The Study Of Tongue Pictures In Primary Gout Patients And Its Correlation To Inflammatory Markers

Objective To investigate the tongue picture of primary gout patients,summarize The characteristics of tongue and the relationship between inflammatory markers and tongue pictures,provides ponder-able value for the clinical syndrome differentiation of gout.Methods According to the diagnostic criteria set by American College of Rheumatology/European League Against Rheumatism(ACR/EULAR)in 2015,selected 120 patients with primary gout(80 cases in acute stage,40 in chronic stage)and 40 healthy volunteers in outpatient or inpatient department of Tongde Hospital of Zhejiang Province from July 2016 to December 2017,collected tongue pictures and relevant clinical data.The level of NLRP3 and IL-1β were measured using ELISA,analysis the differences of tongue in acute and chronic stage of gout and healthy person,and the correlation between tongue picture and degree of inflammation in acute phase.Results1.It collected 120 patients with primary gout,male 78 cases,female 42 cases,the male-female ratio is 13:7,and all the patients were divided into 80 cases of acute gout group and 40 cases of chronic gout group.51 Male patients in acute phase(63.75%),29 female(36.25%),the average age was 52.51±15.74 years old;in chronic phase,27 male(67.50%),and 13 female(32.50%),the average age was 50.15±17.50 years old.There was no statistical difference in gender and age between three groups(P>0.05).2.In the acute gout group,the systolic blood pressure(135.20±19.97 vs 119.50±11.11)compared with healthy people have statistical significant difference(P<0.05).Patients with gout in acute and chronic stage,the BMI(22.29±3.01 vs 22.05±3.02 vs 20.32±1.43),blood uric acid level(458.88±80.78 vs 432.93 ±35.86 vs 238.74±66.07),total cholesterol(5.32±2.85 vs 5.91±3.37 vs 3.91±0.61)and triglyceride(1.89±1.42 vs 1.86 ± 0.85 vs 1.16±0.44)all obviously higher than healthy subjects(P<0.05).3.In the acute gout group,the white blood cell count(9.23±4.24 vs 6.22±2.19 vs 5.84±1.46),neutrophilic granulocyte percentage(70.71±11.32 vs 62.87±10.61 vs 60.10±6.99),erythrocyte sedimentation rate(38.28±19.04 vs 12.98±3.56 vs 12.81±2.97),hypersensitive C-reactive protein(36.43±20.07 vs 5.40±10.26 vs 2.01±1.03),NLRP3(10.34±4.03 vs 3.20±1.69 vs 2.70±1.00),IL-1β(42.83±17.74 vs 42.83±17.74 vs 11.41±2.89)levels were statistically significantly higher than the chronic phase and health group(P<0.01).4.Compared with healthy group,the red tongue(69.2% vs 35%)occupied a large proportion in tongue color of the gout patients,while the yellow coating distribution(60% vs 25%)in coating color,the greasy coating(67.5% vs 12.5%),slippery coating(41.7% vs 20%)and dry coating(23.3% vs 5%)in coating body,which were statistically significant(P<0.05);there were no statistical difference in other tongue picture.5.Compared with chronic gout group,the red tongue(80% vs 40%)occupied a large proportion in tongue color of the patients in acute stage,while the yellow coating distribution(75% vs 30%)in coating color,the greasy coating(77.5% vs 47.5%)and slippery coating(50% vs 22.5%)in coating body,which were statistically significant(P<0.05);In chronic phase,the positive rate of pale tongue(57.5% vs 13.75%)and white coating(70% vs 23.75%)in tongue color and coating color were higher than acute gout(P<0.05),and there were no statistical difference in other tongue color,coating color,tongue shapes,sub-lingual vein and purple dots on the tongue.5.The red tongue,the yellow coating,greasy coating,curdy coating and fat coating were positively correlated with the incidence of acute gout,thin tongue was negatively correlated to the incidence of acute gout.The occurring rate of acute gout about red tongue is 5.068 times than pale tongue,while yellow coating is 26.573 times than white coating,the incidence of acute gout about greasy coating is 5.707 times and curdy coating is 3.772 times than the normal tongue coating.And the rate about fat coating is 2.618 times than the normal.The accuracy of the Logistic regression model in predicting is 76.7%.6.For acute gout group,the quantitative score of red tongue was positively correlated with hypersensitive C-reactive protein(r=0.401,P<0.01),NLRP3(r=0.270,P<0.05)and IL-1β(r =0.441,P<0.01).The quantitative score of yellow coating and NLRP3(r =0.473,P<0.473),IL-1β(r =0.269,P<0.05)were positively correlated.There were a positive correlation between quantitative score of greasy coating and NLRP3(r =0.357,P<0.01),IL-1β(r =0.282,P<0.01);The quantitative score of slippery coating and NLRP3(r =0.415,P<0.01)showed a negative correlation.Conclusion1.The red tongue,the yellow coating,the greasy coating,slippery coating and dry coating occupied a large proportion in tongue color of patients with primary gout;and the red tongue,the yellow coating,the greasy coating and slippery coating occupied a large proportion in tongue color of the patients in acute stage,while pale tongue and white coating in chronic phase.2.The red tongue,the yellow coating,greasy coating were positively correlated with the incidence of acute gout,the occurrence of them indicated the incident rate of acute gout was significantly increased.The Logistic regression model established by the tongue factor was used to predict the accuracy rate of gout acute was 76.7%.3.For acute gout group,the characteristics of tongue was positively correlated with inflammation marker(hypersensitive C-reactive protein),inflammatory mediators(NLRP3,IL-1β).It indicates that the change of tongue picture is helpful to reflect the inflammatory state of the body in the acute stage of gout.4.There were metabolic disorders and chronic inflammatory state in patients with gout(BMI,blood uric acid level,total cholesterol,triglyceride were increased).