文章摘要
王伟杰,唐晓颇,王新昌,等.京杭两地类风湿关节炎中医证候规律的研究[J].浙江中医药大学学报,2021,45(8):904-910.
京杭两地类风湿关节炎中医证候规律的研究
Research on TCM Syndromes Rule of Rheumatoid Arthritis in Beijing and Hangzhou
DOI:10.16466/j.issn1005-5509.2021.08.016
中文关键词: 类风湿关节炎  证候规律  因地制宜  临床研究  横断面研究  湿热瘀阻证  疾病活动  多中心
英文关键词: rheumatoid arthritis  syndrome rule  according to local conditions  clinical research  cross-sectional study  damp heat stasis obstruction syndrome  disease activity  multi-center
基金项目:“十二五”国家科技支撑计划项目(2013BAI02B06);中国博士后科学基金项目(2019M660952);浙江省自然科学基金项目(LQ20H270007);浙江省自然科学基金联合基金项目(BY21H270001);浙江省医药卫生科技项目(2021KY843);浙江中医药优秀青年人才基金项目(2020ZQ022)
作者单位E-mail
王伟杰 浙江中医药大学附属第二医院 杭州 310005  
唐晓颇 中国中医科学院广安门医院  
王新昌 浙江中医药大学附属第二医院 杭州 310005  
范永升 浙江中医药大学 fyszjtcm@163.com 
姜泉 中国中医科学院广安门医院 doctorjq@126.com 
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中文摘要:
      [目的]通过对京杭两地类风湿关节炎(rheumatoid arthritis,RA)患者疾病状态及中医证候分布进行临床调查和统计分析,更加科学地认识RA的地域分布特点,并为中医药防治RA提供临床参考。[方法]采用前瞻、多中心横断面观察研究方法,于北京、杭州两地5家医疗机构共收集302例RA患者,采用EpiData 3.1软件录入数据,用SPSS 20.0统计软件分析患者的基本情况、证候情况以及与地域、实验室指标、疾病活动之间的相关性。[结果]RA的诱因以受凉和劳累最多,产后次之。RA患者证候分型中,比例最高的为湿热瘀阻证,其余依次为痰瘀痹阻证和肝肾不足证,寒湿痹阻证与风湿痹阻证最少。湿热瘀阻证28个关节的疾病活动评分(the disease activity score in 28 joints,DAS28)水平最高。实验室指标中风湿痹阻证和寒湿痹阻证C反应蛋白(C reaction protein,CRP)水平低于其他证候,各证候间类风湿因子(rheumatoid factor,RF)和血沉(erythrocyte sedimentation rate,ESR)差异无统计学意义(P=0.489,P=0.0678)。所调查的北京和杭州两地的RA患者中,杭州的肝肾不足证比例高于北京,差异具有统计学意义(P=0.005);而北京湿热瘀阻证比例虽然高于杭州,但差异无统计学意义(P=0.144)。[结论]京杭两地的RA患者的中医证候规律既表现出RA病机的共性,湿、热、瘀,又表现出一定的地域差异性,提示在临床辨治RA时应注意共同病机与三因制宜相结合。
英文摘要:
      [Objective]To analyze the traditional Chinese medicine(TCM) syndrome and disease status of patients with rheumatoid arthritis(RA), in order to understand the regional distribution characteristics of RA more scientifically for the prevention and treatment of RA. [Methods]A prospective, multi-center, cross-sectional observational research method was used to collect 302 patients with RA in 5 medical institutions in Beijing and Hangzhou. The data were recorded using EpiData 3.1, and the basic conditions and syndromes situation and correlations with geography, laboratory indicators and disease activity of the patients were analyzed using SPSS 20.0. [Results] The most incentives of RA are cold and tiredness, followed by postpartum. Among the syndrome types of RA patients, the highest proportion was damp heat stasis obstruction syndrome, and the rest were ranked in order of phlegm stasis obstruction syndrome and liver and kidney deficiency syndrome, cold damp obstruction syndrome and wind damp obstruction syndrome are the least. The disease activity score in 28 joints(DAS28) of damp heat stasis obstruction syndrome was the highest. The levels of C reaction protein(CRP) in wind damp obstruction syndrome and cold damp obstruction syndrome were lower than those in other syndrome types. There was no significant difference of the rheumatoid factor(RF) and erythrocyte sedimentation rate(ESR) among the syndromes types(P=0.489, P=0.0678). Among the RA patients surveyed in Beijing and Hangzhou, the proportion of liver and kidney deficiency syndrome in Hangzhou was higher than that in Beijing with significant difference(P=0.005). Meanwhile, the proportion of damp heat stasis obstruction syndrome in Beijing was higher than in Hangzhou with no significant difference(P=0.144). [Conclusion]The TCM syndromes of RA patients in Beijing and Hangzhou not only show the common characteristics of RA pathogenesis, such as dampness, heat and blood stasis, but also show certain regional differences, which suggests that doctors should pay attention to the combination of common pathogenesis and three factors in the clinical diagnosis and treatment of RA.
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