强直性脊柱炎不同证型与病情活动的相关性分析

Analysis on Correlation between Different Syndrome of Ankylosing Spondylitis and Disease Activity

目的探索强直性脊柱炎(AS)中医证候规律,为中医药辨证论治AS提供客观依据。方法采用观察性研究方法,将中医证候诊断明确的50例肾虚督寒证和43例肾虚湿热证AS患者作为观察对象,分析AS不同证型在性别、年龄、病程方面的分布规律,以及不同证型与症状、体征、疾病活动度及炎症指标免疫球蛋白(IgG、IgA、IgM)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素(IL)-1、IL-6的相关性。结果肾虚督寒证和肾虚湿热证患者在年龄分布、病程、外周关节肿胀、肌腱端压痛程度、巴氏AS疾病活动指数(BASDAI)、疾病活动性评分(ASDAS)、ESR方面存在差异(P<0.05);在性别、疼痛程度、晨僵程度、晨僵时间、疲劳/困倦、巴氏AS功能指数(BASFI)、巴氏AS活动测量指数(BASMI)、患者总体评价积分等方面无明显差异(P>0.05)。其中,病程、外周关节肿胀、ESR与肾虚督寒证和肾虚湿热证的辨证关系密切(P<0.05)。AS患者的血清IL-6水平与ESR、CRP、ASDAS评分、BASDAI存在相关关系(相关系数分别为r=0.21、r=0.21、r=0.30、r=0.29,P<0.05)。结论肾虚督寒证AS患者年龄大,病程长;肾虚湿热证AS的疾病活动度较肾虚督寒证患者高;病程、外周关节肿胀、ESR对于肾虚督寒证和肾虚湿热证的辨证关系密切;血清IL-6水平与AS疾病活动度相关。

Objective To explore the rule of syndrome of ankylosing spondylitis（AS）,provide an objective evidence for Chinese medicine diagnosis and treatment of AS.Methods Fifty cases of kidney deficiency and cold govenor vessel syndrome and 43 cases of kidney deficiency and damp-heat syndrome were the object of observation.The distribution of different syndrome of AS in age,gander,staging,and the correlation between syndrome and symptoms,signs,disease activity and inflammation indexes（IgG,IgA,IgM,ESR,CRP,IL-1,IL-6） were analyzed.Results There was difference between AS patients of kidney deficiency and cold govenor vessel syndrome and kidney deficiency and damp-heat syndrome in age distribution,staging,peripheral joint swelling,tenderness of the tendon end,BASDAI,ASDAS and ESR（P 0.05）,and there was no significant difference in gender,degree of pain and morning stiffness,fatigue,BASFI and BASMI（P 0.05）.Staging,peripheral joint swelling,ESR had closely relationship with the differentiation in two syndrome（P 0.05）.There was correlation between serum IL-6 level and ESR,CRP,ASDAS score,BASDAI in AS patients（correlation coefficients were r =0.21,r =0.21,r =0.30,r =0.29,P 0.05）.Conclusion AS patients of kidney deficiency and cold govenor vessel syndrome were elder age and longer staging.The disease activity of patients with kidney deficiency and damp-heat syndrome was higher than patients of kidney deficiency and cold govenor vessel syndrome.Staging,peripheral joint swelling and ESR have closely relationship with the differentiation between the two syndromes.Serum IL-6 level was associated with AS disease activity.