类风湿关节炎辨证与关节超声表现的相关性研究

Correlation Between Syndromes of Rheumatoid Arthritis and Performance of Articular Ultrasonography

【目的】从现代医学影像学的角度探讨中医对类风湿关节炎(RA)病因、病机的认识,研究RA的中医辨证与关节超声的表现是否相关,为中医辨证提供客观依据。【方法】收集广州中医药大学第一附属医院风湿病科的RA患者并对其进行辨证分型,应用关节超声检查患者双侧手部关节,对所得数据进行分析。【结果】(1)本研究共纳入422例患者,其中风寒湿痹证161例,湿热痹阻证98例,痰瘀痹阻证54例,肝肾不足证109例;(2)肝肾不足证的血流信号程度较风寒湿痹证、湿热痹阻证低,差异有统计学意义(P<0.008 3);(3)肝肾不足证的骨侵蚀发生率较其他3个证型组高,差异有统计学意义(P<0.008 3);(4)湿热痹阻证的肌腱炎/腱鞘炎发生率较其他3个证型组高,差异有统计学意义(P<0.008 3)。【结论】关节超声可作为一种现代的、微观的、局部的手段辅助中医临床辨证。

Objective To research the correlation between syndromes of rheumatoid arthritis(RA) and the performance of articular ultrasonography, so as to supply the medical imaging evidence for the etiology,pathogenesis,and syndrome differentiation of RA. Methods The ultrasonographic data of bilateral hand joints of the RA patients admitted in the Rheumatology Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected. The syndrome types of the RA patients were also differentiated. And then the correlation between syndromes of RA and the performance of articular ultrasonography was analyzed. Results(1)A total of 422 patients were enrolled into the study. Of them,161 cases were differentiated into wind-cold-damp blockage syndrome, 98 cases into damp-heat blockage syndrome, 54 cases into phlegm-stasis blockage syndrome,and 109 cases into liver and kidney deficiency syndrome.(2)The level of color Doppler blood flow signal in liver and kidney deficiency syndrome was lower than that of the wind-cold-damp blockage syndrome and damp-heat blockage syndrome(P < 0.008 3).(3)The incidence of bone erosion was higher in the liver and kidney deficiency syndrome than that in the other three syndromes(P < 0.008 3).(4)The incidence of tendinitis/tenosynovitis was higher in the damp-heat blockage syndrome than that in the other three syndromes(P < 0.008 3).Conclusion Articular ultrasonography can be used as a modern, microscopic and focal examination method to assist the syndrome differentiation of RA.