膝骨性关节炎中医辨证分型与CT影像学特征的相关性研究

Correlative Study between Traditional Chinese Medicine Syndrome Differentiation and CT Imaging Characteristics in Knee Osteoarthritis

目的:探析膝骨性关节炎(KOA)中医辨证分型与CT影像学特征的相关性。方法:选取2018年4月-2021年4月本院收治的KOA患者126例,按中医膝痹辨证分为肾虚髓亏型41例(A组)、瘀血阻滞型45例(B组)及阳虚寒凝型40例(C组),对各组一般资料、病情分度、疼痛程度、实验室指标及CT影像学资料进行统计分析。结果:三组Kellgren-Lawrence(K-L)分级和疼痛视觉模拟(VAS)评分比较有统计学差异(P<0.05),其中A组、B组K-LⅡ级及轻度疼痛比例较C组更高,而K-LⅢ级及重度疼痛比例较C组更低(P<0.05);三组血清转化生长因子(TGF)-β1、肿瘤坏死因子(TNF)-α、抗酒石酸盐酸性磷酸酶异构体(TRACP)-5b水平比较有统计学差异(P<0.05),其中B组和C组IL-1β水平较A组更高,C组TNF-α水平较B组更高,A组和B组TRACP-5b水平较C组更高(P<0.05);比较不同证型CT影像学特征发现,三组患者均发生关节游离体,其检出率分别为39.02%、28.89%、30.00%;骨质增生、半月板退变以B组发生率最高,分别为91.11%、95.56%,高于A组和C组(P<0.05);滑膜改变以C组发生率最高,为32.50%,高于A组和B组(P<0.05);关节积液以A组发生率最高,为68.29%,高于B组(P<0.05)。结论:不同证型KOA患者的K-L分级、疼痛程度、实验室指标和CT影像学特征存在差异;KOA中医证型与CT影像学表现有一定相关性,检测患者CT影像学特征可为其中医证型的辨证提供参考。

Objective:To explore the correlation between TCM syndromes and CT imaging characteristics in knee osteoarthritis(KOA).Methods:A total of 126 patients with KOA admitted to the hospital were enrolled between April 2020 and April 2021.According to different TCM syndromes,they were divided into kidney-marrow deficiency type(41 cases,group A),blood-stasis block type(45 cases,group B)and Yang-deficiency cold cohesion type(40 cases,group C).The general data,disease severity,pain degree,laboratory indexes and CT imaging data in the different groups were statistically analyzed.Results:There were significant differences in Kellgren-Lawrence(KL)grading and score of Visual Analogue Scale(VAS)among the three groups(P<0.05).The proportions of cases with KL at grade II and mild pain in the group A and the group B were higher than those in the group C,while proportions of cases with KL at grade III and severe pain were lower than those in the group C(P<0.05).The differences in levels of serum transforming growth factor(TGF)-β1,tumor necrosis factor(TNF)-αand tartrate resistant acid phosphatase(TRACP)-5 b among the three groups were statistically significant(P<0.05).IL-1βlevel in the group B and the group C was higher than that in the groupA.TNF-αlevel in the group C was higher than that in the group B.TRACP-5 b level in the group A and the group B was higher than that in the group C(P<0.05).By comparing CT imaging characteristics of different syndromes,all the three groups had joint free bodies,which were 39.02%、28.89%and 30.00%respectively.The incidence rates of hyperostosis and meniscus degeneration were the highest in the group B(91.11%,95.56%),higher than those in the group A and the group C(P<0.05).The incidence of synovial changes was the highest in the group C(32.50%),higher than that in the group A and the group B(P<0.05).The incidence of joint effusion was the highest in the group A(68.29%),higher than that in the group B(P<0.05).Conclusion:There are differences in KL grading,pain degree,laboratory indexes and CT imaging characteristics among KOA patients with different syndromes.KOA TCM syndromes are related to CT imaging characteristics.Detecting CT imaging characteristics can provide reference for differentiation of TCM syndromes.