不同中医证型痛风患者的临床指标对比分析及其意义

Comparative Analysis of Clinical Indicators of Gout Patients of Different Syndrome Types and Its Significance

目的了解痛风患者中医辨证不同证型的临床指标差异及其临床意义。方法对2011年11月—2012年12月川北医学院附属医院风湿门诊和住院的257例男性痛风患者进行中医辨证分型,以50名男性健康体检者为对照,并收集临床及实验室数据,所有研究对象均排除感染及其他炎性疾病。结果在痛风患者中存在痰瘀互结、湿热瘀阻、脾虚湿困、气血亏虚4个证型,其中痛风急性期痰瘀互结证53例,湿热瘀阻证41例,气血亏虚证25例,脾虚湿困证17例;痛风非急性期气血亏虚证41例,脾虚湿困证40例,湿热瘀阻证24例,痰瘀互结证16例。不同证型痛风患者血液常规(WBC、GR、LY、MO)及血生化指标(UA、Ur、Cr、ALT、AST、ALB、GLOB、TG、HDL-C、VLDL-C、apoA、apoB100)与正常对照组比较,差异均有统计学意义(P<0.05,P<0.01);不同中医证型组间比较,各项指标存在不同差异,并存在相关性。结论在痛风的急性期以痰瘀互结证、湿热瘀阻证2个证型为主,而在痛风非急性期多见气血亏虚证、脾虚湿困证2个证型。在痛风痰瘀互结证与湿热瘀阻证2型患者中炎症与免疫反应较为明显,提示对该类患者若采用清热化瘀等相关抗炎与调节免疫反应的治疗可能取得较好的疗效;在痛风气血亏虚证与脾虚湿困证2型患者中肾功能受损较为显著,提示对该患者以健脾补肾为主的治疗可能取得较好的疗效。

Objective To understand the difference in clinical indicators of gout patients of different Chinese medical syndromes and its clinical significance. Methods Form November 2011 to December 2012, syndrome typed were 257 male gout in-loutpatients from Affiliated Hospital of Chuanbei Medical College. Another 50 healthy male subjects were recruited as the control. Their clinical and laboratory data were collected. All were excluded from infections and other inflammatory diseases. Results Four syn- drome types existed in gout patients, i.e., intermingled phlegm-stasis blood syndrome （IPSBS）, obstruc- tion of dampness and heat syndrome （ODHS）, Pi-deficiency induced dampness syndrome （PDIDS）, qi- blood deficiency syndrome （QBDS）. Of them, 53 acute phase gout patients suffered from IPSBS, 41 from ODHS, 25 from QBDS, and 17 from PDIDS; 41 non-acute phase gout patients suffered from QBDS, 40 from PDIDS, 24 from ODHS, and 16 from IPSBS. Statistical analysis of clinical data showed that, when compared with the normal control group, there was statistical difference in blood routines （WBC, GR, LY, MO） and blood biochemical indices （UA, Ur, Cr, ALT, AST, ALB, GLOB, TG, HDL-C, VLDL-C, apoA, apoB100） of gout patients of different syndromes （P 〈0.05, P 〈0.01 ）. There was also statistical difference or correlation among different syndromes （P 〈0.05）. Conclusions In the acute phase gout patients, IPSBS and ODHS were dominated, while in the non-acute phase gout patients, QBDS and PDIDS were often seen. In patients of IPSBS and ODHS, inflammation and immune response were more obvious,indicating that better efficacy might be achieved by clearing heat and removing blood stasis associated anti-inflammatory and immune regulation therapies. In patients of QBDS and PDIDS, impaired renal functions were more significant, indicating that better efficacy might be achieved by invigorating Pi and tonifying Shen dominated treatment.