类风湿关节炎中医证型与肌骨超声改变的关系
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摘要
目的探讨类风湿关节炎(RA)不同中医证型与肌骨超声改变的关系。方法将87例RA患者按中医证候分型标准分为湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾亏虚证、肝郁脾虚证5型。应用超声技术探测关节的滑膜厚度、滑膜血流、关节软骨及软骨下骨质破坏、关节积液、肌腱炎或腱鞘炎等情况,分析RA不同证型与超声改变的关系。结果湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾亏虚证、肝郁脾虚证的滑膜增厚阳性率分别为88.46%(92/104)、77.78%(28/36)、86.67%(52/60)、61.90%(52/84)、62.50%(40/64);滑膜血流阳性率分别为84.62%(88/104)、55.56%(20/36)、46.67%(28/60)、47.62%(40/84)、25.00%(16/64);软骨及软骨下骨破坏阳性率分别为15.38%(16/104)、11.11%(4/36)、26.67%(16/60)、42.86%(36/84)、25.00%(16/64);关节积液的阳性率分别为80.77%(84/104)、55.56%(20/36)、73.33%(44/60)、66.67%(64/84)、62.50%(40/64);肌腱炎或腱鞘炎的阳性率15.38%(16/104)、11.11%(4/36)、46.67%(20/60)、9.52%(8/84)、18.75%(8/64)。湿热痹阻证的滑膜增厚阳性率、血流阳性率、关节积液阳性率均高于肝肾亏虚证、肝郁脾虚证(P<0.05,P<0.01);肝肾亏虚证的软骨及软骨下骨破坏阳性率最高(P<0.01);痰瘀痹阻证的肌腱炎或腱鞘炎的阳性率最高(P<0.01)。结论 RA患者的关节超声变化与中医证型存在一定的相关性,湿热痹阻证滑膜增生明显,血流较丰富,易产生关节积液;肝肾亏虚证患者易出现骨破坏;痰瘀痹阻证易出现肌腱炎或腱鞘炎,为RA的辨证分型提供了一定的客观依据。
Objective To observe the relationship between different traditional Chinese medicine( TCM) syndrome types of rheumatoid arthritis( RA) patients and the changes of muscle and bone ultrasound. Methods Totally 87 RA patients were assigned to five types groups according to TCM syndrome differentiation: damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome. By using ultrasonic technique,a comparative observation of synovium thickness,synovium blood flow,destructions of arthrodial cartilage and subchondral bone,effusion of joint,tendonitis or tenosynovitis were performed in all patients to ana-lyze correlation between different TCM syndrome types and ultrasonic changes of muscle and bone in RA patients. Results The synovium thickness positive rate of damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome were respectively 88. 46%( 92/104),77. 78%( 28/36),86. 67%( 52/60),61. 90%( 52/84),62. 50%( 40/64); the synovium blood flow positive rate were respectively 84. 62%( 88/104),55. 56%( 20/36),46. 67%( 28/60),47. 62%( 40/84),25. 00%( 16/64); the positive rate of cartilage and subchondral bone destructions were respectively 15. 38%( 16/104),11. 11%( 4/36),26. 67%( 16/60),42. 86%( 36/84),25. 00%( 16/64); the positive rate of effusion of joint were respectively 80. 77%( 84/104),55. 56%( 20/36),73. 33%( 44/60),66. 67%( 64/84),62. 50%( 40/64); the positive rate of tendonitis or tenosynovitis were respectively 15. 38%( 16/104),11. 11%( 4/36),46. 67%( 20/60),9. 52%( 8/84),18. 75%( 8/64). The synovium thickness positive rate,the synovium blood flow positive rate,and the positive rate of effusion of joint in Damp-heat obstruction syndrome were higher than those in Gan-Shen deficiency syndrome and Gan depression Pi deficiency syndrome(P < 0. 05,P < 0. 01); the positive rate of cartilage and subchondral bone destruction was the highest in Gan-Shen deficiency syndrome(P < 0. 01); the positive rate of tendonitis or tenosynovitis was the highest in phlegm-stasis obstruction syndrome(P < 0. 01). Conclusions There is a certain correlation between joint ultrasound changes and TCM syndrome types in RA patients. In Damp-heat obstruction syndrome the proliferation of synovium was obviously seen,blood was abundant,joint effusion was prone to produce. Destruction of arthrodial cartilage and subchondral bone easily occurred in RA patients with Gan-Shen deficiency syndrome. Tenosynovitis or myotenositis easily occurred in RA patients with phlegm-stasis obstruction syndrome. These provided certain objective evidence for TCM syndrome differentiation of RA.
Objective To observe the relationship between different traditional Chinese medicine( TCM) syndrome types of rheumatoid arthritis( RA) patients and the changes of muscle and bone ultrasound. Methods Totally 87 RA patients were assigned to five types groups according to TCM syndrome differentiation: damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome. By using ultrasonic technique,a comparative observation of synovium thickness,synovium blood flow,destructions of arthrodial cartilage and subchondral bone,effusion of joint,tendonitis or tenosynovitis were performed in all patients to ana-lyze correlation between different TCM syndrome types and ultrasonic changes of muscle and bone in RA patients. Results The synovium thickness positive rate of damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome were respectively 88. 46%( 92/104),77. 78%( 28/36),86. 67%( 52/60),61. 90%( 52/84),62. 50%( 40/64); the synovium blood flow positive rate were respectively 84. 62%( 88/104),55. 56%( 20/36),46. 67%( 28/60),47. 62%( 40/84),25. 00%( 16/64); the positive rate of cartilage and subchondral bone destructions were respectively 15. 38%( 16/104),11. 11%( 4/36),26. 67%( 16/60),42. 86%( 36/84),25. 00%( 16/64); the positive rate of effusion of joint were respectively 80. 77%( 84/104),55. 56%( 20/36),73. 33%( 44/60),66. 67%( 64/84),62. 50%( 40/64); the positive rate of tendonitis or tenosynovitis were respectively 15. 38%( 16/104),11. 11%( 4/36),46. 67%( 20/60),9. 52%( 8/84),18. 75%( 8/64). The synovium thickness positive rate,the synovium blood flow positive rate,and the positive rate of effusion of joint in Damp-heat obstruction syndrome were higher than those in Gan-Shen deficiency syndrome and Gan depression Pi deficiency syndrome(P < 0. 05,P < 0. 01); the positive rate of cartilage and subchondral bone destruction was the highest in Gan-Shen deficiency syndrome(P < 0. 01); the positive rate of tendonitis or tenosynovitis was the highest in phlegm-stasis obstruction syndrome(P < 0. 01). Conclusions There is a certain correlation between joint ultrasound changes and TCM syndrome types in RA patients. In Damp-heat obstruction syndrome the proliferation of synovium was obviously seen,blood was abundant,joint effusion was prone to produce. Destruction of arthrodial cartilage and subchondral bone easily occurred in RA patients with Gan-Shen deficiency syndrome. Tenosynovitis or myotenositis easily occurred in RA patients with phlegm-stasis obstruction syndrome. These provided certain objective evidence for TCM syndrome differentiation of RA.
引文
[1]吕芳,李兴福.2010年美国风湿病学会联合欧洲抗风湿病联盟的类风湿关节炎分类标准解读[J].诊断学理论与实践,2010,9(4):307-310.
[2]郑筱萸主编.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:115-119.
[3]王承德主编.实用中医风湿病学[M].北京:人民卫生出版社,2009:260-269.
[4]姜萍,张琳英,戴玲玲,等.和痹方治疗类风湿关节炎疗效观察[J].中国中西医结合杂志,2016,36(1):24-28.
[5]Wakefield RJ,Balint PV,Szkudlarek M,et al.Musculoskeletal ultrasound including definitions for ultrasonographicpathology[J].J Rheumatol,2005,32(12):2485-2487.
[6]Szkudlarek M,Court-Payen M,Jacobsen S,et al.Inter observer agreement in ultrasonography of the finger and toe joints in rheumatoidarthritis[J].Arthritis Rheum,2003,48(4):955-962.
[7]Alder DD,Carson PL,Rubin JM,et al.Doppler ultrasound color flow imaging in the study of breast cancer preliminary finding[J].Ultrasound Med Biol,1990,16(6):553-559.
[8]Szkudlarek M,Court-Payen M,Strandberg C,et al.Power Doppler ultrasonnography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis:a comparison with dynamic magnetic resonance imaging[J].Arthritis Rheum,2001,44(9):2018-2023.
[2]郑筱萸主编.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:115-119.
[3]王承德主编.实用中医风湿病学[M].北京:人民卫生出版社,2009:260-269.
[4]姜萍,张琳英,戴玲玲,等.和痹方治疗类风湿关节炎疗效观察[J].中国中西医结合杂志,2016,36(1):24-28.
[5]Wakefield RJ,Balint PV,Szkudlarek M,et al.Musculoskeletal ultrasound including definitions for ultrasonographicpathology[J].J Rheumatol,2005,32(12):2485-2487.
[6]Szkudlarek M,Court-Payen M,Jacobsen S,et al.Inter observer agreement in ultrasonography of the finger and toe joints in rheumatoidarthritis[J].Arthritis Rheum,2003,48(4):955-962.
[7]Alder DD,Carson PL,Rubin JM,et al.Doppler ultrasound color flow imaging in the study of breast cancer preliminary finding[J].Ultrasound Med Biol,1990,16(6):553-559.
[8]Szkudlarek M,Court-Payen M,Strandberg C,et al.Power Doppler ultrasonnography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis:a comparison with dynamic magnetic resonance imaging[J].Arthritis Rheum,2001,44(9):2018-2023.