| Objective:1.A meta-analysis of randomized controlled trials of external treatment of traditional Chinese medicine for acute gouty arthritis was conducted to evaluate the efficacy and safety of external treatment of traditional Chinese medicine for gout from the perspective of evidence-based medicine.2.To compare the clinical efficacy and safety of Erqingsan combined with etoricoxib and etoricoxib alone in the treatment of damp-heat-condensed acute gouty arthritis.Methods:1.A randomized controlled trial of CNKI,VIP,WANFANG,and PubMed databases in accordance with the Chinese medicine external treatment method for acute gouty arthritis was searched.The time was set since the establishment of the database to December 2019.On the11 th.The search terms are: "gout","gouty arthritis","traditional Chinese medicine","traditional Chinese medicine","gout","Traditional Chinese medicine" and related words.2.Sixty patients who were admitted to the outpatient department and inpatient department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to February 2020 and met the diagnostic criteria for western medicine and the syndrome differentiation of TCM based on damp heat syndrome were randomly divided into2 groups.There were 30 cases in the group and 30 cases in the control group.The control group was treated with cortisol,and the treatment group was given topical application of Erqing powder,and the two groups were given guidance on diet,work and rest for 1 week.The daily pain scores,TCM syndrome scores before and after treatment,and physical and chemical examinations such as ESR,C-reactive protein,and blood uric acid were observed in the two groups of patients.Statistical analysis was performed after treatment.Results:1.Study 1: 157 articles were included,a total of 1273 patients,including 642 patients in the experimental group and 631 patients in the control group.All the research and treatment groups were treated with traditional Chinese medicine combined with Western medicine,and the control group was treated with conventional Western medicine,and all research interventions had basic treatments such as diet control.Meta-analysis of the included literature,the main outcome indicators are as follows:(1)Clinical total effective rate: OR=3.30,Z=6.69(P<0.01),the difference is statistically significant.(2)Joint pain score: It was found that there was a high degree of heterogeneity in the merger,and no merger was carried out.Eight studies showed that the treatment group was superior to the control group,and four studies reported no significant difference between the two groups.(3)SUA: MD =-48.09,95%,Z= 6.25(P<0.01),the difference is statistically significant.(4)ESR: divided into sub-groups according to the course of treatment.As a result,at 14 days、10 days and7 days of treatment,The differences are statistically significant(P<0.01).CRP:divided into subgroups according to the course of treatment.At 14 days of treatment,there was no significant difference between the two groups(P>0.05);at 10 days and 7 days of treatment,The difference between the two groups was statistically(P<0.01).(5)Adverse reactions: the occurrence of total adverse reactions,the difference is statistically significant(P<0.05).In terms of gastrointestinal reactions,the difference was statistically significant(P<0.01).In terms of rash,there was no statistically significant difference between the two groups(P>0.01).2.There was 1 case of shedding in the treatment group,which was not included in the statistical analysis.The results of each study are as follows:(1)Disease efficacy: 2 cases of clinical healing in the observation group,12 cases of marked effect,14 cases of effective,1 case of ineffective,total effective rate of 96.55%;0 cases of clinical healing in the control group,7 cases of marked effect,16 cases of effective,7 cases of ineffective,total effective rate 76.67%.There was a statistically significant difference in the effect of disease between the two groups(P<0.05).(2)Pain NRS score: There was a statistically significant difference between the 2nd to 7th day of treatment and before treatment(P>0.01).The test group was compared with the previous day on the 2nd to 4th days of treatment,the difference was statistically significant(P<0.05),and compared with the previous day on the 1st,5th to 7th days of the treatment,the difference was not statistically significant(P>0.05).In the control group,the difference was statistically significant between the 2nd and 7th day of treatment and before treatment(P<0.01).The control group was compared with the previous day from 1 to 7 days of treatment,and the difference was not statistically significant(P>0.05).Compared between the two groups,the difference between the first and third days of treatment was not statistically significant(P>0.05);the difference between the results of the fourth and sixth days of treatment was statistically significant(P<0.05).On the seventh day,the NRS scores of pain in the two groups The difference was not statistically significant(P>0.05).(3)TCM syndrome score: The difference between the two groups before and after treatment is statistically significant(P<0.01).The difference between the two groups after treatment was statistically significant(P<0.05).In terms of joint swelling,the difference between the two groups was statistically significant(P<0.01).In joint pain and joint tenderness,the difference was statistically significant(P<0.05).In terms of flexion and extension and skin temperature,the difference was not statistically significant.Significance(P>0.05).Compared with the experimental group,there was significant statistical difference in joint pain,swelling,tenderness,unfavorable flexion and extension,and skin temperature before and after treatment(P<0.01).In the control group,the differences in joint pain,tenderness,flexion and extension,and skin temperature were statistically significant before and after treatment(P<0.01),and the joint swelling was statistically significant before and after treatment(P>0.05).(4)Laboratory indicators: In terms of SUA,the difference between the two groups before and after treatment was statistically significant(P<0.05),and the difference between the two groups after treatment was not statistically significant(P>0.05).In terms of ESR,there was no statistically significant difference between the two groups before and after treatment(P>0.05),and there was no statistically significant difference between the two groups after treatment(P>0.05).In terms of CRP,the difference between the experimental group before and after treatment was statistically significant(P<0.05),and the difference between the control group before and after treatment was not statistically significant(P>0.05).The difference between the two groups after treatment was not statistically significant(P>0.05).(5)Security:There were 1 case of elevated white blood cells in each of the two groups,and 1case of abnormal renal function and 1 case of rash in the test group.Two groups of total adverse reactions occurred after 2 tests,the difference was not statistically significant(P>0.05).Conclusion:1.This study initially confirmed that traditional Chinese medicine combined with western medicine has certain advantages in the treatment of acute gout,and it is superior to the western medicine group in clinical effectiveness,blood uric acid and safety.2.The external application of Erqingsan for the treatment of acute gouty arthritis combined with western medicine has a synergistic effect,especially in terms of joint swelling and tenderness.It has obvious advantages in improving patients’ CRP and blood uric acid. |
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