Efficacy and Safety of Chinese Medicinal Prescriptions in Treatment of Acute Gouty Arthritis： A Network Meta-analysis / 中国实验方剂学杂志

ObjectiveIn the treatment of acute gouty arthritis （AGA）， western medicine is mostly used for anti-inflammatory and analgesic purposes to control the blood uric acid level， but some patients are still at risk of poor control and recurrent attacks. Chinese medicinal prescriptions， potent in resisting inflammation and relieving pain， are able to stabilize the blood uric acid level， reduce acute attacks， and improve the clinical efficacy of western medicine. However， there is a lack of evidence to support their use as evidence-based medicine. This study employed network Meta-analysis （NMA） to evaluate the efficacy and safety of common Chinese medicinal prescriptions in the treatment of AGA， aiming to provide evidence-based medical evidence for the clinical use of Chinese medicinal prescriptions in the treatment of AGA. MethodChinese and English databases were searched for prospective cohort studies and randomized controlled trials （RCTs） on Chinese medicinal prescriptions against AGA from database inception to December 1， 2022. Stata software and Review Manager were used for statistical analysis. ResultForty-four papers with 3 564 cases involved were included in the current NMA. In terms of reducing blood uric acid， the cumulative probability results showed that Mahuang Lianyao Chixiaodou Tang showed optimal efficacy （87.60%）. In terms of relieving joint pain， Danggui Niantongtang and Guizhi Shaoyao Zhimutang showed optimal efficacy （92.00% and 82.30%）. In terms of improving erythrocyte sedimentation rate （ESR）， Simiaowan was superior to other prescriptions （87.00%）. In terms of reducing C-reactive protein （CRP）， Simiaowan and Baihutang modified with Guizhitang showed superior efficacy （76.00% and 66.10%）. In terms of safety， except for the basic treatment group， Mahuang Lianyao Chixiaodou Tang had the lowest probability of adverse events， and Danggui Niantongtang had the highest probability of adverse reactions during treatment. According to the results of cluster analysis， Mahuang Lianyao Chixiaodou Tang and Simiaowan are effective and safe. ConclusionAccording to the results of NMA， Chinese medicinal prescriptions can assist in the treatment of AGA and improve the effectiveness of western medicine. For patients with AGA， clinicians can choose Mahuang Lianyao Chixiaodou Tang or Simiaowan as an auxiliary drug for routine western medicine treatment.

Global identification of chemical constituents and rat metabolites of Si-Miao-Wan by liquid chromatography-electrospray ionization/quadrupole time-of-flight mass spectrometry / 中国天然药物

Si-Miao-Wan (SMW), a tradiational Chinese medicinal formula consisting of Atractylodis Rhizoma, Phellodendri Chinensis Cortex, Coicis Semen, and Achyranthis Bidentatae Radix, has been used for the treatment of gout and gouty arthritis for many years. In the present study, a liquid chromatography quadrupole-time-of-flight mass spectrometry (LC-Q-TOF/MS) method was established to identify the multiple constituents of SMW and its metabolites in rat biological samples after oral administration. A total of 48 compounds in SMW, including 21 alkaloids, 12 organic acids, 2 terpenes, 3 lactones, 2 phytosterols, and 8 other compounds, were tentatively characterized with the diagnostic-ion filtering strategy. Based on the diagnostic ions applied to identify compounds in SMW, 28 prototype compounds and 10 metabolic compounds were detected in the biological samples. This was the first comprehensive drug metabolism investigation of SMW in rats. The developed method could be a useful means for identifying the multi-components in SMW and the metabolic components. The results may help explore the possible metabolic processes and mechanism of action for SMW in vivo.

Effect of active fractions from modified Simiao Wan on hyperuricemia and its mechanism / 中国药理学与毒理学杂志

OBJECTIVE Tostudytheeffectofeffectivefractions(EFC)frommodifiedSimiaoWan (MSW)onthelevelofuricacidinhyperuricemicratsandinvestigatethemechanism.METHODS Two types of hyperurice mic models were established.A persistant hyperurice mic model was prepared by giving rats oxonic acid 200 mg·kg -1 and feeding the m with hypoxanthine.The models were ig given with modified Simiaowan (MSW)50 g·kg -1 or EFC 1 2.5,25 and 50 g·kg -1 consecutively for 5 d.The models were treated with MSW or EFC 50 g·kg -1 for 3 d.After the final treatment,the uric acid concen-trations in seru m and urine were determined by an auto matic bioche mistry analyzer.The activity of xan-thine oxidase (XOD )in the serum and liver was determined by enzymic colorimetric method.The activity of purine nucleoside phosphorylase (PNP)and uricase was detected by spectrophotometry. RESULTS Comparedwithnormalcontrolgroup,theserumlevelofuricacidinbothmodelgroupswas remarkably increased(P<0.01 ).Compared to model control group,MSW 50 g·kg -1 and EFC 12.5, 25 and 50 g·kg -1 significantly reduced the serum level of uric acid(P<0.05,P<0.01 ),but increased the activity of erythrocyte PNP(P<0.01 )in the oxonic acid potassium-induced hyperuricemia rats. MSW 50 g·kg -1 and EFC 50 g·kg -1 elevated the activity of liver uricase in the nicotinic acid-induced hyperuricemia rats(P<0.05).EFC 50 g·kg -1 also significantly decreased the serum XOD activity of hyperuricemicrats.CONCLUSION EFCsignificantlyinhibitstheserumlevelofuricacidinhyperurice-mic rats,which might involve down-regulation of protein levels of serum XOD to inhibit the production of uric acid and activation of uricase to pro mote the deco mposition of uric acid.