1602例类风湿关节炎患者中医证候分布特点的多中心横断面调查
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摘要
目的分析类风湿关节炎中医证候分布特点。方法采集全国18家研究中心1602例类风湿关节炎患者的病史及中西医诊断信息,设计类风湿关节炎病证规律调查表,将所有信息录入类风湿关节炎中医临床数据库。将患者辨证分为风湿痹阻证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、气血两虚证、肝肾不足证。分析患者中医证候分布及组合特点。结果共收集符合标准的调查表1602份。因部分调查表证候诊断缺如,1418例证候填写完整的RA患者中,单一证候1232例占86.88%,其中湿热痹阻证比例最高共计622例,占43.86%,其他依次为寒湿痹阻证、肝肾不足证、痰瘀痹阻证、风湿痹阻证、气血不足证。RA患者不同证候分布差异具有统计学意义(P<0.05)。除西南地区外,其他各地区RA患者均以湿热痹阻证为主要证候,湿热痹阻证在华北地区的证候分布中所占比例最高为57.08%(137例/240例),西南地区最低为25.48%(66例/259例),西南地区以寒湿痹阻证为主要证候占32.82%(85例/259例)。各地区证候分布差异具有统计学意义(P<0.05)。痰瘀痹阻证、肝肾不足证病程与风湿痹阻证、寒湿痹阻证、湿热痹阻证、气血两虚证相比,差异具有统计学意义(P<0.05)。结论湿热痹阻证是类风湿关节炎患者的主要证候类型,其地域分布广,病程较痰瘀痹阻证、肝肾不足证患者短。
Objective To analyze the characteristics of the distribution of Chinese Medicine syndromes in rheumatoid arthritis. Methods A total of 1602 rheumatoid arthritis patients from 18 research centers across the country were recruited for the diagnosis of rheumatoid arthritis and the diagnostic information of traditional Chinese and western medicine. The questionnaire for rheumatoid arthritis syndrome was designed and all information was recorded in the Chinese Medicine clinical database of rheumatoid arthritis. The patients were divided into wind dampness obstruction syndrome,cold dampness obstruction syndrome,dampness heat obstruction syndrome,phlegm stasis obstruction syndrome,qi and blood deficiency syndrome,liver and kidney deficiency syndrome. Patients' TCM syndrome distribution and combination characteristics were analyzed. Results A total of 1602 questionnaires that met the criteria were collected. Due to lack of diagnosis in some of the questionnaires,in 1418 patients who completed the questionnaire,1236 cases with single syndrome accounted for 86. 88%,of which the highest proportion of dampness heat obstruction syndrome totaled 622 cases,accounting for 43. 86%,followed by cold dampness obstruction syndrome,liver and kidney deficiency syndrome,phlegm stasis obstruction syndrome,wind dampness obstruction syndrome,qi and blood deficiency syndrome,The difference in distribution of different syndromes in RA patients was statistically significant( P < 0. 05). Except for the southwest region,all patients in other regions had major symptoms of dampness heat obstruction syndrome. The highest proportion of damp heat obstruction syndrome in the distribution of syndromes in North China was 57. 08%( 137/240 cases). The lowest was 25. 48%( 66/259 cases) in the southwest region. The major syndrome was cold dampness obstruction syndrome of 32. 82%( 85/259 cases) in the southwest region. There was a statistically significant difference in the distribution of syndromes in each region( P < 0. 05). Significant differences were found between the phlegm stasis obstruction syndrome,liver and kidney deficiency syndrome duration and wind dampness obstruction syndrome,wind dampness obstruction syndrome,dampness heat obstruction syndrome,and qi and blood deficiency syndrome( P < 0. 05). Conclusion Dampness heat obstruction syndrome is the main syndrome type of patients with rheumatoid arthritis. Its geographical distribution is wide,and the course of disease is shorter than that of patients with phlegm stasis obstruction syndrome and liver and kidney deficiency syndrome.
Objective To analyze the characteristics of the distribution of Chinese Medicine syndromes in rheumatoid arthritis. Methods A total of 1602 rheumatoid arthritis patients from 18 research centers across the country were recruited for the diagnosis of rheumatoid arthritis and the diagnostic information of traditional Chinese and western medicine. The questionnaire for rheumatoid arthritis syndrome was designed and all information was recorded in the Chinese Medicine clinical database of rheumatoid arthritis. The patients were divided into wind dampness obstruction syndrome,cold dampness obstruction syndrome,dampness heat obstruction syndrome,phlegm stasis obstruction syndrome,qi and blood deficiency syndrome,liver and kidney deficiency syndrome. Patients' TCM syndrome distribution and combination characteristics were analyzed. Results A total of 1602 questionnaires that met the criteria were collected. Due to lack of diagnosis in some of the questionnaires,in 1418 patients who completed the questionnaire,1236 cases with single syndrome accounted for 86. 88%,of which the highest proportion of dampness heat obstruction syndrome totaled 622 cases,accounting for 43. 86%,followed by cold dampness obstruction syndrome,liver and kidney deficiency syndrome,phlegm stasis obstruction syndrome,wind dampness obstruction syndrome,qi and blood deficiency syndrome,The difference in distribution of different syndromes in RA patients was statistically significant( P < 0. 05). Except for the southwest region,all patients in other regions had major symptoms of dampness heat obstruction syndrome. The highest proportion of damp heat obstruction syndrome in the distribution of syndromes in North China was 57. 08%( 137/240 cases). The lowest was 25. 48%( 66/259 cases) in the southwest region. The major syndrome was cold dampness obstruction syndrome of 32. 82%( 85/259 cases) in the southwest region. There was a statistically significant difference in the distribution of syndromes in each region( P < 0. 05). Significant differences were found between the phlegm stasis obstruction syndrome,liver and kidney deficiency syndrome duration and wind dampness obstruction syndrome,wind dampness obstruction syndrome,dampness heat obstruction syndrome,and qi and blood deficiency syndrome( P < 0. 05). Conclusion Dampness heat obstruction syndrome is the main syndrome type of patients with rheumatoid arthritis. Its geographical distribution is wide,and the course of disease is shorter than that of patients with phlegm stasis obstruction syndrome and liver and kidney deficiency syndrome.
引文
[1]吴方真,吴宽裕,赵钟文,等.中医药优化方案治疗湿热痹阻型活动期类风湿关节炎临床观察[J].中医药通报,2014,13(6):40-42.
[2]程仕萍,贾冬梅,周平生,等.基于文本挖掘的中医药治疗类风湿关节炎骨破坏用药规律[J].中医杂志,2016,57(11):970-974.
[3]赖爱云,徐健,梁维,等.阿达木单抗注射液联合白芍总苷治疗甲氨蝶呤不耐受型类风湿关节炎的临床疗效[J].现代生物医学进展,2017,17(8):1474-1476,1486.
[4]侯雷,马武开.类风湿关节炎中医证候分类临床文献研究[J].中国中西医结合杂志,2014,34(3):279-283.
[5]AMETT FC,EDWORTHY SM,BLOCK DA,et al.The American Rheumatism Assotiation 1987 revised criteria for the classification of rheumatoid arthritis[J].Arthritis Rheum,1988,31(3):315-324.
[6]ALETAHA D,NEOGI T,SILMAN AJ,et al.2010 rheumatoid arthritis classification criteria:An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Arthritis Rheum,2010,62(9):2569-2581.
[7]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:47.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:115-117.
[9]国家中医药管理局医政司.22个专业95个病种中医临床路径(合订本)[M].北京:中国中医药出版社,2010:247.
[10]姜泉,蒋红,曹炜,等.475例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[11]王志中,方勇飞,罗彦,等.322例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究[J].中国中西医结合杂志,2011,31(4):466-470.
[12]鲁丽,吴洋,陈艳林,等.类风湿关节炎中医主要证候分析[J].世界中西医结合杂志,2011,6(6):491-493.
[13]何羿婷,付丽媛,阎小萍,等.类风湿性关节炎中医证候分布规律的初步探讨[J].中国中医基础医学杂志,2004,10(1):26-28.
[14]谢丽萍,肖敬,史伟,等.广西地区类风湿关节炎中医证候分布的研究[J].时珍国医国药,2008,19(2):380-381.
[15]陈慕芝,巴哈尔古丽,照日格图.新疆哈萨克族类风湿关节炎中医证候特点分析[J].现代中西医结合杂志,2015,24(22):2412-2414.
[16]彭江云,狄朋桃,方春凤,等.云南地区类风湿关节炎中医证候学研究[J].中国中医药信息杂志,2012,19(7):15-17.
[17]李文杰,黄闰月,晏菁遥,等.用因子分析法解析广东地区类风湿关节炎证候分型的特点[J].中华中医药学刊,2014,32(10):2359-2362.
[18]邢丽丽,高明利.辽宁地区类风湿关节炎患者中医证候规律的回顾性研究[J].风湿病与关节炎,2013,2(7):35-38.
[19]李静,柏干苹,王勇,等.401例类风湿关节炎患者中医证候要素分析[J].第三军医大学学报,2009,31(21):2103-2105.
[20]宋玉洁.类风湿性关节炎中医辨证的客观化研究[J].中国中医药科技,2007,14(5):308-309.
[21]于秀明,刘学明,侯云峰,等.类风湿性关节炎中医辨证分型与实验室指标的研究[J].中华中医药学刊,2007,25(7):1462-1464.
[22]查青林,何羿婷,吕爱平.类风湿关节炎寒热属性分类及其对中西药疗效的影响[J].江西中医学院学报,2007,19(6):21-23.
[2]程仕萍,贾冬梅,周平生,等.基于文本挖掘的中医药治疗类风湿关节炎骨破坏用药规律[J].中医杂志,2016,57(11):970-974.
[3]赖爱云,徐健,梁维,等.阿达木单抗注射液联合白芍总苷治疗甲氨蝶呤不耐受型类风湿关节炎的临床疗效[J].现代生物医学进展,2017,17(8):1474-1476,1486.
[4]侯雷,马武开.类风湿关节炎中医证候分类临床文献研究[J].中国中西医结合杂志,2014,34(3):279-283.
[5]AMETT FC,EDWORTHY SM,BLOCK DA,et al.The American Rheumatism Assotiation 1987 revised criteria for the classification of rheumatoid arthritis[J].Arthritis Rheum,1988,31(3):315-324.
[6]ALETAHA D,NEOGI T,SILMAN AJ,et al.2010 rheumatoid arthritis classification criteria:An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Arthritis Rheum,2010,62(9):2569-2581.
[7]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:47.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:115-117.
[9]国家中医药管理局医政司.22个专业95个病种中医临床路径(合订本)[M].北京:中国中医药出版社,2010:247.
[10]姜泉,蒋红,曹炜,等.475例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[11]王志中,方勇飞,罗彦,等.322例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究[J].中国中西医结合杂志,2011,31(4):466-470.
[12]鲁丽,吴洋,陈艳林,等.类风湿关节炎中医主要证候分析[J].世界中西医结合杂志,2011,6(6):491-493.
[13]何羿婷,付丽媛,阎小萍,等.类风湿性关节炎中医证候分布规律的初步探讨[J].中国中医基础医学杂志,2004,10(1):26-28.
[14]谢丽萍,肖敬,史伟,等.广西地区类风湿关节炎中医证候分布的研究[J].时珍国医国药,2008,19(2):380-381.
[15]陈慕芝,巴哈尔古丽,照日格图.新疆哈萨克族类风湿关节炎中医证候特点分析[J].现代中西医结合杂志,2015,24(22):2412-2414.
[16]彭江云,狄朋桃,方春凤,等.云南地区类风湿关节炎中医证候学研究[J].中国中医药信息杂志,2012,19(7):15-17.
[17]李文杰,黄闰月,晏菁遥,等.用因子分析法解析广东地区类风湿关节炎证候分型的特点[J].中华中医药学刊,2014,32(10):2359-2362.
[18]邢丽丽,高明利.辽宁地区类风湿关节炎患者中医证候规律的回顾性研究[J].风湿病与关节炎,2013,2(7):35-38.
[19]李静,柏干苹,王勇,等.401例类风湿关节炎患者中医证候要素分析[J].第三军医大学学报,2009,31(21):2103-2105.
[20]宋玉洁.类风湿性关节炎中医辨证的客观化研究[J].中国中医药科技,2007,14(5):308-309.
[21]于秀明,刘学明,侯云峰,等.类风湿性关节炎中医辨证分型与实验室指标的研究[J].中华中医药学刊,2007,25(7):1462-1464.
[22]查青林,何羿婷,吕爱平.类风湿关节炎寒热属性分类及其对中西药疗效的影响[J].江西中医学院学报,2007,19(6):21-23.