Plum-blossom Needle With Baihu Guizhi Decoction In Treating Acute Gout Arthritis And The Release Of Inflammatory Cytokines

Objective:To observe the clinical effects of Baihu Guizhi Decoction with plum-blossom needle in treating acute gout arthritis by a randomized controlled trial and the mechanism of inflammatory cytokines.Methods:All patients were divided into 4 groups randomly,each group has 45patients.Western medicine group:Celecoxib orally,0.2g/time,2 times/day,taking 7 days;Traditional Chinese medicine(TCM)group:Anemarrhena 12g,gypsum 30g,Guizhi 12g,rice 6g,licorice 6g,decoction,3 times/day,taking/days;Combined treatment group(Baihu Guizhi Decoction with plum-blossom needle).The BUA(blood uric acid),ESR(erythrocyte sedimentation rate),TCM(Traditional chinese medicine)syndrome scores,clinical effects,efficacy score and security score were calculated.The release of inflammatory cytokines in blood were measured by Enzyme linked immunosorbent assay kit.The gene expression were determined by qPCR.Results:There was no significant difference in the basic data between the 4groups.Before treatment,there was no significant difference in the level of serum uric acid(F=0.5582,P=0.6433)and ESR(F=0.0659,P=0.9779).There was no significant difference between the 4 groups in TCM syndrome score(F=0.5582,P=0.6433),the follow-up was comparable.The total effective rate of the four groups were 91.11%,82.22%,66.67%and 88.89%,The difference was statistically significant(x~2=11.25,P=0.0105).There was significantly difference in BUA(F=7.627,P<0.0001),BSR(F=11.94,P<0.0001)and Therapeutic index(F=21.98,P<0.0001)of the 4 groups after treatment.The curative effect index of Baihu Guizhi decoction(t=2.171,P=0.0341)and plum acupuncture group(t=4.025,P=0.0002)were less than that of western medicine control group,the difference was statistically significant.There was no significant difference between the combination therapy group and western medicine control group(t=0.092,P=0.9267).The safety scores of the 4 groups were not statistically significant(F=2.226,P=0.0888).There was no significant difference in the release of TNF-?and IL-1?between the four groups before and after treatment(P>0.05).After treatment,the levels of IL-18 release in the four groups were statistically significant(F=83.21,P<0.0001).The comparison between the two groups found that the TCM group(t=11.97,P<0.0001)and the plum blossom needle group(t=11.51,P<0.0001)was significantly higher than that of the western medicine group.There was no significant difference between the combination group and the control group(t=2.580,P=0.0115).There was a statistically significant difference in IL-18 gene expression in the peripheral blood of the 4 groups after treatment(F=21.66,P<0.0001).Comparison between the two groups showed that the expression of IL-18 in the Chinese medicine group(t=7.442,P<0.0001)and the plum blossom needle group(t=8.328,P<0.0001)was greater than that in the control group,and there was no significant difference between the combination group and the control group(t=2.580,P=0.0115).Conclusion:Baihu Guizhi Decoction with plum-blossom needle can effectively improve patients with acute gouty arthritis and inhibition the release and expression of inflammatory cytokines IL-18.