【目的】 观察基于“清浊相干”理论的升清降浊针法联合西药治疗湿热蕴结型痛风性肾病（GN）患者的临床疗效。 【方法】 选取2023年9月至2024年9月广州中医药大学第一附属医院重庆医院病房及门诊收治的117例明确诊断为GN的患者 作为研究对象。按随机数字表将患者随机分为西药组、对照组和观察组，每组各39例。西药组给予非布司他片治疗，对照 组在西药组治疗的基础上，给予常规针刺治疗，观察组在西药组治疗的基础上，给予升清降浊针法治疗，3组均治疗 4周。 治疗1个月后，评价3组临床疗效。观察3组患者治疗前后中医证候积分和疼痛视觉模拟量表（VAS）评分的变化情况，以及 血尿酸（UA）、血尿素氮（BUN）、肌酐（Scr）、肾小球滤过率（eGFR）、β2-微球蛋白（β2-MG）、24 h 尿蛋白定量（24 h-UTP）、 胱抑素C（CysC）含量的情况。比较3组患者治疗前后血沉（ESR）、C-反应蛋白（CRP）的变化情况。【结果】（1）西药组总有效率 为 71.79%（28/39），对照组为 84.62%（33/39），观察组为 92.31%（36/39），观察组疗效明显优于西药组，差异有统计学意义 （P＜0.05）；观察组疗效稍优于对照组，但与对照组比较，差异无统计学意义（P＞0.05）。（2）治疗后，3组患者的ESR、CRP、 UA水平均明显改善（P＜0.05），且观察组在改善ESR、CRP水平方面明显优于其余两组，同时在改善UA水平方面明显优于 西药组，差异有统计学意义（P＜0.05）；但观察组在改善UA水平方面与对照组比较，差异无统计学意义（P＞0.05）。对照组 在改善 ESR、CRP、UA 水平方面明显优于西药组，差异有统计学意义（P＜0.05）。（3）治疗后，3组患者的 Scr、BUN、eGFR 水平均明显改善（P＜0.05），且观察组在改善Scr、eGFR水平方面明显优于其余两组，差异有统计学意义（P＜0.05）；但对照 组在改善 Scr、eGFR水平方面与西药组比较，差异无统计学意义（P＞0.05）。3组患者在改善 BUN水平方面比较，差异无统 计学意义（P＞0.05）。（4）治疗后，3组患者的β2-MG、CysC水平比较，差异均有统计学意义（P＜0.05）；观察组和对照组患者 的 24h-UTP 水平明显改善，差异有统计学意义（P＜0.05），但西药组 24h-UTP 水平无明显改善，差异无统计学意义（P＞ 0.05）。观察组在改善24h-UTP、β2-MG水平方面明显优于其余两组，同时在改善CysC水平方面明显优于西药组，差异均有 统计学意义（P＜0.05）；在改善 CysC 水平方面与对照组比较，差异无统计学意义（P＞0.05）。对照组在改善 24h-UTP、 β2-MG、CysC水平方面与西药组比较，差异无统计学意义（P＞0.05）。（5）治疗后，3组患者的中医证候积分、VAS评分均明 显改善（P＜0.05），且观察组在改善中医证候积分、VAS评分方面明显优于西药组；在改善VAS评分方面与对照组比较，差 异无统计学意义（P＞0.05）。对照组在改善VAS评分方面明显优于观察组，差异有统计学意义（P＜0.05）；但对照组在改善中 医证候积分方面与其余两组比较，差异无统计学意义（P＞0.05）。【结论】 基于“清浊相干”理论的升清降浊针法治疗湿热蕴 结型痛风性肾病，能有效降低患者血尿酸水平，有效控制炎症，保护肾功能，疗效显著。

Objective To evaluate the clinical efficacy of Shengqing Jiangzhuo（lifting lucid yang and lowering turbid yin） Acupuncture Method，based on the “turbidity-clearness interaction”theory，combined with western medicine in treating gouty nephropathy（GN） patients with damp-heat accumulation syndrome. Methods A total of 117 patients diagnosed with GN from September 2023 to September 2024 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine Chongqing Hospital were enrolled and randomly divided into three groups，with 39 cases in each group. The western medicine group received Febuxostat Tablets，the control group was given western medicine + conventional acupuncture， and observation group was given western medicine + Shengqing Jiangzhuo Acupuncture Method. All groups received 4 weeks of treatment. Clinical efficacy，traditional Chinese medicine （TCM） syndrome scores，visual analogue scale（VAS） of pain scores，and laboratory parameters— including serum uric acid（UA），blood urea nitrogen（BUN），creatinine（Scr），estimated glomerular filtration rate （eGFR），β2-microglobulin（β2-MG），24-hour urinary protein（24h-UTP），cystatin C（CysC） were assessed. The erythrocyte sedimentation rate（ESR）， and C-reactive protein（CRP） were compared before and after treatment. Results（1） The total effective rate was 71.79% （28/39） in the western medicine group，84.62% （33/ 39） in the control group， and 92.31% （36/39） in the observation group. The observation group demonstrated statistically significant superiority over the western medicine group （P＜0.05），while showing marginally better efficacy than the control group without statistical significance （P＞0.05）.（2） After treatment，all three groups exhibited significant improvements in ESR，CRP，and UA levels （P＜0.05）. The observation group significantly outperformed the other two groups in reducing ESR and CRP levels （P＜0.05），and was statistically superior to the western medicine group in lowering UA levels （P＜0.05），though no significant difference was observed versus the control group for UA improvement （P＞0.05）. The control group showed significantly greater reductions in ESR，CRP，and UA levels than the western medicine group （P＜0.05）.（3） After treatment，Scr，BUN，and eGFR levels were significantly improved in all groups （P＜0.05）. The observation group achieved significantly better improvements in Scr and eGFR than the other two groups （P＜0.05）. However， no statistical difference existed between the control and western medicine groups for Scr or eGFR enhancement （P＞0.05）. No intergroup differences were detected in BUN improvement （P＞0.05）.（4） Significant differences emerged in β2-MG and CysC levels among all groups after treatment （P＜0.05）. Both observation and control groups demonstrated statistically significant improvements in 24-hour 24h-UTP （P＜0.05）， whereas the western medicine group showed no significant change （P＞0.05）. The observation group significantly outperformed the other groups in reducing 24h-UTP and β2-MG levels （P＜0.05），and was superior to the western medicine group in lowering CysC （P＜0.05），though no difference versus the control group was observed for CysC reduction （P＞0.05）. The control group showed no statistical advantage over the western medicine group in improving 24h-UTP，β2-MG， or CysC （P＞0.05）.（5）After treatment，TCM syndrome scores and VAS scores were significantly improved in all groups （P＜0.05）. The observation group achieved significantly greater reductions in TCM syndrome scores and VAS scores than the western medicine group （P＜0.05）. The control group showed statistically superior VAS score improvement versus the western medicine group （P＜0.05）， but no significant differences emerged in TCM syndrome score improvement compared to either group （P＞0.05）. No statistical difference existed between observation and control groups for VAS score reduction （P＞0.05）. Conclusion Shengqing Jiangzhuo Acupuncture Method， grounded in the “turbidity-clearness interaction” theory， effectively reduces serum UA， controls inflammation， and preserves renal function in damp-heat accumulation type of GN， demonstrating significant therapeutic benefits.

R246.9

巴渝青年岐黄学者支持项目（渝中医药发[2024]1号）；重庆市科卫联合中医药科研项目（编号：2020ZY4043）