| Objective:According to the diagnostic criteria of Western medicine in acute stage of gout, the topic strictly screens and includes patients who meet a criterion. The topic collects clinical data and designs TCM Syndrome Scale. We preliminarily summarize the TCM Syndromes of all cases. We analyse the TCM Syndrome Distribution Characteristics and study the change law of related biochemical index of each type of syndrome, which provide a valuable syndromes diagnosis scheme for the syndrome differentiation and treatment of acute gouty arthritis.Methods:According to standard of diagnosis and therapeutic effect of traditional Chinese medicine promulgated by the administration of traditional Chinese medicine, the standard of efficacy of TCM gout in" Practical Chinese rheumatology" and TCM Syndromes of patients with gout in my tutor’s clinic, we divide the TCM syndromes in acute stage of gout into five types which include rheumatic arthralgia, arthritis, damp arthritis, phlegm and blood stasis type, deficiency of liver and kidney type. We statistic various of TCM syndrome types of age, gender, blood pressure, body mass index, inducement, joint symptoms, extra articular symptoms, tongue and pulse related biochemical indicators (including uric acid, white blood cell, C reactive protein, fasting blood glucose, blood lipid) etc. We explore the distribution characteristics of acute gouty arthritis of TCM syndromes and the data of biochemical indicators whether have some changing rules.Results:By collecting 100 cases, we preliminarily summarize the syndrome differentiation of acute gouty arthritis patients. We observe the relationship between the type of syndrome and study the change law of the data which related research laboratory. The results are as following:1. Distribution characteristics of syndrome types1.1 rheumatic arthralgia:the total number of cases 42%, which Age over 58 years old. The majority of patients are normal size, but with 5 overweight patients and 1 obese patients. The diet of carelessness or overstrain are the main prevalence of inducement. The majority of patients symptoms are joint pain, swelling, heat and dry mouth waiting for the Lord.1.2 arthritis:the total number of cases 17%, which Age over 72 years old. The majority of patients are normal size, but with 2 overweight patients. The diet of carelessness or the cold are the main prevalence of inducement. The majority of patients symptoms are joint pain, swelling and chest phlegm.1.3 damp arthritis:the total number of cases 7%, which Age over 58 years old. All of patients are normal size. The diet of carelessness or the cold are the main prevalence of inducement. The majority of patients symptoms are joint pain, swelling.1.4 phlegm and blood stasis type:the total number of cases 17%, which Age over 60 years old. The majority of patients are normal size, but with 1 overweight patients. The diet of carelessness or overstrain or the cold are the prevalence of inducement. The majority of patients symptoms are joint pain, swelling and skin ecchymosis or induration.1.5 deficiency of liver and kidney type:the total number of cases 17%, which Age over 69 years old. The majority of patients are normal size, but with 2 overweight patients and 1 obese patients. The diet of carelessness or overstrain are the main prevalence of inducement. The majority of patients symptoms are joint pain, swelling and the overstrain of waist and knees.2. Analysis of various syndromes and biochemical indexes2.1rheumatic arthralgia:A total of 42 cases, include 34 cases of blood uric acid in patients with outside the normal range. With Inflammatory indexes, about 8 cases,26 cases patients were respectively shown as white blood cell (WBC) increased and C reactive protein (CRP) increased. About 19 cases,7 cases,8 cases patients were respectively shown as fasting blood glucose (FPG), total cholesterol (CHOL), triglyceride (TG), low density lipoprotein (LDL) increased in different extent. There were 29 cases of patients with HDL have decreased in different degree.2.2 arthritis:A total of 17 cases, include 13 cases of blood uric acid in patients with outside the normal range. With Inflammatory indexes, about 8 cases,9 cases patients were respectively shown as white blood cell (WBC) increased and C reactive protein (CRP) increased. About 9 cases,3 cases,9 cases,1 cases patients were respectively shown as fasting blood glucose (FPG), total cholesterol (CHOL), triglyceride (TG), low density lipoprotein (LDL) increased in different extent. There were 13 cases of patients with HDL have decreased in different degree.2.3 damp arthritis:A total of 17 cases, all cases of blood uric acid in patients with outside the normal range. With Inflammatory indexes, about 2 cases,4 cases patients were respectively shown as white blood cell (WBC) increased and C reactive protein (CRP) increased. About 3 cases,1 cases,1 cases,1 cases patients were respectively shown as fasting blood glucose (FPG), total cholesterol (CHOL), triglyceride (TG), low density lipoprotein (LDL) increased in different extent. There were 5 cases of patients with HDL have decreased in different degree.2.4 phlegm and blood stasis type:A total of 17 cases, include 12 cases of blood uric acid in patients with outside the normal range. With Inflammatory indexes, about 2 cases,6 cases patients were respectively shown as white blood cell (WBC) increased and C reactive protein (CRP) increased. About 7 cases, 7 cases,11 cases,3 cases patients were respectively shown as fasting blood glucose (FPG), total cholesterol (CHOL), triglyceride (TG), low density lipoprotein (LDL) increased in different extent. There were 10 cases of patients with HDL have decreased in different degree.2.5 deficiency of liver and kidney type:A total of 17 cases, include 12 cases of blood uric acid in patients with outside the normal range. With Inflammatory indexes, about 3 cases,8 cases patients were respectively shown as white blood cell (WBC) increased and C reactive protein (CRP) increased. About 6 cases, 5 cases,9 cases,5 cases patients were respectively shown as fasting blood glucose (FPG), total cholesterol (CHOL), triglyceride (TG), low density lipoprotein (LDL) increased in different extent. There were 12 cases of patients with HDL have decreased in different degree.Conclusion:1. The distribution of TCM syndromes characteristics of acute gouty arthritis is main for rheumatic arthralgia, arthritis, damp arthritis, phlegm and blood stasis type, deficiency of liver and kidney type five syndrome typeso With rheumatic arthralgia is the most common, accounting for 42%; followed by damp arthritis, phlegm and blood stasis type, deficiency of liver and kidney type, accounted for 17%; once again as arthritis, accounting for 7%. 2. Analysis of inflammatory markers in the TCM Syndromes of acute gouty arthritis patients displays as:White blood cells and CRP, two as an inflammatory index, all have some degree of increased (including 23 patients with WBC and 55 patients with elevated CRP increased), has a certain correlation with degree of acute gouty arthritis. Among them, the difference has statistical significance of C reactive protein level between rheumatic arthralgia and phlegm and blood stasis type, but there is no significant difference in the rest of the TCM syndrome and in the level of white blood cells between each type of syndrome.3. Analysis of acute gouty arthritis about the TCM syndrome type and patient related metabolism indexes displays as:In five kinds of TCM syndrome, there are 78 cases of patients with gout uric acid increase in different degree, which shows that hyperuricemia is the most important biochemical basis for the gouty arthritis. In the index of blood lipid metabolism, About 44 cases, 23 cases,51 cases,18 cases patients were respectively shown as FPG, CHOL, TG, LDL increased in different extent. There were 69 cases of patients with HDL have decreased in different degree, which prompts gout patients accompanied by abnormal metabolism and the metabolic abnormalities in FPG, TG increased and HDL decreased more common. Statistical analysis show that there is no significant differences between the various types of blood uric acid level. The difference has statistical significance of fasting blood glucose between arthritis and deficiency of liver and kidney card, but there is no significant difference in the rest of the TCM syndrome. Otherwise, CHOL, TG, HDL, LDL levels in different TCM syndrome types were not significantly difference.Considering the deficiency of the sample size, add into the cases of patients for the elderly, there may be some differences, so the relationship between data and various TCM syndrome types of fasting blood glucose, blood lipid and other related laboratory needs to be further studied.4. Through the analysis of research on this topic, for the traditional Chinese medicine syndrome differentiation and treatment of gout standardization provides objective basis for certain, also provides ideas for the diagnosis and treatment of acute gouty arthritis in clinical. Because the time is hasty, resulting in inadequate sample size collected, therefore, the discussion of related biochemical indexes of the TCM syndrome type whether have some change law, need to be further studied. |
PDF Full Text Request