病程2年以内类风湿关节炎临床表现随病程演变规律的研究
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摘要
目的:观察病程2年以内类风湿关节炎临床表现随病程的演变规律。方法:从河南风湿病医院类风湿关节炎数据库(HFRA数据库)收录的409例患者中,选取病程为2年以内的患者共140例,以病程半年划分为4组,分别为半年以内组(A组)、半年到<1年组(B组)、1年到<1年半组(C组)、1年半到<2年组(D组),两两进行组间比较,得出4组患者在关节表现及关节外表现方面的区别和联系。结果:①左近指受限,A组> B组;左近指疼痛、右腕受限、左腕受限、关节畸形,A组 D组;右踝肿胀,C组 C组;左肘疼痛、右趾指疼痛、颈椎疼痛、左踝受限、神倦懒动、动则汗出,B组 B组。结论:随着病程延长,关节表现逐渐加重,并由上肢逐渐发展到下肢,下肢关节的破坏多出现在1年以后,证候由虚过渡为虚、痰、湿均明显,时间间隔大概1年。
Objective:To investigate the evolution of clinical manifestations of rheumatoid arthritis with the course of disease within 2 years.Methods:Four hundred and nine patients with rheumatoid arthritis in the database of Henan Rheumatism Hospital(HFRA database),a total of 140 patients with a course of less than 2 years were selected,then divided into four groups according to the course of disease for half a year:group A(within half a year),group B(from half a year to less than a year),group C(from a year to less than a year and a half)and group D(from a year and a half to less than 2 years).Two groups of them were respectively compared and differences and connections in joint and extraarticular manifestations of the four groups were obtained.Results:(1) The left proximal fi nger was limited more in group A than in group B(group A > group B),and as for pain in the left proximal fi nger,limitation of the right wrist,limitation of the left wrist and joint deformity,group A was better than group B(group A < group B).(2) The left elbow was more painful in group C than group D(group C > group D),and the right ankle swelling was less severe in group C than in group D(group C < group D).(3) Group A was better than Group C on the aspects of the left elbow pain,mental fatigue and laziness,and the reduction of body weight after the illness(group A < group C).(4) Group A was better than group D in the joint deformity and the reduction of body weight after disease(Group A < Group D).(5) Group B was worse than group C on the aspects of aggravation after fatigue and thirst for hot drink(Group B > Group C),while group B was better than group C in left elbow pain,right toe pain,cervical pain,left ankle limitation,fatigue and laziness,sweating while moving(Group B < Group C).(6) Group D was better than group B in depression and thirst without desire to drink(group D < group B),while group D was better than group B on the aspects of left ankle flexibility,susceptibility to cold and more phlegm(group D > group B).Conclusion:With the prolongation of the course of disease,the joint manifestations gradually aggravate,and develop from upper limbs to lower limbs.The destruction of lower limb joints occurs more than one year later.The transition time to deficiency and phlegmdampness is about one year.
Objective:To investigate the evolution of clinical manifestations of rheumatoid arthritis with the course of disease within 2 years.Methods:Four hundred and nine patients with rheumatoid arthritis in the database of Henan Rheumatism Hospital(HFRA database),a total of 140 patients with a course of less than 2 years were selected,then divided into four groups according to the course of disease for half a year:group A(within half a year),group B(from half a year to less than a year),group C(from a year to less than a year and a half)and group D(from a year and a half to less than 2 years).Two groups of them were respectively compared and differences and connections in joint and extraarticular manifestations of the four groups were obtained.Results:(1) The left proximal fi nger was limited more in group A than in group B(group A > group B),and as for pain in the left proximal fi nger,limitation of the right wrist,limitation of the left wrist and joint deformity,group A was better than group B(group A < group B).(2) The left elbow was more painful in group C than group D(group C > group D),and the right ankle swelling was less severe in group C than in group D(group C < group D).(3) Group A was better than Group C on the aspects of the left elbow pain,mental fatigue and laziness,and the reduction of body weight after the illness(group A < group C).(4) Group A was better than group D in the joint deformity and the reduction of body weight after disease(Group A < Group D).(5) Group B was worse than group C on the aspects of aggravation after fatigue and thirst for hot drink(Group B > Group C),while group B was better than group C in left elbow pain,right toe pain,cervical pain,left ankle limitation,fatigue and laziness,sweating while moving(Group B < Group C).(6) Group D was better than group B in depression and thirst without desire to drink(group D < group B),while group D was better than group B on the aspects of left ankle flexibility,susceptibility to cold and more phlegm(group D > group B).Conclusion:With the prolongation of the course of disease,the joint manifestations gradually aggravate,and develop from upper limbs to lower limbs.The destruction of lower limb joints occurs more than one year later.The transition time to deficiency and phlegmdampness is about one year.
引文
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[3]鲁丽,吴洋,陈艳林,等.类风湿关节炎主要证候分析[J].世界中西医结合杂志,2011,6(6):491-493.
[4]闫军堂,刘晓倩,王雪茜,等.王庆国教授治疗类风湿关节炎经验[J].中华中医药杂志,2012,27(9):2341-2344.
[5]娄玉钤,张子扬,许平英,等.基于病证结合的类风湿关节炎数据库建立及其409例基线资料报告[J].风湿病与关节炎,2016,5(8):5-9.
[6]中华医学会.临床诊疗指南·风湿病分册[M].北京:人民卫生出版社,2005:3.
[7]包军.类风湿关节炎的影像学变化与早期病程的判断[C]//全国自身免疫性疾病专题研讨会暨第十一次全国风湿病学学术年会论文汇编.2006:197.
[8]娄玉钤,娄高峰,娄多峰,等.基于“虚邪瘀”理论的风湿病学科体系建立及相关研究[J].风湿病与关节炎,2012,1(1):10-15.