加味四妙散对湿热痹阻型慢性痛风性关节炎炎症因子的影响及相关性分析OA

Objective:To explore the mechanism of modified Wonderfully Effective Four Powder(MWEFP)in the treatment of chronic gout by analyzing the correlation between chronic gout and interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),as well as traditional Chinese medicine(TCM)symptoms and clinical indicators.Methods:Sixty patients with damp-heat obstruction type chronic gouty arthritis were randomly divided into an observation group and a control group,with 30 cases in each group.Additionally,30 healthy subjects were enrolled as the healthy control group.The control group received oral administration of febuxostat,while the observation group received MWEFP in addition to the treatment in the control group,with a treatment cycle of 4 weeks.General clinical data,TCM symptom scores,and biochemical indicators were observed in all patients.Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of IL-1β,TNF-α,and IL-6,and the correlation of IL-1β,IL-6,TNF-α with TCM syndrome scores and biochemical indexes was analyzed.Results:Compared with the healthy control group,the levels of IL-1β,TNF-α,and IL-6 were significantly elevated in patients with chronic gout(P<0.01).In patients with chronic gout,joint pain,joint swelling,sticky stools,and tongue coating were positively correlated with IL-1β,TNF-α,and IL-6,while joint tenderness,joint fever,and fatigue were positively correlated with IL-1β and TNF-α.Additionally,greasy tongue coating,bitterness in the mouth,and urine were positively correlated with TNF-α.The pulse condition was positively correlated with IL-1β,and IL-1β was positively correlated with fasting plasma glucose(FPG),total cholesterol(TC),erythrocyte sedimentation rate(ESR),and visual analog scale(VAS)score.TNF-α was positively correlated with body mass index(BMI),uric acid(UA),high-density lipoprotein(HDL),ESR,VAS score,and negatively correlated with HDL.IL-6 was positively correlated with systolic blood pressure(SBP),UA,and C-reactive protein(CRP)(P<0.05,P<0.01).After treatment,the levels of IL-1β,TNF-α,and IL-6 were significantly reduced in both groups(P<0.01),with the observation group showing a significant decrease in IL-1β levels compared with the control group(P<0.05).Compared with baseline,joint pain,joint tenderness,joint swelling,joint fever,activity limitation,fatigue,greasy tongue coating,bitterness in the mouth,dark yellow urine,and TCM symptom score were significantly reduced in both groups after treatment(P<0.05,P<0.01).When compared with the control group after treatment,the observation group showed significant reductions in joint fever,fatigue,greasy tongue coating,bitterness in the mouth,sticky stools,dark yellow urine,tongue coating,and pulse condition(P<0.05).Compared with baseline,BMI,SBP,diastolic blood pressure(DBP),UA,serum creatinine(Scr),blood urea nitrogen(BUN),FPG,low-density lipoprotein(LDL),triglycerides(TG),TC,ESR,CRP,IL-1β,TNF-α,IL-6 levels,and VAS scores were significantly increased(P<0.05,P<0.01).Compared with the control group after treatment,the observation group showed significant reductions in BMI,ESR,IL-1β levels,and VAS scores(P<0.05).The total effective rate was 80.0%(24/30)in the observation group and 56.7%(17/30)in the control group,with the observation group having a significantly higher total effective rate than the control group(χ2=11.916,P<0.05).Conclusion:The levels of IL-1β,IL-6,and TNF-α in gout patients are closely related to obesity,blood sugar,blood lipids,UA,joint pain and inflammation status,as well as systemic symptoms.Modified Wonderfully Effective Four Powder can effectively improve the clinical symptoms of damp-heat obstruction type chronic gouty arthritis and reduce inflammation,with good safety.Its mechanism may be related to the inhibition of IL-1β-related inflammatory signaling pathways.