| Objective1.Observe the changes of main clinical symptoms,physical and chemical parameters and safety indicators before and after treatment of Qingre Chubi Decoction in patients with chronic gouty arthritis and heat stasis block type.To investigate the clinical efficacy and safety of Qingre Chubi Decoction,and to provide clinical evidence for prevention and treatment of chronic gouty arthritis and heat stasis block type.2.The effect of Qingre Chubi Decoction on the gait of gouty arthritis,synovial pathology,NALP3 inflammasome and IL-1? in rats was observed.To study the curative effect and mechanism of Qingre Chubi Decoction on gouty arthritis in rats,and provide a strong basis for the clinical application of Qingre Chubi Decoction.Methods1.Clinical research: Eighty patients with chronic gouty arthritis and heat stasis block type were randomly divided into treatment group and control group.In each group,40 patients in both groups were treated with basic uric acid lowering treatment: allopurinol tablets;acute exacerbation was treated with etoricoxib.The treatment group was treated with Qingre Chubi Decoction,and the control group was treated with colchicine.Both courses of treatment are 8 weeks.The levels of CRP,ESR,IL-1?,and SUA were measured before and after treatment.The number of acute attacks of gouty arthritis during the treatment was recorded.Record adverse reactions during treatment and perform safety assessments.2.Experimental research: 162 rats were randomly divided into 6 groups,27 in each group,which were normal group,model group,high dose,medium dose and low dose group of Qingre Chubi Decoction group and colchicine-positive group.The experimental group were respectively intragastrically administered with drugs.The model group and the normal group were given equal volume of distilled water to gavage,and the stomach was continuously fed for 11 days.On the 8th day,except for the normal group,all rats were modeled with sodium uric acid knee joint cavity injection.At the 24 th,48th,and 72 th hours after model establishment,9 rats were killed in each group and the synovial tissue of the right knee joint of the rats was taken.The gait of the rats was observed and histopathological analysis of synovial membranes was performed by H&E staining.The expressions of NALP3,ASC and caspase-1 in synovium were detected by RT-qPCR and Western blot.The contents of IL-1? in synovial membrane were determined by RT-qPCR and ELISA.Results1.Clinical research:(1)After treatment,the total effective rate was 86.11% in the treatment group and 57.89% in the control group.The treatment group was superior to the control group(P<0.05).(2)The scores of joint tenderness and joint swelling after treatment in the two groups were significantly lower than before(P <0.05),and the reduction was more obvious in the treatment group(P <0.05).After treatment,the scores of joint flexion and extension in the treatment group were significantly lower than those before treatment(P <0.05),and better than those in the control group(P <0.05).There was no significant difference in the joint flexion and extension score between the control group and the control group before and after treatment(P >0.05).There was no significant difference in the scores of tophi before and after treatment between the two groups(P >0.05).(3)The traditional chinese medicine syndrome scores and VAS scores of the two groups after treatment were significantly lower than before(P <0.05),and the treatment group was more significantly reduced(P <0.05).(4)After treatment,the levels of CRP,ESR,IL-1?,and SUA in the two groups were significantly lower than those before treatment(P <0.05).The levels of CRP,ESR,and SUA in the treatment group decreased more significantly(P <0.05).(5)The number of acute episodes of chronic gouty in the treatment group was lower than that in the control group(P <0.05).(6)The WBC levels after treatment in both groups were lower than before treatment(P <0.05).Compared with before treatment,the PLT level in the treatment group was significantly lower(P <0.05),and there was no significant difference in the PLT level in the control group(P >0.05).There was no significant difference in the levels of RBC,Hb,ALT,AST,BUN,and Scr between the two groups before and after treatment(P >0.05).The incidence of adverse reactions in the treatment group was lower than that in the control group(P<0.05).2.Experimental research:(1)Compared with the normal group,the gait of the model group was significantly worse(P <0.05),the synovial tissue inflammatory response was obvious,and the expression of NALP3,ASC,caspase-1,and L-1? in the synovial tissue was significantly increased(P <0.05).(2)Compared with the model group,the gait of rats in the Qingre Chubi Decoction high dose,medium dose and low dose group and colchicine group were significantly improved(P <0.05),and the synovial tissue inflammation was alleviated to varying degrees.(3)Compared with the model group,the expression of NALP3,ASC,caspase-1 and L-1? in the synovial tissue of the Qingre Chubi Decoction high dose,medium dose and low dose group and colchicine group was significantly decreased at each time point(P <0.05).Conclusion1.Clinical research: Qingre Chubi Decoction can significantly improve the clinical symptoms of chronic gouty arthritis and heat stasis block type patients,reduce uric acid levels,reduce inflammatory reactions,and can reduce the number of gout attacks.The clinical efficiency is better than colchicine,and the side effects are small.Additinally,the clinical safety is affirmed,so it is worth of clinical promotion.2.Experimental research: Qingre Chubi Decoction has preventive and therapeutic effects on gouty arthritis in rats,and the mechanism may be to inhibit the assembly of NALP3 inflammasome,thereby reducing the expression of IL-1?. |
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