标题：小剂量秋水仙碱联合美洛昔康治疗痛风性关节炎疗效观察

      作者：刘元德，李昊    (中国人民解放军第91388部队医院内科，广东 湛江 524022)

      卷次： 2018年29卷17期

      【摘要】 目的 探讨小剂量的秋水仙碱联合美洛昔康治疗痛风性关节炎的临床疗效及不良反应。方法 选取2015年12月至2018年3月在91388部队医院内科门诊就诊的痛风性关节炎患者共73例，采用随机数表法随机将患者分成A组(25例)、B组(24例)和C组(24例)，A组采用秋水仙碱联合美洛昔康治疗，B组采用秋水仙碱传统的大剂量治疗，C组采用美洛昔康治疗，疗程均为1周。比较三组患者的临床疗效、疼痛视觉模拟评分(VAS)、疼痛缓解时间、血尿酸、红细胞沉降率(ESR)、C反应蛋白(CRP)以及用药后的不良反应。结果 A组患者的临床治疗总有效率为96.0%，明显高于C组的70.8%，差异有统计学意义(P<0.05)，而B组患者的临床治疗总有效率为87.5%，与A组比较，差异无统计学意义(P>0.05)；三组患者治疗后VAS评分均较治疗前明显降低，差异均有统计学意义(P<0.05)，治疗后24~72 h，A组患者的VAS评分显著低于B组和C组，差异均有统计学意义(P<0.05)，而治疗后120~168 h，三组患者的VAS评分比较差异无统计学意义(P>0.05)；三组患者的关节疼痛缓解时间比较差异有统计学意义(P<0.05)，A组患者的疼痛缓解时间显著短于B组和C组，差异有统计学意义(P<0.05)；治疗后三组患者的ESR、CRP水平均明显下降，差异有统计学意义(P<0.05)，A组、B组均显著低于C组，差异有统计学意义(P<0.05)，三组患者血尿酸水平治疗前后无明显变化(P>0.05)；A组患者在治疗过程中的不良反应率为20.0%，C组的不良反应率为16.7%，均显著低于B组58.3%的不良反应率，差异有统计学意义(P<0.05)。结论 小剂量秋水仙碱联合美洛昔康治疗痛风性关节炎临床疗效显著，其能迅速改善患者关节疼痛症状，安全性高。
      【关键词】 痛风性关节炎；秋水仙碱；美洛昔康；联合治疗；疗效
      【中图分类号】 R684.3 【文献标识码】 A 【文章编号】 1003—6350（2018）17—2486—04

Clinical observation of small dose of colchicine combined with meloxicam in the treatment of acute goutyarthritis.
LIU Yuan-de, LI Hao. Department of Internal Medicine, the 91388th Hospital of Chinese PLA, Zhanjiang 524022,Guangdong, CHINA
【Abstract】 Objective To observe the clinical effects and safety of small dose of colchicine combined withmeloxicam in the treatment of acute gouty arthritis. Methods A total of 73 patients with acute gouty arthritis, who weretreated in Department of Internal Medicine of the 91388th Hospital of Chinese PLA from December 2015 to October2017, were selected and divided into the group A (n=25), group B (n=24) and group C (n=24) according to random num-ber table method. The group A was treated with a small dose of colchicine, the group B was treated with the conventionaldose of colchicine, and the group C was treated with meloxicam. The clinical efficacy, the Visual Analogue Scale (VAS)scores, the time of pain relief, the level of serum uric acid, erythrocyte sedimentation rate and C reactive protein, and ad-verse reaction were compared among the three groups. Results The clinical effective rate in the group A was 96.0%,which was significantly higher than 70.8% in the group C (P<0.05), but there was no significant difference comparedwith 87.5% in the group B (P>0.05). After the treatment, the VAS scores of three groups were all significantly lowerthan those before treatment (P<0.05). After the treatment for 24~72 hours, the VAS scores of the group A were signifi-cantly lower than those of the group B and group C (P<0.05), while the difference of VAS scores in the three groupswere not significant after the treatment for 120~168 hours (P>0.05). There were statistically significant differences in thetime of pain relief among three groups (P<0.05), which was significantly lower in group A and group B than group C(P<0.05). After the treatment, the level of erythrocyte sedimentation rate and C reactive protein were significantly de-creased among three groups (P<0.05), and they were significantly lower in the group A and group B than the group C (P<0.05). There was no significant difference in the level of serum uric acid among three groups (P>0.05). The adverse reac-tion rate of the group A and group C were respectively 20.0% and 16.7%, which were significantly lower than 58.3% inthe group B (P<0.05). Conclusion Small dose of colchicine combined with meloxicam has a significant clinical effica-cy in the treatment of gouty arthritis. It can rapidly relieve the pain of patients with high safety, and is worthy of popular-ization and application.
      【Key words】 Gouty arthritis; Colchicine; Meloxicam; Combined treatment; Clinical effect·临床经验·doi:10.3969/j.issn.1003-6350.2018.17.034