湖南地区类风湿性关节炎主要中医证型分布规律研究

Study on Distribution Law of Main Types of Traditional Chinese Medicine Syndromes of Rheumatoid Arthritis in Hunan

目的：研究分析湖南地区类风湿性关节炎（Rheumatoid Arthritis,RA）的主要中医证型流病学分布规律,为其临床辨证论治研究提供参考依据。方法：采集2013年1月—2014年12月于湖南中医药大学第一附属医院风湿内科就诊且确诊为类风湿性关节炎患者病历资料299例。建立数据库,并采用SPSS 22.0软件进行统计,分析类风湿性关节炎主要中医证型在性别、年龄及病程方面的分布规律。结果：类风湿性关节炎各证型分布存在显著差异（χ2=179.679,P=0.000）。类风湿性关节炎各证型在性别（P=0.217）、病程（P=0.804）方面无显著性差异,而在年龄（P=0.012）方面存在显著性差异。在年龄方面：年龄〈40岁的患者,证型分布依次为寒湿痹阻证〉湿热痹阻证〉肾气虚寒证〉肝肾阴虚证;40~60岁的患者,证型分布为寒湿痹阻证〉湿热痹阻证〉肝肾阴虚证〉肾气虚寒证〉痰瘀互结证;年龄〉60岁的患者,证型分布为寒湿痹阻证〉肝肾阴虚证〉湿热痹阻证〉肾气虚寒证〉痰瘀互结证。结论：湖南地区类风湿性关节炎主要证型为寒湿痹阻证,其次为湿热痹阻证、肝肾阴虚证,肾气虚寒证、痰瘀互结证相对较少。年龄可能是影响湖南地区类风湿性关节炎证型分布的主要因素之一。

Objective： To investigate the distribution law of main types of traditional Chinese medicine （TCM） syn- drome of rheumatoid arthritis （RA） in Huhan region and build upon a reference criterion for clinical practice of RAg dif- ferentiation TCM syndrome and personalized treatment. Methods ： Medical data was collected from a total of 299 patients with definitive diagnosis of RA who admitted in our university＇s 1st Affiliated Hospital from January 2013 to December 2014. Distribution laws of main types of TCM differentiation of RA were statistically studied in terms of gender, age, and disease course. Results ： Statistical analyses revealed significant differences in the distribution law among six main types of TCM syndromes of RA （X2 = 179. 679 ,P = 0.000）. Significant differences in the distribution of different TCM syndrome types of RA were seen in age （ P = 0. 012） but not between gender （ P = 0. 217 ） and among disease courses （ P = O. 804 ）. For patients aged less than 40, the distribution was in the order of cold - damp stagnation 〉 damp - heat stagna- tion 〉 coldness and deficiency of kidney qi 〉 Yin deficiency of liver and kidney. For patients aged from 40 - 60, the order was cold - damp stagnation 〉 damp - heat stagnation 〉 Yin deficiency of liver and kidney 〉 coldness and deficiency of kid- ney qi 〉 intermingled phlegm with blood stasis. In patients aged over 60, the order was cold - damp stagnation 〉 Yin defi- ciency of liver and kidney 〉 damp - heat stagnation 〉 coldness and deficiency of kidney qi 〉 intermingled phlegm with blood stasis. Conclusion： Our results show that the predominant TCM differentiation of RA in Hutaan region is the cold - damp stagnation, followed by the damp - heat stagnation, the Yin deficiency of liver and kidney and the coldness and defi- ciency of kidney qi,with the tntermingled phlegm with blood stasis being least frequent. These data also reveal that age has significant impact on the distribution of TCM syndromes of RA in Hu nan region.