文章摘要
王晨彤,姜德友.我国类风湿性关节炎中医证候分布频率Meta分析[J].浙江中医药大学学报,2022,46(4):439-450.
我国类风湿性关节炎中医证候分布频率Meta分析
Meta-analysis on the Distribution Frequency of TCM Syndromes of Rheumatoid Arthritis in China
DOI：10.16466/j.issn1005-5509.2022.04.016
中文关键词: 类风湿  证候  循证医学  横断面研究  Meta分析  地域  年限
英文关键词: rheumatoid  syndrome  evidence-based medicine  cross-section study  Meta-analysis  region  years
基金项目:国家中医药管理局龙江医学流派传承工作室建设项目(LPGZS2012-14)；黑龙江中医药大学研究生创新科研项目(2020yjscx001)
作者单位
王晨彤 黑龙江中医药大学　哈尔滨　150040 
姜德友 黑龙江中医药大学　哈尔滨　150040 
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中文摘要:
      [目的] 系统评价我国类风湿性关节炎证候分布频率。[方法] 计算机检索中国知识资源总库(China National Knowledge Infrastructure，CNKI)、维普中文期刊数据库(China Science and Technology Journal Database，VIP)、万方学术期刊全文数据库、中国生物医学文献数据库(China Biology Medicine disc，CBM)、PubMed、Embase、Cochrane、中国临床试验注册中心(Chinese Clinical Trial Registry，ChiCTR)、美国临床试验注册中心(U.S. National Library of Medicine，ClinicalTrials.gov)数据库，搜集我国类风湿性关节炎患者的基本特征及中医证候信息，检索时限为建库至2021年7月1日。由2名研究者独立筛选文献，提取资料并评价纳入研究的偏倚风险，随后采用Stata 14.0软件进行Meta分析。[结果] 共纳入25篇文献研究，涉及病例13 788例，其中男女比例为1:3.61，患者年龄4～92岁，病程2周～79年。Meta分析结果显示，5种证候分布频率由高到低依次为湿热痹阻证0.26[95%置信区间(confidence interval，CI)(0.21，0.31)，P＜0.001]、寒湿痹阻证0.21[95%CI(0.13，0.29)，P＜0.001]、痰瘀痹阻证0.11[95%CI(0.09，0.13)，P＜0.001)]、肝肾不足证0.12[95%CI(0.10，0.15)，P＜0.001)]、气血(含气阴)两虚证0.10[95%CI(0.08，0.11)，P＜0.001)]。亚组分析结果显示，地域亚组中华北地区的湿热痹阻证0.38[95%CI(0.30，0.46)]；东北地区的湿热痹阻证0.32[95%CI(0.05，0.59)]；华东地区的痰瘀痹阻证0.22[95%CI(0.08，0.36)]；西南地区的寒湿痹阻证0.58[95%CI(0.49，0.67)]；华南地区的肝肾不足证0.27[95%CI(0.21，0.33)]；华中地区的湿热痹阻证0.26[95%CI(0.16，0.36)]；西北地区的寒湿痹阻证和湿热痹阻证0.22[95%CI(0.11，0.33)](两证型在西北地区分布频率相同)较同一地域的其他证型高发。年限亚组中1995至2005年的湿热痹阻证0.42[95%CI(0.37，0.46)]；2005至2015年的寒湿痹阻证0.27[95%CI(0.10，0.44)]；2015年至今的湿热痹阻证0.20[95%CI(0.08，0.33)]较同一时间段内的其他证型高发。[结论] 我国的类风湿性关节炎证候分布由多到少依次为湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾不足证、气血(含气阴)两虚证；五种证候类型的分布情况存在地域及年限差异。由于受到纳入研究数量和质量的影响，需要更多高质量的研究加以验证。
英文摘要:
      [Objective] To systematically evaluate the distribution frequency of traditional Chinese medicine(TCM) syndromes of rheumatoid arthritis in China. [Methods] The China National Knowledge Infrastructure(CNKI)，China Science and Technology Journal Database(VIP)，WanFang Data， China Biology Medicine disc(CBM)， PubMed， Embase， Cochrane， Chinese Clinical Trial Registry(ChiCTR)， U.S. National Library of Medicine(ClinicalTrials.gov) databases were searched by computer to collect the basic characteristics and TCM syndrome information of patients with rheumatoid arthritis in our country. The search time limit was from the establishment of the database to July 1st 2021. Two researchers independently screened the literature， extracted data and evaluated the risk of bias in the included studies， and then used Stata 14.0 software for Meta-analysis. [Results] A total of 25 literature studies were included， involving 13 788 cases. The male to female ratio was 1:3.61， the patient's age span was from 4 to 92 years old， and the disease course span was from 2 weeks to 79 years. Meta-analysis results showed that the distribution frequency of the 5 syndromes from high to low was 0.26 for damp-heat arthralgia syndrome[95% Confidence Interval(CI)(0.21，0.31)， P＜0.001]， 0.21 for cold-dampness arthralgia syndrome[95%CI(0.13，0.29)， P＜0.001]， 0.11 for phlegm-stasis arthralgia syndrome[95%CI(0.09，0.13)， P＜0.001]， 0.12 for liver and kidney deficiency syndrome[95%CI(0.10，0.15)， P＜0.001] and 0.10 for Qi and blood (including Qi and Yin) deficiency syndrome[95%CI(0.08，0.11)， P＜0.001]. The results of subgroup analysis showed that in the regional subgroup， the incidence of the damp-heat arthralgia syndrome 0.38[95%CI(0.30，0.46)] in North China; the damp-heat arthralgia syndrome 0.32[95%CI(0.05，0.59)] in Northeast China; the phlegm-stasis arthralgia syndrome 0.22[95%CI(0.08，0.36)] in East China; the cold-damp arthralgia syndrome 0.58[95%CI(0.49，0.67)] in Southwest China; the liver and kidney deficiency syndrome 0.27[95%CI(0.21，0.33)] in South China; the damp-heat arthralgia syndrome 0.26[95%CI(0.16，0.36)] in Central China; the cold-damp arthralgia syndrome and damp-heat arthralgia syndrome 0.22[95%CI(0.11，0.33)] in the northwest region(the frequency of the two syndromes is the same in the northwest region) was higher than that of other syndromes in the same region. In the subgroup of years of age， the incidence of the damp-heat arthralgia syndrome 0.42[95%CI(0.37，0.46)] from 1995 to 2005; the cold-damp arthralgia syndrome 0.27[95%CI(0.10，0.44)] from 2005 to 2015; the damp-heat arthralgia resistance syndrome 0.20[95%CI(0.08，0.33)] from 2015 to present was higher than that of other syndromes in the same time period. [Conclusion] The distribution of rheumatoid arthritis syndromes in our country， in descending order， is damp-heat arthralgia syndrome， cold-damp arthralgia syndrome， phlegm-stasis arthralgia syndrome， liver and kidney deficiency syndrome， and deficiency of both Qi and blood (including Qi and Yin); the distribution of the types of syndromes differs by region and age. Due to the influence of the number and quality of included studies， more high-quality studies are needed to verify.
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