Clinical Observation Of Zhibai Bixie Dihuang Decoction In The Treatment Of Acute Gouty Arthritis And Metabonomics Study

Objective:To observe the clinical efficacy and safety of Zhibai Bixie Dihuang Decoction in the treatment of acute gouty arthritis with damp-heat accumulation syndrome,and analysis of serum metabolites in gouty arthritis patients with damp-heat accumulation syndrome and healthy people by metabonomics,looking for potential biomarkers of damp-heat retention acute gouty arthritis,to provide basis for exploring the mechanism of ZBBXDH Decoction in treating acute gout arthritis with damp-heat accumulation syndrome.Methods:(1)65 patients with AGA(acute gouty arthritis)who met the inclusion criteria were selected.All the patients were divided into two groups according to the principle of randomized control with 32 cases in the treatment group and 33 cases in the control group.Both groups were given diet control and lifestyle adjustment,the control group was treated with meloxicam,and the treatment group was treated with ZBBXDH Decoction on the basis of the control group.The course of treatment was 7 days,and the observation nodes were 0 and 7 days.The main observation items were joint symptoms,TCM symptom score,inflammation index,serum uric acid and safety index before and after treatment in both groups.(2)57 AGA patients w-ho met the inclusion criteria were selected as the disease group,and 92 healthy people in the physical examination center of our hospital were selected as the normal group during the same period.The LC-MS metabonomics method was used to analyze the serum metabolite profiles in two groups,and PCA for the aggregation analysis of the metabolic data,then PLS-DA was used to classify and predict different groups,OPLS-DA was also used to cross-validate the quality of the model.The potential differential compounds were searched and identified in the HMDB/METLIN/KEGG database to obtain the final matching endogenous compounds.Results:(1)Sixty-five patients were included for the study,3 cases were excluded and 2 cases were felled out,60 cases were finally admitted to clinical observation.The total effective rates of ZBBXDH Decoction combined with meloxicam and meloxicam alone in the treatment of AGA were 96.67%and 80.00%,with statistically significant difference(P<0.01);The treatment group was superior to the control group in reducing the VAS score of joint pain,TCM syndrome score,joint tenderness score,welling score and capacity for action score(P<0.05);Compared with the control group,CRP,ESR and UA for the treatment group after treatment was reduced,with statistically difference(P<0.05);Before and after treatment in both groups,there was no significant difference in blood routine and liver and kidney function(P>0.05).(2)There were significant differences in serum metabolites between gout group and normal group.In the positive ion mode,there were three different metabolites in gout group compared with normal group:propanoic acid,cysteine and linoleic acid;In the negative ion mode,the gout group had two different metabolites:phenylalanine and glycine.Conclusion:(1)ZBBXDH Decoction combined with meloxicam is effective in the treatment of AGA,it can significantly alleviate the joint symptoms of patients,improve the TCM syndromes of patients,and reduce blood uric acid,it has less adverse reactions and high safety,which is worthy of clinical promotion.(2)There are significant differences in serum metabolites between ACA with damp-heat accumulation syndrome patients and healthy people.Propanoic acid,cysteine,linoleic acid,phenylalanine and glycine may be potential metabolic markers of acute gouty arthritis with damp-heat accumulation syndrome.