【目的】 探讨胃苓汤治疗脾虚湿阻型痛风的临床疗效及其对血尿酸（BUA）和炎症指标的影响。【方法】 选取2023年9月 至 2024年 9月佛山市中医院风湿免疫科收治的脾虚湿阻型痛风患者 100例，采用随机数字表法将患者随机分为对照组 51例 与观察组49例。对照组给予非布司他片、依托考昔片、秋水仙碱片口服的西医常规治疗，观察组在对照组基础上联合胃苓 汤治疗，疗程均为4周。观察2组患者治疗前后中医证候积分、疼痛视觉模拟量表（VAS）评分、BUA水平及炎症指标[C反应 蛋白（CRP）、红细胞沉降率（ESR）、白细胞计数（WBC）、血小板计数（PLT）]和尿pH值的变化情况，并评估2组的临床疗效和 用药安全性。【结果】（1）疗效方面：治疗4周后，观察组的总有效率为93.88%（46/49），对照组为80.39%（41/51），组间比较 （χ2 检验），观察组的疗效明显优于对照组（P＜0.05）。（2）中医证候积分方面：治疗后，2组患者的中医证候积分均较治疗前降 低（P＜0.01），且观察组的降低幅度明显优于对照组（P＜0.01）。（3）疼痛程度方面：治疗后，2组患者的疼痛程度VAS评分均 较治疗前明显降低（P＜0.01），且观察组的降低幅度明显优于对照组（P＜0.01）。（4）相关实验室指标方面：治疗后，2组患者 的BUA、CRP、ESR、WBC、PLT水平均较治疗前降低（P＜0.01），且观察组对BUA、CRP、ESR的降低幅度均明显优于对照 组（P＜0.01），而观察组对 WBC、PLT 水平的降低幅度与对照组比较未见明显差异（P＞0.05）。（5）尿 pH 值和安全性指标方 面，2组患者治疗前后的尿 pH值和血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血清肌酐（SCr）等肝肾功能 指标均无明显变化，差异均无统计学意义（P＞0.05）。【结论】 胃苓汤联合西医常规治疗脾虚湿阻型痛风患者效果显著，能够 有效缓解患者临床症状，改善BUA和相关炎症指标，其疗效优于单纯西医常规治疗。

Objective To investigate the clinical efficacy of Weiling Decoction in treating gout patients with spleen deficiency and dampness obstruction syndrome and to observe its effects on blood uric acid （BUA） and inflammatory markers. Methods A total of 100 patients with spleen deficiency and dampness obstruction syndrome admitted to the Rheumatology and Immunology Department of Foshan Hospital of Traditional Chinese Medicine between September 2023 and September 2024 were selected. Patients were divided into a control group （51 cases） and an observation group （49 cases） using a random number table method. The control group received conventional western medicine treatment including Febuxostat Tablets，Etoricoxib Tablets，and Colchicine Tablets orally. The observation group received Weiling Decoction in addition to the conventional western medicine treatment. The treatment course for both groups was 4 weeks. The following parameters were observed before and after treatment in both groups：TCM syndrome scores，Visual Analogue Scale （VAS） scores of pain，BUA levels，inflammatory markers [C-reactive protein （CRP）， erythrocyte sedimentation rate （ESR）， white blood cell count （WBC）， platelet count （PLT）]， and urine pH. Clinical efficacy and medication safety were evaluated in both groups. Results （1） Therapeutic efficacy：After 4 weeks of treatment，the total effective rate was 93.88% （46/49） in the observation group and 80.39% （41/51） in the control group. The intergroup comparison （by chi-square test） revealed that the efficacy in the observation group was significantly superior to that in the control group （P＜0.05）. （2） TCM syndrome scores：After treatment，TCM syndrome scores decreased in both groups compared to before treatment （P＜0.01），and the reduction in the observation group was significantly greater than that in the control group （P＜0.01）.（3） Pain intensity：After treatment，pain VAS scores significantly decreased in both groups compared to before treatment （P＜0.01），and the reduction in the observation group was significantly greater than that in the control group （P＜0.01）.（4） Relevant laboratory indicators：After treatment，levels of BUA，CRP， ESR，WBC，and PLT decreased in both groups compared to before treatment （P＜0.01）. The reductions in BUA， CRP，and ESR were significantly greater in the observation group than in the control group （P＜0.01），while no significant difference was observed in the reductions of WBC and PLT levels between the observation group and the control group （P＞0.05）.（5） Urine pH and safety indicators：No significant changes were observed in the urine pH and in the liver and kidney function indicators of serum alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and serum creatinine （SCr） before and after treatment in either group， with no statistically significant differences （P＞0.05）. Conclusion Weiling Decoction combined with conventional western medicine demonstrates significant efficacy in treating gout patients with spleen deficiency and dampness obstruction syndrome. It effectively alleviates clinical symptoms and improves BUA and related inflammatory markers，with superior therapeutic effects compared to conventional western medicine alone.

R259.897

国家重点研发计划项目（编号：2018YFC2002500）