关节遇冷痛增是否类风湿关节炎中医证候寒痹关键指标的临床研究

Clinical Study on Whether Cold-aggravated Joint Pain Is the Key Indicator to Cold Bi in the Syndrome Differentiation of Rheumatoid Arthritis

目的：探讨关节遇冷痛增是否是类风湿关节炎中医证候寒痹的关键指标。方法：将河南风湿病医院RA数据库（HFRA数据库）中收录的409例RA患者按有无关节遇冷痛增分为关节遇冷痛增组和无关节遇冷痛增组,并运用SPSS 19.0分析2组在关节表现及关节外表现方面的区别和联系。结果：关节遇冷痛增组的聚类分析结果 3中出现了热痛、口干、咽干、口苦、鼻干等“热”的临床表现;无关节遇冷痛增组由于不适合因子分析,未做进一步聚类分析。对2组中的82个关节表现及关节外表现进行χ~2检验,关节遇冷痛增组出现了阴雨天加重、凉痛、全身怕风怕冷、畏寒肢冷、渴喜热饮等“寒”的临床表现多于无关节遇冷痛增组的现象,2组比较,差异有统计学意义（P〈0.05）。关节遇冷痛增组294例患者中有“热”的表现如口干151例（51.36%）、多梦122例（36.75%）、口苦103例（35.03%）、小便黄87例（29.59%）、五心烦热78例（26.53%）、咽干77例（26.19%）、热痛57例（19.39%）、渴喜冷饮33例（11.22%）、咽痛32例（10.88%）;无关节遇冷痛增组的115例患者中有“寒”的表现如全身怕风怕冷61例（53.04%）、畏寒肢冷38例（33.04%）、渴喜热饮23例（20.00%）、四肢不温21例（18.26%）、食冷腹泻15例（4.35%）。结论：关节遇冷痛增不能作为类风湿关节炎寒痹的关键指标。

Objective：To investigate whether cold-aggravated joint pain is the key indicator to cold bi in the syndrome differentiation of rheumatoid arthritis.Methods：Four hundred cases with Rheumatoid Arthritis from the HFRA Database of the Henan Rheumatism Hospital were divided into a cold-aggravated group and a control group.SPSS 19.0 was used to analyze the difference and relationship on the aspects of joint and extra articular manifestations of the 2 groups.Results：In the clustering analysis result 3 of the cold-aggravated group,heat manifestations such as heat pain,dry mouth,dry throat,bitter taste of mouth and dry nose appeared. This analysis was not carried out for the control group since it was not suitable.After the X2 test for 82 joints and extra articular manifestations,cold manifestations such as aggravation due to coldness,cold pain,aversion to cold,cold limbs and hot drink preference appeared more frequently in the cold-aggravated group than the control group,the difference between them being significant （ P 〈 0.05 ） .In the cold-aggravated group,294 cases had heat manifestations： 151 cases （ 51.36% ） with dry mouth, 122 cases （ 36.75% ） with dreaminess, 103 cases （ 35.03% ） with bitter taste of mouth,87 cases （ 29.59% ） with yellow urine,78 cases （ 26.53% ） with burning sensation of five centres,77 cases （ 26.19% ） with dry throat,57 （ 19.39% ） cases with heat pain,33 cases （ 11.22% ） with hot drink preference,and 32 cases with sore throat （ 10.88% ） .In the control group,115 cases had cold manifestations：61 cases （ 53.04% ） with aversion to coldness,38 cases （ 33.04% ） with aversion to coldness and cold limbs,23 Cases （ 20% ） with hot drink preference,21 cases （ 18.26% ） with cold limbs,and 15 cases （ 4.35% ） with cold diarrhea.Conclusion：The increase of pain due to coldness cannot be seen as a key indicator for arthritis rheumatoid.