322例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究

The Objectivity Research on 322 Rheumatoid Arthritis Patients of Dampness-heat Impeding and Cold-dampness Impeding Chinese Medical Syndrome Types

目的探讨湿热痹阻型与寒湿痹阻型类风湿关节炎(RA)中医证型客观化分型的规律。方法收集322例住院和门诊RA患者临床数据及血清,进行DAS28评分,常规方法检测患者的血沉(ESR)、C反应蛋白(CRP)、血清白蛋白(ALB)、球蛋白(GLB)及血常规(WBC、RBC、PLT),ELISA检测血清肿瘤坏死因子-α(TNF-α)及白介素-1β(IL-1β)水平,分析各指标在湿热痹阻型与寒湿痹阻型RA间的差异。结果湿热痹阻型RA的DAS28、ESR、CRP、白细胞计数(WBC)、血小板计数(PLT)及GLB水平均显著高于寒湿痹阻型(P<0.01)。而ALB水平显著低于寒湿痹阻型(P<0.01)。ROC曲线结果显示:以湿热痹阻型为阳性对照,曲线下面积从大到小依次为:DAS28>ESR>CRP>GLB>PLT>WBC(P<0.01)。以寒湿痹阻型为阳性对照,仅ALB对RA寒湿痹阻型有诊断作用,曲线下面积为0.636(P=0.000)。结论 DAS28、ESR、CRP、PLT、WBC、GLB及ALB指标可作为湿热痹阻型与寒湿痹阻型类风湿关节炎的客观化分型参考指标。

Objective To analyze the Chinese medical syndrome typing laws in rheumatoid arthritis（RA） patients of the dampness-heat impeding syndrome and the cold-dampness impeding syndrome.Methods Clinical data and serum of 322 inpatients and outpatients were collected to perform DAS28 score.Laboratory indices including erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,albumin（ALB）,globulin（GLB）,and blood routines（white blood cell,red blood cell,and platelet） were tested by conventional methods,and the serum levels of tumor necrosis factor（TNF）-α and interleukin（IL）-1β were detected by ELISA.The difference of each index was analyzed between RA patients of the dampness-heat impeding syndrome and the cold-dampness impeding syndrome.Results The levels of DAS28 scores,ESR,CRP,white blood cell count,and platelet of RA patients of the dampness-heat impeding syndrome were significantly higher than those of the cold-dampness impeding syndrome（P0.01）.The serum level of GLB of RA patients of the dampness-heat impeding syndrome was obviously higher than that of the cold-dampness impeding syndrome（P0.01）,while the serum ALB level of RA patients of the dampness-heat impeding syndrome was obviously lower than that of the cold-dampness impeding syndrome（P0.01）.Compared with the dampness-heat impeding syndrome,ROC curve results showed the area under the curve（AUC） were ranked from large to small as DAS28 scoreESRCRPGLBPLTWBC（P0.01）.Compared with the cold-dampness impeding syndrome,only ALB was of diagnostic value for cold-dampness impeding syndrome and the AUC was 0.636（P=0.000）.Conclusion DAS28 score,ESR,CRP,PLT,WBC,GLB,and ALB could be used as objective index in identifying the differences between the dampness-heat impeding syndrome and the cold-dampness impeding syndrome in RA patients.