| Objective To study the distribution characteristics of clinical TCM syndromes and related influencing factors of different syndrome types in patients with gouty arthritis(GA),and extract the feces of patients with two groups of TCM syndrome types(damp heat accumulation syndrome and liver kidney yin deficiency syndrome)with a high proportion of TCM syndrome types for 16 S r DNA high-throughput sequencing,so as to preliminarily explore the distribution characteristics of intestinal flora of the two syndrome types,so as to provide objective basis and new ideas for TCM clinical syndrome differentiation and treatment of GA.Methods The cross-sectional study method was used to collect the relevant clinical data of traditional Chinese and Western medicine of GA patients who met the inclusion and exclusion criteria in the rheumatology department of traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region from December 2020 to August 2021,including general data,clinical symptoms,signs(tongue and pulse),laboratory examination,imaging examination,etc.the syndrome types were determined by associate senior doctors,and spss22.0 was selected 0 statistical analysis of the data obtained.At the same time,based on the distribution of the above syndrome types,10 GA patients with damp heat accumulation syndrome and liver and kidney yin deficiency syndrome with a high proportion of syndrome types were selected respectively and divided into groups A and B for fecal samples collection,and the feces of 10 healthy people were collected as the healthy control group(Group C).The collected feces were subjected to 16 S r DNA high-throughput sequencing,and the differences between the syndrome types of the two groups and the flora of healthy people were compared.Result 1.A total of 150 patients with GA were collected,including 139 males,11 females,40 patients with gout stone,2 patients with joint deformity and 10 patients with family genetic history.The proportion of TCM syndrome types is as follows: 86 cases of damp heat accumulation syndrome,accounting for 57%;45 cases of liver and kidney yin deficiency syndrome,accounting for 30%;10 cases of phlegm turbidity block syndrome,accounting for 7%;There were 9 cases of blood stasis heat block syndrome,accounting for 6%.There was no significant difference in gender,age,course of disease,BMI index,drinking and smoking years between the two groups(P > 0.05);There were significant differences in joint swelling and pain index and joint function classification(P < 0.05);There was no significant difference in serum uric acid,urea,creatinine,leukocyte,high-density lipoprotein and low-density lipoprotein(P > 0.05),but the values of CRP and ESR in damp heat accumulation group were significantly higher than those in liver and kidney yin deficiency group(P< 0.05),while cholesterol was lower than that in liver and kidney yin deficiency group(P < 0.05);Imaging examination showed no significant difference in joint effusion and gout stone(P > 0.05),but the blood flow signal grade and synovial hyperplasia in damp heat accumulation group were significantly higher than those in liver and kidney yin deficiency group(P < 0.05).2.A total of 26 qualified fecal samples were included in this study.After 16 S r DNA sequencing,2130448 effective sequences were obtained,and 1653495 effective tags sequences were finally used for subsequent analysis.Alpha diversity showed that compared with the healthy control group,the diversity and richness of flora in damp heat accumulation group were significantly higher,and there was no significant change in liver and kidney yin deficiency group;The diversity and richness of flora in damp heat accumulation group were higher than those in liver and kidney yin deficiency group.Beta diversity showed that there were significant differences in the flora structure of the three groups of samples.According to metastat statistics,the specific difference flora of each level is as follows:In terms of phylum level,compared with the healthy control group,the abundance of acidobacteria,desulfovibrota,unidentified bacteria and other unidentified phylum in the damp heat accumulation group was higher(P < 0.05),and there was no significant difference in phylum in the liver kidney yin deficiency group;The abundance of acidobacteria,unidentified bacteria and other unidentified bacteria in damp heat accumulation group was higher than that in liver kidney yin deficiency group(P < 0.05).In terms of order level,compared with the healthy control group,the richness of clostridales,burkholderiales,acidaminococcales and other unidentified bacteria in the damp heat accumulation group increased(P < 0.05),while the richness of Bacteroides,Pseudomonas and selenomonadales decreased(P < 0.05),and there was no significant difference between the liver and kidney yin deficiency group;Compared with the syndrome types of the two groups,the abundance of Bacteroides in the damp heat accumulation group was lower than that in the liver and kidney yin deficiency group(P< 0.05).In terms of family level,compared with the healthy control group,the abundance of amino acid coccaceae,rikeneliaceae,comamonadaceae,clostridiaceae,ruminococcaceae,sutterellaceae and other unidentified bacteriaceae in the damp heat accumulation group was higher(P < 0.05),and there was no significant difference in bacteriaceae in the liver and kidney yin deficiency group;The abundance of acidaminococcaceae,rikeneliaceae and sutterellaceae in damp heat accumulation group was higher than that in liver and kidney yin deficiency group(P < 0.05).In terms of genus level,compared with the healthy control group,the richness of phascolarctobacterium and clostridium-sencu-stricto-1 in the damp heat accumulation group was increased(P < 0.05),and there was no significant difference in the genus of liver and kidney yin deficiency group;There was no significant difference between the two groups.Conclusion 1.The distribution proportion of TCM Syndrome Types in GA patients in this study is as follows: Damp heat accumulation syndrome > liver and kidney yin deficiency syndrome > phlegm turbidity block syndrome > blood stasis heat block syndrome.2.There are differences between GA damp heat accumulation syndrome and liver kidney yin deficiency syndrome in joint swelling and pain index,joint function grade,cholesterol,CRP,ESR,blood flow signal grade and synovial hyperplasia,which can provide a certain objective basis for clinical syndrome differentiation.The order of influence is: joint swelling and pain index,joint function grade,blood flow signal grade,cholesterol,ESR,synovial hyperplasia and CRP.3.Compared with healthy people,the richness and diversity of GA patients with damp heat accumulation syndrome were significantly higher,but there was no significant change in patients with liver and kidney yin deficiency syndrome;The richness and diversity of damp heat accumulation syndrome were higher than that of liver and kidney yin deficiency syndrome.4.Acidobacteriata,acidaminococcales,acidaminococcaceae and Bacteroides can provide some help for the clinical syndrome differentiation of GA damp heat accumulation syndrome and liver kidney yin deficiency syndrome. |
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