岭南地区痛风患者血尿酸与血脂比值关系及中药用药规律研究

Study on the Relationship between Blood Uric Acid and Blood Lipid Ratio and the Medication Rules of Chinese Medicine for Gout Patients in Lingnan Area

【目的】探讨岭南地区痛风患者血尿酸(BUA)水平与血脂比值的相关性,寻找痛风中药用药规律,为指导痛风临床中医诊疗提供客观证据。【方法】采用回顾性分析方法,选取2019年1月至2021年12月在广州中医药大学第一附属医院住院治疗,明确诊断为痛风的患者,共99例。根据血脂情况将入组患者分为胆固醇(TC)和甘油三酯(TG)均正常组(简称血脂正常组)42例、单纯TC升高组(TC升高组)14例、单纯TG升高组(TG升高组)27例、TC和TG均升高组(血脂升高组)16例。收集并整理患者的一般资料及相关实验室指标,分析BUA水平与红细胞沉降率(ESR)、C反应蛋白(CRP)、TC、TG、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及血脂比值[TC/HDL-C、TG/HDL-C、LDL-C/HDL-C]的相关性;同时收集中药处方资料,并运用中医传承辅助平台V2.5对中药用药规律进行分析。【结果】(1)TC升高组及血脂升高组的TC/HDL-C、LDL-C/HDL-C明显高于血脂正常组,差异均有统计学意义(P<0.05),而HDL-C、TG/HDL-C、ESR、CRP与血脂正常组比较,差异均无统计学意义(P>0.05);TG升高组的TC/HDL-C、TG/HDL-C、LDL-C/HDL-C明显高于血脂正常组,差异均有统计学意义(P<0.05),而HDL-C、ESR、CRP与血脂正常组比较,差异均无统计学意义(P>0.05)。(2)Pearson相关分析提示,痛风患者BUA与LDL-C/HDL-C、TC/HDL-C呈正相关,差异均有统计学意义(P<0.01);BUA与ESR、CRP、TC、TG、LDL-C、HDL-C、TG/HDL-C无明显相关性,差异均无统计学意义(P>0.05)。(3)共纳入99例患者的临床有效处方,涉及中药131味,用药频次最高的前5味中药依次为薏苡仁、甘草、牛膝、绵萆薢、苍术。共提取23个核心组合和23个关联度较高的用药组合,并演化得到13首治疗痛风的新处方,新方中用药种类较多,清热药、祛风湿药、利水渗湿药、活血药等均有不同程度的使用。【结论】痛风患者BUA与血脂比值密切相关,血脂比值对痛风患者管理有较好的预测和诊断价值;岭南地区治疗痛风中药大多以祛风湿药、清热药、活血药为主,用药符合痛风发作病因病机。

Objective To investigate the correlation of blood uric acid(BUA)level with blood lipid ratio in gout patients in Lingnan area,and to explore the Chinese medicine medication rules for gout,so as to provide objective evidence to guide the clinical treatment with Chinese medicine.Methods A total of 99 patients who were hospitalized at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2019 to December 2021 with the confirmed diagnosis of gout were enrolled into the retrospective analysis.The enrolled patients were divided according to their lipid profiles into normal cholesterol(TC)and triglycerides(TG)group(42 cases),elevated TC group(14 cases with only the elevation of TC),elevated TG group(27 cases with only the elevation of TG),and elevated TC and TG group(16 cases with the elevation of both TC and TG).The general data and relevant laboratory indexes of the patients were collected and analyzed.The correlation of BUA levels with erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),TC,TG,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and blood lipid ratio of TC/HDL-C,TG/HDL-C,and LDL-C/HDL-C was analyzed.Meanwhile,the Chinese medicine prescription data were also collected to explore the medication rules of Chinese medicine for gout by using the Traditional Chinese Medicine Inheritance Support System(TCMISS)V2.5.Results(1)The ratios of TC/HDL-C and LDL-C/HDL-C in the elevated TC group and the elevated TC and TG group were significantly higher than those in normal TC and TG group,and the differences were statistically significant(P<0.05).However,HDL-C,TG/HDL-C,ESR,and CRP in the elevated TC group and the elevated TC and TG group were not statistically different from those in normal TC and TG group(P>0.05).The elevated TG group had higher ratios of TC/HDL-C,TG/HDL-C,and LDL-C/HDL-C than the normal TC and TG group,and the differences were statistically significant(P<0.05).But the differences of HDL-C,ESR,and CRP between the elevated TG group and normal TC and TG group were not statistically significant(P>0.05).(2)Pearson correlation analysis suggested that BUA was positively correlated with LDL-C/HDL-C and TC/HDL-C in gout patients,and the differences were all statistically significant(P<0.01).However,BUA was not significantly correlated with ESR,CRP,TC,TG,LDL-C,HDL-C,and TG/HDL-C,and the differences were not statistically significant(P>0.05).(3)The effective prescriptions for 99 cases of gout patients involved 131Chinese medicines,and the top 5 Chinese medicines with the highest frequency in descending order were Semen Coicis,Radix Glycyrrhizae,Radix Achyranthis Bidentatae,Rhizoma Dioscoreae Septemlobae,and Rhizoma Atractylodis.A total of 23 core combinations and 23 groups with high association were extracted,and then 13 new prescriptions for gout were derived from the core herbs.The new prescriptions contained a wide range of drugs,with various use of drugs for clearing heat,drugs for dispelling wind-damp,drugs for inducing diuresis and removing damp,and drugs for activating blood.Conclusion The BUA level of gout patients is closely related to the blood lipid ratios,and the blood lipid ratio has good predictive and diagnostic value for the management of gout patients.Drugs for dispelling wind-damp,drugs for clearing heat,and drugs for activating blood are frequently used for the treatment of gout in Lingnan area,and the medication rules are in accordance with the etiology and pathogenesis of gout attacks.