Clinical Observation On The Treatment Of AGA With Qingre Tongluo Method And Its Effect On P2X7R Signal Pathway

Objective:To observe the clinical efficacy and safety of Qingre Tongluo Method in the treatment of acute gouty arthritis(AGA),and to explore the mechanism of the treatment of AGA from the perspective of P2X7 R signaling pathway.To provides basis for prevention and treatment of gout.Methods: Forty patients with damp-heat accumulation type AGA in outpatient clinic were selected and treated with Qingre Tongluo Decoction for 5 days.Observe the changes of TCM syndrome score,joint pain,joint tenderness and general health VAS score,joint swelling,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and blood uric acid(UA)before and after treatment.RT-PCR was used to detect the expression levels of P2X7 and IL-1β mRNA in peripheral blood mononuclear cells(PBMCs);Western blot was used to detect the protein expression levels of PBMCs P2X7,IL-1β,NLRP3,and NF-κB(P50,P65);ELISA was used to detect the plasma levels of IL-1β,IL-8,and IL-37;and ATP levels in plasma were measured by biochemical methods.Those result were compared before and after treatment.And to explore the clinical efficacy observation indicators,ATP,IL-1β and P2X7 mRNA expression level of correlation.Results: 1.After the course of treatment,8 patients were clinically controlled,27 cases were markedly effective,4 were effective,and 1 was ineffective.The total effective rate was 97.50%.The result of TCM syndrome curative effect judgment was that 23 persons were markedly effective,15 persons were effective,and 2 persons were ineffective.The total effective rate was 95.00%.The method of Qingre Tongluo can reduce the TCM syndrome scores of patients with AGA,improve joint pain,joint tenderness and general health of patients,and relieve joint swelling(P<0.05).In addition,this method can reduce the levels of ESR and CRP in AGA patients(P<0.01),and has a certain effect of lowering UA(P<0.05).During the entire treatment process,there was no significant difference in the safety indicators of patients’ blood routine,liver and kidney function(P>0.05),and no serious adverse reactions and adverse events occurred.2.The method of Qingre Tongluo can down-regulate the expression of P2X7 and IL-1β mRNA in the PBMCs of AGA patients,and reduce the protein expression levels of P2X7,IL-1β,NLRP3 and NF-κB(P50,P65).The difference before and after is statistically significant(P<0.01).The levels of IL-1β,IL-8,IL-37 and ATP in plasma were significantly decreased by this method(P<0.01).Correlation analysis showed that the TCM syndrome score,joint pain,joint tenderness and overall health VAS score,joint swelling,ESR,and CRP levels of AGA patients before and after treatment were significantly positively correlated with the expression level of P2X7 mRNA(P<0.01,P<0.05).There was no significant correlation between UA level and P2X7 mRNA expression level(P>0.05).The expression levels of IL-1β and its mRNA,ATP and P2X7 mRNA were positively correlated before and after treatment,and the results were statistically significant(P<0.01,P<0.05).Conclusion: 1.The method of Qingre Tongluo is safe and effective in treating AGA without obvious side effects.2.The method of Qingre Tongluo may exert the therapeutic effect of AGA by regulating the expression of P2X7 R signaling pathway and its related factors.