurinol tablets in the same period were included as the observation group，and they were both treated for 8 weeks.The 24-hour urine protein quantification，24-hour urine uric acid level，clinical efficacy，renal function indicators such as serum creatinine(SCr)，blood urea nitrogen(BUN)，glomerular filtration rate(GFR)，uric acid(UA)，traditional Chinese medicine syndrome score，and incidence of adverse reactions between the two groups were compared.Results:The total effective rates of the observation group and the control group were 91.30%(42 cases/46 cases) and 66.66%(28 cases/42 cases)，respectively.The renal function indicator SCr were(98.21±14.01) μmol/L and(121.52±29.14) μmol/L，respectively; BUN were(7.56±0.63) mmol/L and(9.24±0.98) mmol/L，respectively; serum UA were(681.43±106.73) μmol/L and(549.63±87.49) μmol/L，respectively; GFR were(28.97±9.23) mL/(min·1.732) and(24.56±8.44) mL/(min·1.732)，respectively，and the difference was statistically significant(P<0.05).The uric acid metabolism indicator 24-hour urine protein quantifications were(1.01±0.87) g and(1.94±1.12) g，respectively; 24-hour uric acid levels were(398.31±32.47) μmol/L，(456.32±40.58) μmol/L，respectively，and the difference was statistically significant(P<0.05).TNF-α levels were(45.27±5.93) μg/L and(88.62±8.71) μg/L，respectively; IL-6 levels were(41.73±6.21) ng/L and(82.56±8.98) ng/L，respectively; CRP levels were(7.97±0.38) mg/L and(14.22±1.89) mg/L，respectively，and the difference was statistically significant(P<0.05).The traditional Chinese medicine(TCM) symptom scores of the two groups were both improved，and that of the observation group was lower than that of the control group; the differences were both statistically significant(P<0.05).There were no adverse drug reactions in the observation group and the control group.Conclusion:The treatment of hyperuricemia in patients with CKD with modified Dahuang Mudan Decoction combined with allopurinol tablets is more effective and safe than that with allopurinol tablets alone.

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