类风湿性关节炎中医证型与病情活动指标的相关性研究

目的:了解豫北地区类风湿性关节炎(rheumatoid arthritis,RA)患者的中医证型与病情活动指标的相关性。方法:回顾性分析从2014年10月—2017年5月在新乡市中心医院风湿免疫科就诊的类风湿性关节炎患者320例,以中医辨证分型分组,分为寒湿痹阻、湿热痹阻、痰瘀痹阻、寒热错杂、肝肾两虚等5种证型,统计不同中医证型年龄与病程分布情况,全自动血细胞分析仪测定血小板(Platelet,PLT)计数,魏氏法测定血沉(erythrocyte sedimentation rate,ESR),采用免疫比浊法测定C反应蛋白(C reactive protein,CRP)及风湿因子(Rheumatic factor,RF),采用酶联免疫吸附试验方法(ELISA法)测定抗环瓜氨酸肽抗体(cyclic citrullinated peptide,CCP)。分析不同中医证型与实验室指标阳性率的相关性。结果:湿热痹阻证RA患者年龄相对年轻,不同年龄段各个证型间的构成比比较,差异有统计学意义(P0.05)。湿热痹阻病程多为10 a以下,病程超过20 a的多为寒湿痹阻证、痰瘀痹阻证及肝肾两虚证。RA患者的PLT在湿热痹阻、痰瘀痹阻中明显升高,抗CCP抗体在湿热痹阻RA患者中更高,与其他证型比较,差异有统计学意义(P0.05);不同证型的RF、ESR、CRP比较,差异无统计学意义(P0.05)。结论:豫北地区RA证候以湿热痹阻多见,病程短,且与PLT计数与抗CCP抗体滴度相关,可作为中医药治疗的指导参考。

The Study on Correlation Between TCM Type and Disease Activity Index of Rheumatoid Arthritis

Objective:To understand the correlation between TCM type and disease activity index of rheumatoid arthritis in the north area of Henan Province.Methods:By using retrospective analysis,320 patients with rheumatoid arthritis who were treated in Xinxiang Central Hospital between October 2014 and May 2017 were chosen as the research subjects,and divided into the following 5 TCM types:cold-damp bi-syndrome,damp-heat bi-syndrome,phlegm stasis bi-syndrome,syndrome of intermingled cold and heat,liver and kidney deficiency.Different TCM syndromes age and disease course distribution were counted;Platelet(PLT) count was determined by using automatic blood cell analyzer;Erythrocyte sedimentation rate(ESR) was measured by using Westergren method;C reactive protein(CRP) and Rheumatic factor(RF) were determined by using immunoturbidimetry.Cyclic citrullinated peptide(CCP) was measured by using ELISA method.Results:The RA patients with damp-heat bi-syndrome were relatively younger,and there was statistical difference in the ratio of syndrome types among different age groups(P ＜ 0.05).The course of dampheat bi-syndrome was often less than 10 years,while those of cold-damp bi-syndrome,phlegm stasis bi-syndrome,liver and kidney deficiency are often more than 20 years.PLT of RA patients was significantly higher in damp-heat bi-syndrome and phlegm stasis bi-syndrome;anti CCP antibody was much higher in damp-heat bi-syndrome,and compared with other syndromes,the difference was statistically significant(P ＜0.05).The differences in RF,ESR,CRP of different syndromes were not statistically significant (P ＞0.05).Conclusion:In the north area of Henan Province,RA syndrome is mainly seen in patients with damp-heat bi-syndrome.The course is short,RA is correlated with PLT count and the titer of anti CCP antibody,which can provide guidance and reference for TCM treatment.