气阴两虚型类风湿关节炎的临床特点研究
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摘要
[目的]探讨气阴两虚型类风湿关节炎(rheumatoid arthritis,RA)的临床特点。[方法]选择2015年1月至2017年12月就诊于辽宁中医药大学附属医院的气阴两虚型RA患者,提取、记录并统计相关信息,探讨本证型患者年龄、性别、病程、合并疾病,以及炎症指标C反应蛋白(C reactive protein,CRP)、血沉(erythrocyte sedimentation rate,ESR)等临床特点,并与其他证型进行比较。[结果]气阴两虚型RA多见于中老年女性患者,多数病程大于10年;病情活动度较大多数证型低;常合并干燥综合征、慢性病性贫血、骨关节炎、骨质疏松、肺间质纤维化、2型糖尿病等疾病;患者的临床主要症状及体征为关节肿痛、晨起僵硬、口眼干涩、神疲乏力、脉细无力、肌肉酸痛、腰膝酸软、气短咳嗽、消瘦等;炎症指标轻度升高;处方的中药方剂以益气养阴中药配合活血通络中药为主,西医治疗中糖皮质激素的应用比例明显高于其他证型,联合用药中白芍总苷胶囊比例高于其他植物药,生物制剂应用比例较低。[结论]气阴两虚型RA患者的年龄、性别、病程、病情活动度、合并疾病、炎症指标、临床用药具有一定的特点。
[Objective] To explore the clinical characteristics of rheumatoid arthritis(RA) with Qi and Yin deficiency. [Methods] RA patients with Qi and Yin deficiency in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2015 to December 2017 were collected, relevant information and record were extracted and statistically analyzed to explore the clinical characteristics, including age, gender, disease course, concomitant diseases, inflammatory indicators C reactive protein(CRP) and erythrocyte sedimentation rate(ESR), and compared with other syndrome types. [Results] The syndrome of RA with Qi and Yin deficiency is more common in middle-aged and elderly women, and the course of disease is more than 10 years. The disease activity is lower than most syndromes, often associated with Sj gren's syndrome, chronic anemia, osteoarthritis, osteoporosis, pulmonary interstitial fibrosis, type 2 diabetes and other diseases. The main clinical symptoms and signs are swelling and pain of the joints, stiffness in the morning, dry mouth and eyes, fatigue, thready and weak pulse, muscle soreness, weak waist and knee, short breath, cough and emaciation, etc; and inflammation index is elevated slightly. The prescription of traditional Chinese medicine is mainly for invigorating Qi, nourishing Yin and invigorating blood circulation. The proportion of glucocorticoid use is significantly higher than that of other syndromes, the proportion of Paeony Capsules use in combination medication is higher than other plant drugs, and the proportion of biological agents is lower. [Conclusion] The age, gender, course of disease, disease activity,concomitant disease, inflammatory indicator and prescription of RA patients with Qi and Yin deficiency have certain characteristics.
[Objective] To explore the clinical characteristics of rheumatoid arthritis(RA) with Qi and Yin deficiency. [Methods] RA patients with Qi and Yin deficiency in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2015 to December 2017 were collected, relevant information and record were extracted and statistically analyzed to explore the clinical characteristics, including age, gender, disease course, concomitant diseases, inflammatory indicators C reactive protein(CRP) and erythrocyte sedimentation rate(ESR), and compared with other syndrome types. [Results] The syndrome of RA with Qi and Yin deficiency is more common in middle-aged and elderly women, and the course of disease is more than 10 years. The disease activity is lower than most syndromes, often associated with Sj gren's syndrome, chronic anemia, osteoarthritis, osteoporosis, pulmonary interstitial fibrosis, type 2 diabetes and other diseases. The main clinical symptoms and signs are swelling and pain of the joints, stiffness in the morning, dry mouth and eyes, fatigue, thready and weak pulse, muscle soreness, weak waist and knee, short breath, cough and emaciation, etc; and inflammation index is elevated slightly. The prescription of traditional Chinese medicine is mainly for invigorating Qi, nourishing Yin and invigorating blood circulation. The proportion of glucocorticoid use is significantly higher than that of other syndromes, the proportion of Paeony Capsules use in combination medication is higher than other plant drugs, and the proportion of biological agents is lower. [Conclusion] The age, gender, course of disease, disease activity,concomitant disease, inflammatory indicator and prescription of RA patients with Qi and Yin deficiency have certain characteristics.
引文
[1]姜泉,王海隆,巩勋,等.类风湿关节炎病证结合诊疗指南[J].中医杂志,2018,59(20):1794-1800.
[2]Barrett E M,Scott D G,Wiles N J,et al.The impact of rheumatoid arthritis on employment status in the early years of disease:A UK community based study[J].Rheumatology(Oxford),2000,39(12):1403-1409.
[3]Saralynn A,Frederick W,Jingbo N,et al.Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US[J].Arthritis Rheum,2008,59(4):474-480.
[4]栗占国.类风湿关节炎在我国的低认知度和高致残率不容忽视[J].中华医学杂志,2009,89(27):1873-1875.
[5]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.
[6]李小茜,何建成.充血性心力衰竭气阴两虚证临床特点[J].中国老年学杂志,2015,35(15):4205-4206.
[7]郑筱萸.中药新药临床研究指导原则[J].北京:中国医药科技出版社,2002:115-119.
[8]陈瑶,李达.激素依赖性特发性血小板减少性紫癜中医干预的探讨[J].中国中西医结合杂志,2011,31(2):276-279.
[9]罗毅.肺纤维化的中医药治疗思路[J].新中医,2011,43(4):1-3.
[10]马武开,唐芳,王莹,等.干燥综合征中医证候分类临床文献研究[J].中华中医药杂志,2013,28(2):482-485.
[11]尹德海,梁晓春,朴元林,等.2型糖尿病患者中医证型分析及其与糖尿病慢性并发症关系的探讨[J].中国中西医结合杂志,2009,29(6):506-510.
[12]李建生,王至婉,李素云,等.慢性阻塞性肺疾病稳定期常见证候及特征的临床调查[J].河南大学学报:医学版,2010,29(3):155-159.
[2]Barrett E M,Scott D G,Wiles N J,et al.The impact of rheumatoid arthritis on employment status in the early years of disease:A UK community based study[J].Rheumatology(Oxford),2000,39(12):1403-1409.
[3]Saralynn A,Frederick W,Jingbo N,et al.Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US[J].Arthritis Rheum,2008,59(4):474-480.
[4]栗占国.类风湿关节炎在我国的低认知度和高致残率不容忽视[J].中华医学杂志,2009,89(27):1873-1875.
[5]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.
[6]李小茜,何建成.充血性心力衰竭气阴两虚证临床特点[J].中国老年学杂志,2015,35(15):4205-4206.
[7]郑筱萸.中药新药临床研究指导原则[J].北京:中国医药科技出版社,2002:115-119.
[8]陈瑶,李达.激素依赖性特发性血小板减少性紫癜中医干预的探讨[J].中国中西医结合杂志,2011,31(2):276-279.
[9]罗毅.肺纤维化的中医药治疗思路[J].新中医,2011,43(4):1-3.
[10]马武开,唐芳,王莹,等.干燥综合征中医证候分类临床文献研究[J].中华中医药杂志,2013,28(2):482-485.
[11]尹德海,梁晓春,朴元林,等.2型糖尿病患者中医证型分析及其与糖尿病慢性并发症关系的探讨[J].中国中西医结合杂志,2009,29(6):506-510.
[12]李建生,王至婉,李素云,等.慢性阻塞性肺疾病稳定期常见证候及特征的临床调查[J].河南大学学报:医学版,2010,29(3):155-159.