类风湿性关节炎的病理生理特点与中医四诊信息的相关性分析

Correlation of Physiopathalogical Characteristics with TCM Syndromes Obtained by Four Diagnostic Methods

【目的】运用多元统计分析的方法分析中医四诊信息与类风湿性关节炎(RA)细胞因子[白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)]、临床炎性检查指标[血沉(ESR)和C反应蛋白(CRP)]和临床免疫学检查指标[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、类风湿因子(RF)、补体C3]的相关性。【方法】随机选取符合纳入标准的早期RA女性患者70例,按RA证候问卷表采集患者各项证候信息,参照相应标准进行寒、热证候判断和活动性判断。同时,取患者晨起空腹血样,检测细胞因子(IL-8、TNF-α、IL-10)、临床炎性检查指标(ESR、CRP) 和临床免疫学检查指标(IgA、Ign、IgG、RF、C3)。采用因子分析方法对患者证候信息进行降维处理,然后采用典型相关分析方法探索各公因子与客观指标之间的相关性。【结果】将收集的中医四诊信息用因子分析得到5个公因子,他们分别能较好地反映关节局部病情以及中医寒证、热证、虚证的症状;除CRP外,早期女性RA患者各公因子的细胞因子(IL-8、 TNF-α、IL-10)、临床炎性检查指标(ESR)及各免疫学指标(IgA、IgM、IgG、RF、C3)均未见显著性差异。【结论】因子分析能够对症状进行分类研究,因子分析结果与传统证候分型有一致性;代表寒热证候的公因子CRP在早期RA患者之间有显著性差异,寒证的CRP低于热证,提示CRP可以作为RA寒热主观症状分类的微观指标之一;联合运用因子分析和典型相关分析方法分析主观症状与客观指标之间的相关性是可行的。

[ Objective] Multiple statistical analysis was used to investigate the relationship of TCM syndromes based on four diagnostic methods with the levels of rheumatoid arthritis （RA） cytokines such as interleukin-8 （IL-8）, tumor necrosis factor α （TNF-α） and interleukin-10 （IL-10）, and with the inflammatory indicators of erythmcyte sedimentation rate （ESR） and C-reactive protein （CRP） as well as with the immune function indexes of immunoglobulin A （lgA）, IgM, IgG, rheumatoid factor （RF） and activated third component of complement （C3）. [Methods] The outcomes of RA syndrome questionnaire about the manifestions of 70 early RA female patients were collected and classified to cold and heat syndromes accordiug to the TCM syndrome criteria. The activity of RA was also evaluated. Blood samples were, collected in the morning and were used to test the RA cytokines （ IL-8, TNF-α and IL-10）, the inilammatory indicators （ESR and CRP） and the inunune function indexes （IgA, IgM, IgG, RF and C3）. The collected information of RA syndromes were treated first by the integration of principal components analysis and factor analysis, and then the correlation of common factors of RA syndromes with the laboratory indexes was investigated by typical correlation analysis. [Results] Five common factors of RA syndromes were obtained, which were indicative of the affection of the joints and the symptoms and signs of cold-, deficiency- and heat-type syndrome. Except CRP, the difference between common factors and the RA cytokines （IL-8, TNF-α and IL-10）, the inflammato,y indicator of ESR and the immune function indexes （IgA, IgM, IgG, RF and C3） was insignificant. [ Conclusion] It is feasible to analyze the symptoms of RA with factor analysis methods. The result of factor analysis accords with the syndrome differentiatiation in TCM. There is significant difference between CRP and common factors of cold and heat syndromes in early RA patients. CRP level in cold syndrome is lower than that in the heat syndrome, indicating that CRP can be used as one of the laboratory parameters for the classification of cold- and heat-syndrome. It is reasonable to apply factor analysis combined with typical convlation analysis for the correlation between subjective symptoms and objective parameters.