情绪因素(生气后加重)与类风湿关节炎中医证候之间关系的临床研究

Clinical Study on the Relationship Between Emotional Factors and TCM Syndromes of Rheumatoid Arthritis

目的:探讨情绪因素(生气后加重)与类风湿关节炎中医证候之间的关系及对临床辨证论治的意义。方法:将河南风湿病医院类风湿关节炎数据库(HFRA数据库)中收录的409例类风湿关节炎患者按有无生气后加重分为生气后加重组和无生气后加重组。并采用SPSS 19.0软件分析2组在关节表现及关节外表现方面的区别与联系。结果:类风湿关节炎有生气后加重的患者约占患者总人数的1/3(138/409)。从聚类分析结果中可以看出,生气后加重组原始变量之间相关性弱,不适合因子分析的统计学方法,无法进行聚类分析。无生气后加重组原始变量之间存在相关性,适合因子分析的统计学方法,可进行聚类分析,与临床相结合,以聚5类较为合适。从差异有统计学意义的47个临床表现中可以看出,生气后加重组患者的劳累加重、活动减轻、遇冷痛增遇热痛减、阴雨天加重、酸痛、刺痛、全身怕风怕冷、全身乏力、神倦懒动、易怒、心烦、听力下降、畏寒肢冷、抑郁、多梦、休息后乏力减轻、失眠、口苦、渴喜热饮、腰膝酸软、五心烦热、头晕、少气懒言、动则汗出、心神不宁、月经量少、唇甲暗红、月经色暗、患病后体质量减轻、盗汗、心慌、视力减退、口黏腻、夜尿频多、活动后乏力加重、四肢不温、纳少、易感冒、眼干、脱发、口干、月经有块、声低、食后腹胀等虚、邪、瘀表现均较多;而无生气后加重组固定痛、口淡不渴较多。结论:生气后加重组患者人数相对较少病情相对较重,无生气后加重组患者人数相对较多病情相对较轻;对生气后加重者可视为一个相对独立的中医证候,这组患者更容易形成虚、邪、瘀三个方面胶着难解的顽痹。

Objective：To investigate the relationship between the emotional factor （ anger that causes exacerbation of pathogenic condition ） and TCM Syndromes of rheumatoid arthritis and its aggravation in clinical diagnosis and treatment.Methods：Four hundred and nine cases with rheumatoid arthritis recorded in the HFRA database （ database of Henan Rheumatism Hospital ） were divided into an anger-caused aggravation group and an other-factor-caused aggravation group.The software SPSS 19.0 was used to analyze the differences and relations of joint manifestations and extra-articular manifestations of the two groups.Results：Those with aggravated rheumatoid arthritis due to anger were more than 1/3 （ 138/409 ） of the total number of patients. The results of cluster analysis showed that the correlation between the original variables of the anger-caused aggravation group was weak,which was not suitable for the statistical method of factor analysis,so the cluster analysis cannot be carried out.On the contrary, the cluster analysis can be carried out in the other group.47 clinical manifestations with statistically significant differences showed that the anger-caused aggravation group had the symptoms of deficiency, pathogen evil and stasis,manifesting as aggravation due to fatigue,fatigue being relieved by exercise,being more painful due to cold,pain being relieved due to heat,aggravation in rainy days,pain and tingling,aversion to cold and wind,general malaise,lassitude,laziness, being upset and irritable,hearing loss,aversion to cold and cold limbs,depression,dreaminess,being less fatigue after rest,insomnia,bitter taste of mouth,hot drink preference,soreness and weakness of waist and knees,vexing heat in the five centers （ chest,palms and soles ） ,dizziness,lack of qi and no desire to speak,sweating while moving,being not peaceful in mind,hypomenorrhea,dark red lips and nails,dark menstruation,body weight loss,night sweating,palpitation,visual deterioration,sticky and greasy in mouth,frequent urination at night,aggravation of fatigue after exercise,cool limbs,poor appetite,being subject to cold,dry eyes,hair loss,dry mouth,menstruation block,low voice,and abdominal distention after eating.While the other group manifested as fixed pain,and tastelessness in the mouth with thirst.Conclusion：There are a relatively small number of patients with aggravated condition in the anger-caused aggravation group,while there are a relatively large number of patients with mild condition in the other group.As for the former, it can be regarded as a relatively independent set of TCM syndromes and patients in this group are more likely to develop obstinate bi related to deficiency, pathogenic evil and stasis.