上海市社区中老年人膝骨关节炎中医证型分布的调查研究

Investigation on TCM syndromes distribution of knee osteoarthritis in the middle-aged and elderly in Shanghai community

目的调查上海市社区中老年人膝骨关节炎(KOA)的中医证型分布情况和规律。方法自2016年7月1日至2018年9月1日期间,抽取上海市9个市辖区中33个街道社区的中老年KOA患者,采用KOA中医证候调查表,对患者进行一般资料、病程、膝关节局部症状、全身症状、舌脉象及膝关节X线表现的调查,并由专业中医骨伤科医师进行中医证型判定及统计分析,并与年龄、性别、病程及X线分级进行相关性分析。结果 (1)本研究最终纳入KOA患者1 990例,其中男性484例,女性1 506例;年龄45~85岁,平均(66.0±5.8)岁;病程1~480个月,中位病程24个月;寒湿痹阻证702例,肝肾亏虚证542例,痰瘀痹阻证406例,气血两虚证244例,湿热阻络证96例;X线分级为0级62例,Ⅰ级265例,Ⅱ级628例,Ⅲ级666例,Ⅳ级369例。(2)KOA证型与性别存在一定相关性(χ~2=118.8,P<0.001),但关联性较弱(C=0.237);其中寒湿痹阻证、气血两虚证患者中女性居多,湿热阻络证患者男性更多,痰瘀痹阻证、肝肾亏虚证患者男女比例相当。(3)KOA证型与年龄存在一定的相关性(χ~2=361.3,P<0.001),但关联性弱(C=0.392)。寒湿痹阻证、痰瘀痹阻证患者年龄多分布在55~75岁;湿热阻络证多分布在65岁以下;肝肾亏虚证、气血两虚证患者多分布在55岁以上。(4)KOA证型与病程存在一定的相关性(χ~2=190.7,P<0.001),但关联性较弱(C=0.296)。湿热阻络证病程多在6个月以内,寒湿痹阻证、痰瘀痹阻证病程多在7个月以上,肝肾亏虚证和气血两虚证病程多在24个月以上。(5)KOA证型与X线分级存在一定的相关性(χ~2=544.1,P<0.001),但关联性弱(C=0.463)。寒湿痹阻证X线分级多属Ⅰ级、Ⅱ级、Ⅲ级,湿热阻络证X线分级多属Ⅰ级和Ⅱ级,肝肾亏虚证、痰瘀痹阻证X线分级多属Ⅲ级和Ⅳ级,气血两虚证X线分级多属Ⅱ级以上。结论上海市社区中老年人KOA的中医证型分布由高到低依次为寒湿痹阻证、肝肾亏虚证、痰瘀痹阻证、气血两虚证、湿热阻络证;并且KOA证型分布与性别、年龄、病程及X线分级均存在一定的相关性,但总体关联性较弱,有待进一步研究。

Objective To investigate the distribution and general pattern of TCM syndromes of knee osteoarthritis(KOA) among the middle-aged and elderly people in Shanghai community. Methods The middle-aged and elderly KOA patients were selected from 33 communities in 9 municipal districts of Shanghai from July 1, 2016 to September 1, 2018 by using the questionnaire of TCM syndromes of knee osteoarthritis. The general data, course of disease, local symptoms of knee joints, general symptoms, tongue and pulse conditions and X-ray findings of knee joints were collected and statistically analyzed by professional TCM orthopedists and traumatologists to determine TCM syndromes, and the correlation between TCM syndromes and age, sex,course of disease and X-ray grading was also analyzed. Results(1)A total of 1,990 KOA patients were included in the study,including 484 males and 1,506 females. The age ranged from 45 to85 years old,with an average age of 66. 0 ± 5. 8 years old. The course of disease lasted 1 to 480 months,and the median course of disease was 24 months. There were 702 cases of cold-dampness obstruction syndrome,542 cases of liver and kidney deficiency syndrome,406 cases of phlegm-stasis obstruction syndrome,244 cases of qi and blood deficiency syndrome,and 96 cases of damp-heat blocking collaterals syndrome. According to the X-ray findings,62 cases were classified as grade 0,265 cases as grade I,628 cases as grade Ⅱ,666 cases as grade Ⅲ and 369 cases as grade Ⅳ.(2) There was a weak correlation between the distribution of KOA TCM syndromes and gender( χ~2= 118. 8,P<0.001,C = 0.237). More women patients had cold-dampness obstruction syndrome and qi and blood deficiency syndrome,more men patients had damp-heat blocking collaterals syndrome,and the proportion of men and women in patients with phlegm-stasis obstruction syndrome and liver and kidney deficiency syndrome was equivalent.(3)There was a weak correlation between the distribution of KOA TCM syndromes and age( χ~2= 361.3,P<0.001,C= 0.392). Patients with cold-dampness obstruction syndrome and phlegm-stasis obstruction syndrome were mostly aged between 55 and 75 years old.Patients with damp-heat blocking collaterals were mostly under 65 years old. Patients with liver and kidney deficiency syndrome and qi and blood deficiency syndrome were mostly over 55 years old.(4)There was a weak correlation between the distribution of KOA TCM syndromes and disease course( χ~2= 190.7,P<0.001,C = 0.296). The disease course of patients with damp-heat blocking collaterals syndrome was mostly within 6 months,that of patients with cold-dampness obstruction syndrome and phlegm-stasis obstruction syndrome was mostly over 7 months,and that of patients with liver and kidney deficiency syndrome and qi and blood deficiency syndrome was often more than 24 months.(5) There was a weak correlation between the distribution of KOA TCM syndromes and X-ray grading( χ~2= 544. 1,P < 0. 001,C = 0. 463). Based on the X-ray grading system,cold-dampness obstruction syndrome was mostly classified into grade I,Ⅱ and Ⅲ,damp-heat blocking collaterals syndrome was mostly classified into grade I and Ⅱ,liver and kidney deficiency syndrome and phlegm-stasis obstruction syndrome were mostly classified into grade Ⅲ and Ⅳ,and qi and blood deficiency syndrome was classified into grade Ⅱ and above. Conclusion TCM syndromes of knee osteoarthritis in the middle-aged and elderly people in Shanghai community were ranked from cold-dampness obstruction syndrome,liver and kidney deficiency syndrome,phlegm-stasis obstruction syndrome,qi and blood deficiency syndrome to damp-heat blocking collaterals syndrome in turn. Moreover,the distribution of KOA TCM syndromes has weak correlations with gender,age,course of disease and X-ray grading,which needs further study.