The Effect Of The Method Of Jianpixiezhuo On The Treatment Of Primary Gout Arthritis And IL-18 And TGF-β

1 Objective To observe the effect of Jianpi Xiezhuo method in patients with pr imary gout arthritis curative and the effect of cytokines IL-1, IL-6, IL-18, TNF-α, TGF-β, IL-10 and IL-4.And to explore the mechanism of action from the persp ective of cytokines.2 Methods2.1 Theoretical researchBased on the extensive literature research and analysis of primary gouty arthritis patients with cytokines and traditional Chinese medicine spleen deficiency and d ampness turbid stagnation of the relationship, so summarizes the primary etiology and pathogenesis of change of cytokines in gouty arthritis patients, the interpret ation of the Jianpi Xiezhuo method in the treatment of primary gouty arthritis of Chinese medicine theory.2.2 Clinical research2.2.1 Study on the changes of serum cytokines in patients with primary gout arthr itis:To observe 60 cases of primary gouty arthritis inflammation patient age, gend-er, disease duration, TCM syndromes value, quality of life,the scores of SAS an d SDS, blood uric acid (UA),24h urinary uric acid 24hUUA, inflammation inde x and laboratory index were observed.30 normal persons were selected as health y control group, which come From the health examination center of the First Af-filiated Hospital of Anhui Province University of traditional Chinese medicine. Gender and age matched with primary gout arthritis. The ELISA kit were used t o detect primary gouty arthritis patients and healthy control group IL-1, IL-6, IL-18 and TNF-α and TGF-β and IL-4, IL-10 and simultaneous determination of primary gouty arthritis patients of related laboratory index:erythrocyte sedimentat ion rate(ESR), ultra sensitive C reactive protein(hs-CRP), triglyceride (TG), total cholesterol(T-chol), high density lipoprotein cholesterol(HDL-C), low density lipop rotein cholesterol(LDL-C), white blood cell(WBC), blood urea nitrogen(BUN), cre atinine (Cr), uric acid(UA),24h urinary uric acid(24hUUA). To observe primary g-out arthritis patients with Chinese medicine syndrome score, quality of life SF-36(Form-36 Short),anxiety scale (SAS) and Depression Scale (SDS) and other int e-gral values.SPSS19.0 software was used to analyze the correlation between cell factor and the above indexes.2.2.2 Clinical curative effect research30 health workers were selected as the control group, which were from the First Affiliated Hospital of Anhui University of traditional Chinese medicine. Age, ge nder and the primary gout arthritis group were matched, both physical health, no significant organic disease. The 60 cases of primary gouty arthritis patients as s tudy group(Jianpi Xiezhuo grain combined with non division cloth he) and contr ol group (non division cloth he 30 cases in each group, using enzyme-linked im munosorbent adsorption experiments (ELISA) kit for the detection of health contr ol group and primary gouty arthritis arthritis IL-1, IL-6, IL-18 and TNF-aand T GF-β and IL-4, IL-10 of change detection of the primary gouty arthritis rela-ted laboratory index (hs-CRP, ESR, TG, T-chol, HDL-C, LDL-C, WBC, Bun, Cr, U A,24hUUA). Observation of GA patients with SAS, SDS, SF-36 scale and TC M syndrome integral value. SPSS19.0 software was used to analyze the relations hip between cytokines and the above indexes.3 Results3.1 theoretical research results3.1.1 the important role of cytokines play in the occurrence and development of primary gout arthritis;3.1.2 quality of life has become an important index to evaluate the efficacy of p rimary gout arthritis;3.1.3 TCM syndrome of spleen deficiency and phlegm dampness is the basic pat hogenesis of primary gout arthritis;3.1.4 Jianpi Xiezhuo method is the key of TCM treatment of primary gouty arth ritis;3.2 Clinical research results3.2.1 Study on the changes of cytokines in patients with primary gout arthritis Compared with the control group, the primary gouty arthritis inflammation levels of serum IL-1, IL-6, IL-18 and TNF-a significantly increased, TGF-β and IL-4, IL-10 decreased(P<0.01).Correlation analysis showed that primary gouty arthritis inflammation cytokines in patients with IL-1, IL-6, TNF-a and age were positively related (P<0.01) and I L-18 and the duration of the disease into positive correlation(P<0.01), IL-4 and a ge, course of disease showed a negative correlation(P<0.01), IL-10 and TGF-β an d the course of disease was negative correlation(P<0.05orP<0.01).Primary gouty arthritis patients serum IL-18, IL-6, IL-1 and TQ T-chol into posi tive correlation(P<0.05 or P<0.01), IL-18 and LDL-C positive correlation(P<0.05), TGF-β and HDL-C positive correlation, Negative correlation with LDL-C(P<0.0 1), TNF-a and T-chol positive correlation(P<0.01), IL-6, TNF-a and HDL-C into negative correlation(P<0.05 or P<0.01); IL-4 and TQT-chol into negative correla tion (P<0.05 or P<0.01), IL-10 and t-chol into negative correlation(P<0.05), and high-density lipoprotein cholesterol(HDL-C) into a positive correlation(P<0.01).Joint pain was positively correlated with IL-1,IL-6,IL-18,TNF-a (P<0.05 or P<0.0 1)in the patients with primary gout arthriti;Is negatively correlated with IL-4 and TGF-P(P<0.05 or P<0.01); Joint swelling was positively correlated with IL-1, I L-18, TNF-a (P<0.05 or P<0.01); Is negatively correlated with IL-10, TGF-β, I L-4(P<0.05 or P<0.01); Joint flexion and extension with IL-1, IL-6, TNF-α pos itive correlation(P<0.05 or P<0.01), and negative correlation with TGF-β(P<0.05); The positive correlation between and TNF-α(P<0.05), and was negatively correla -ted with IL-10, IL-6(P<0.05); Joint heavy and IL-1, IL-6, IL-18, TNF-α into po s-itive correlation (P<0.05 or P<0.01); and the level of IL-4, IL-10 and TGF-β n e-gative correlation(P<0.05 or P<0.01); Shenpi fatigue and IL-1 and IL-18 into p ositive correlation(P<0.05 or P<0.01), and the level of IL-4, IL-10 and TGF-β ne ga-tive correlation(P<0.05 or P<0.01).GA patients with IL-1, IL-6, IL-18, TNF-α and VAS scores were positively corr elated(P<0.05), IL-1, IL-6 and GH, RE, SF, MH were negative correlated(P<0.05 or P<0.01), IL-18, TNF-α and RP, SF, MH into a negative correlation(P<0.05 or P<0.01), IL-1, IL-18, TNF-α and SAS scores were positively correlated(P<0. 05 or P<0.01), IL-1, IL-6, TNF-α and SDS scores were positively correlated(P <0.05 or P<0.01); TGF-β, IL-4, IL-10 and VAS scores were negatively correlate d (P<0.05), and RP, BP into a positive correlation(P<0.05 or P<0.01), IL-4 and SAS score was negatively correlated (P<0.01), TGF-β, IL-10 and SDS score was negatively correlated(P<0.05 or P<0.01), the rest see table.Primary gouty arthritis inflammation in patients with serum IL-1, IL-6 and serum uric acid(UA), hs-CRP, ESR into positive correlation(P<0.05 or P<0.01); IL-18 and TNF-α and serum uric acid (UA), hs-CRP, ESR into positive correlation(P< 0.05 or P<0.01); IL-18, IL-1, TNF-α and 24hUUA into negative correlation(P<0.0 5 or P<0.01); TGF-β and IL-4, IL-10 and serum uric acid(UA), hs-CRP, ESR int-o negative correlation(P<0.05 or P<0.01) and TGF-β, IL-10 and 24hUUA into p ositive correlation(P<0.01).3.2.2 Clinical effect of Jianpi Xiezhuo grain to treating primary gout arthriti sAfter treatment, the total effective rate of the treatment group and the control gr-oup were 86.67% and 80%, respectively, and there was no significant difference meaning (P>0.05). The treatment group(26.67%) was significantly higher than the control group (10%) (P<0.05).3.2.3The Effect of Jianpi Xiezhuo on the cytokines of primary gout arthritis After treatment, the patients in the two groups of Pro inflammation cytokines IL-1, IL-6, IL-18 and TNF-α levels decreased significantly(P<0.05 or P<0.01), inhi biting inflammatory factor TGF-β, IL-4, IL-10 levels increased(P<0.05 or P<0.01), compared the two groups after treatment, treatment group in reducing Pro-inflam mation cytokines IL-1, IL-6, IL-18 and TNF-a levels was significantly better tha-n the control group(P<0.05). The treatment group at elevated anti inflammation f actor TGF-β, IL-4, IL-10 levels was significantly better than the control group(P <0.05).3.2.4 Effect of Jianpi Xiezhuo on the UA,24hUUA, ESR, hs-CRP of primary g out arthritisUA, hs-CRP, ESR were decreased after treatment, the patients in the two groups, increased 24hUUA and compare after treatment in the two groups, the treatment group decreased UA, ESR, hs-CRP level was significantly better than the contr ol group(P<0.05 or P<0.01), the treatment group in promoting 24hUUA excretion was significantly better than the control group(P<0.05).3.2.5 Effect of Jianpi Xiezhuo on the TG, T-CHOL, HDL-C, LDL-C of primary gout arthritisBefore treatment, there were no significant differences in T-CHOL, LDL-C and TG between the two groups (>0.05 HDL-C). After treatment, treatment group, T G, T-chol, LDL-C laboratory indexes were decreased, HDL-C was increased, with statistical significance(P<0.05 or P<0.01); control group after the laboratory inde xes were improved significantly, without statistical significance(P>0.05); compared with the control treatment group,treatment group, TG, T-chol and LDL-C index decreased, HDL-C increased significantly, with statistical significance(P<0.05 or P <0.01).3.2.6 The Effect of Jianpi Xiezhuo grain on the syndrome of TCM syndrome of primary gout arthritisBefore treatment, no significant difference between the two groups of primary go uty arthritis patients with TCM syndrome score(P>0.05). In the treatment of gout, joint flexion and extension in the two groups of patients after treatment, the trea tment group, joint pain, joint swelling, joint adverse, tophi heavy, God fatigue str ength were decreased(P<0.05 or P<0.01), the control group joint pain, joint swell ing, joint flexion and extension negative, joint heavy, God fatigue strength wered ecreased(P<0.05 or P<0.01), while the stone before treatment had no significant difference(P>0.05), the treatment group to relieve joint pain, joint swelling, tophi, joint heavy, God fatigue strength is obviously superior to the control group(P<0.0 5 or P<0.01), the two groups can improve joints flexor and extensor adverse(P<0. 05).The two groups had no significant difference(P>0.05).3.2.7 The Effect of the Jianpi Xiezhuo grain and the spleen on the VAS score, S F-36 scale, depression and anxiety of the patients with primary gout arthritis Two groups of patients after treatment level of pain VAS score were significantl y lower(P<0.01), Treatment group after treatment, GH, PF, RP, RE, SF, BP, VT, MH levels were increased (P<0.05 or P<0.01),In the control group, the levels of GH, PF, RP, SF, BP, VT and were all increased after treatment(P<0.05 or P<0. 01),treatment group, the SAS and SDS scores were lower than those of the treat ment before, was statistically significant (P<0.05); after the treatment, the patients in the two groups, treatment group in the lower level of pain VAS score was s ignificantly better than the control group(P<0.01).The treatment group in improvin g the SF-36 table GH, RP, RE, SF, MH, and SAS scores level was significantly better than the control group(P<0.05 or P<0.01).4 conclusions4.1 primary gout arthritis patients with serum IL-10, IL-4, TGF-β decline, and I L-1, IL-6, IL-18, TNF-α rised;4.2 the levels of cytokines IL-1, IL-6, IL-18, TNF-α,IL-4,IL-10,UA,and TGF-β c losely related to the levels of cytokines in the patients with primary gout arthriti s.4.3 Jianpi Xiezhuo method can significantly improve the primary gouty joint arth ritis joint pain symptoms, quality of life score, TCM symptoms integral, anxiety and depression of amount of the table, improve joint function, improve the patie nts’quality of life and mental health status, can significantly reduce serum uric a cid level and promote the 24 hours urinary uric acid excretion, control of inflam mat on.4.4 the method of Jianpi Xiezhuo and discharging turbidity can significantly rise the serum levels of IL-4, IL-10, TGF-β, IL-1, IL-6, IL-18, and TNF-α in the patients with acute gout arthritis;4.5 the method of Jianpi Xiezhuo and removing turbidity can significantly impro ve the joint weight, fatigue and other symptoms of primary gout arthritis patients, and has the effect of strengthening the spleen and removing dampness.4.6 to explore the possible mechanism of improving the primary gout arthritis pa tients by the method of cell factorProinflammatory cytokine and uric acid was positively related to the anti inflam matory factor can inhibit the inflammatory cytokines, renal protection, so as to p romote the excretion of uric acid, Jianpi Xiezhuo method can increase anti-infla mmatory cytokines, reduce proinflammatory cytokines, thereby lowering uric acid levels, to improve systemic symptoms of gouty arthritis. Therefore, the method of invigorating the spleen and eliminating turbid has the function of inhibiting in flammation, reducing the production of uric acid and promoting the excretion of uric acid in the kidney.