Distribution Characteristics Of Syndrome Elements And Correlation With Intestinal Flora In Patients With Acute Gout Attack

ObjectiveTo study the distribution of TCM syndrome elements and intestinal flora in patients with acute gout attack,to analyze the relationship and law between them,and to provide a new reference for the clinical diagnosis and treatment and the observation of curative effect of gout.The mixed characteristics of the main syndrome elements of acute gout attack were also analyzed.MethodsFrom January 2019 to December 2019,88 patients with acute gout attack from Jinjiang Traditional Chinese Medicine Hospital and the Third people’s Hospital affiliated to Fujian University of Traditional Chinese Medicine were selected as gout group.Based on the principle of syndrome elements differentiation,the state identification system was used to collect the four methods of diagnosis information.And fecal samples were collected for 16 S rDNA to analyze the distribution of TCM syndrome elements,intestinal flora and their correlation.In addition,the main syndromes were extracted and their mixed characteristics were analyzed.At the same time,30 cases of healthy physical examination were selected as normal group,fecal samples were collected,and compared with the gout group to analyze the characteristics of intestinal flora in patients with acute gout attack.Results1.Distribution of syndrome elements in patients with acute gout attack:Put them in proportional order,the syndrome elements of the position of disease were:Spleen（67.05%）,liver（56.82%）,kidney（51.14%）,lung（23.86%）,stomach（18.18%）,gallbladder（11.36%）,heart（7.95%）;The syndrome elements of the character of disease were:Sputum（88.64%）,heat（87.50%）,dampness（80.68%）,Yin deficiency（63.64%）,blood stasis（55.68%）,Qi stasis（55.68%）,Qi defic--iency（42.05%）,Yang deficiency（30.68%）,blood deficiency（19.32%）,cold（14.77%）,dryness（4.55%）,fluid（1.14%）,fluid deficiency（1.14%）.2.Characteristics of syndrome elements of phlegm and heat syndrome in patients with acute gout attack: In order of size,the syndrome elements of the position of disease were:Spleen（69.01%）,liver（54.93%）,kidney（52.11%）,lung（25.35%）,stomach（21.13%）,gallbladder（9.86%）,heart（7.04%）;The syndrome elements of the character of disease were: dampness（80.28%）,Yin deficiency（61.97%）,blood stasis（57.75%）,Qi stasis（57.7%）,Qi deficiency（39.44%）,Yang deficiency（26.76%）,blood deficiency（16.90%）,cold（14.08%）,dryness（4.23%）,fluid（1.41%）,fluid deficiency（1.41%）.3.The difference of community structure in the intestinal flora of gout group was larger,followed by normal group.Compared with the normal group,the bacterial community structure of gout group was different,and the difference was statistically significant（P<0.01）;Compared with the normal group,the number of phylum,class,order,family,genus,species under the kindom level of gout group was less,and the difference was obvious and statistically significant（P<0.01）.4.Distribution characteristics of intestinal flora in patients with acute gout attack:At the genus level,there were significant differences in the species abundance of intestinal flora in patients with acute attack of gout.According to the order of their relative abundance fromlarge to small,the order was Bacteroides,Fecalibacteria,Megamonas,Escherichia-Shigell,Blautia,Klebsiella,Prevotella₉,Agathobacter,Roseburia and Bifidobacterium.5.At the genus level,compared with the normal people,the abundance of Agathobacter,Bifidobacterium,Faecalibacterium,and Roseburia（P<0.01）in the intestinal flora of patients with acute gout attack was lower,and the difference was statistically significa--nt;the abundance of Bacteroides,Megamonas,Prevotella₉（P<0.05,P<0.01）was higher,and the difference was statistically significant.6.Correlation between the syndrome elements and intestinal flora in patients with acute gout attack:In the syndrome elements of the position of disease,liver was negatively correlate--ed with the abundance of Bacteroides（r=-0.347;P<0.05）;Kidney was negatively correlated with the abundance of Bacteroides（r=-0.347;P<0.01）,Faecalibacterium（r=-0.534;P<0.01）,Megamonas（r=-0.310;P<0.05）and Prevotella₉（r=-0.321;P<0.05）;Lung was positively correlated with the abundance of Bifidobacterium（r=0.542;P<0.05）and Megamonas（r=0.527;P<0.01）;Heart was positively correlated with the abundance of Roseburia（r=0.857;P<0.05）;Stomach was positively correlated with the abundance of Blautia（r=0.522;P<0.05）.In the syndrome elements of the character of disease,heat was positively correlated with the abundance of Bacteroides（r=0.642;P<0.01）and Roseburia（r=0.249;P<0.05）;Phlegm was positively correlated with the abundance of Bacteroides（r=0.576;P<0.01）and Faecalibacteri--um（r=0.249;P<0.01）;Yin deficiency was negatively correlated with the abundance of Prevotella₉（r=-0.268;P<0.05）;Yang deficiency was positively correlated with the abundance of Prevotella₉（r=0.452;P<0.05）;Qi deficiency was positively correlated with the abundance of Agathobacte（r=-0.365;P<0.05）;Blood deficiency was positively correlated with the abundance of Roseburia（r=0.722;P<0.01）.Conclusions1.The acute gout attack is closely related to the spleen,liver,and kidney,mainly showing phlegm,heat,dampness,Yin deficiency,blood stasis,and Qi stasis,and the proportion of phlegm and heat syndrome elements are larger.Treatment should be mainly to clear away heat and phlegm,taking into account to strengthen the spleen and eliminat dampness,promoting Qi and blood circulation,remove heat and protect Yin.2.There are significant differences in intestinal flora between patients with acute gout attack and normal people,and the species diversity of the former is lower than that of the latter.3.In the distribution of intestinal flora in patients with acute gout attack,Bacteroides,Megamonas and Prevotella₉ accounted for a large proportion,the difference is significant with normal people,and they have a correlation with many syndrome elements,suggesting that the genuses with higher abundance in intestinal flora of patients with acute gout attack or play a greater role in the occurrence and development of gout and the distribution of its syndrome elements.