1388例类风湿关节炎患者中医证型与疾病活动度特征横断面调查

Disease Activity of Rheumatoid Arthritis with Different Traditional Chinese Medicine Syndromes:A Cross-sectional Study of 1388 Patients

目的探讨不同证型类风湿关节炎(RA)患者的疾病活动度特征。方法采用横断面调查研究方法,制定"类风湿关节炎中医证候调查问卷",从全国18个中心RA临床数据采集1388例RA患者信息。将RA分为风湿痹阻证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、气血两虚证、肝肾不足证6个证型。比较不同证型的关节肿胀数、关节压痛数、血沉(ESR)、C反应蛋白(CRP)、28个关节疾病活动度(DAS28)等。结果风湿痹阻证135例,寒湿痹阻证272例,湿热痹阻证613例,痰瘀痹阻证142例,气血两虚证47例,肝肾不足证179例。除肝肾不足证外,湿热痹阻证患者压痛关节数、DAS28-ESR(4)评分高于其他证型患者(P<0.05);湿热痹阻证患者肿胀关节数与风湿痹阻证、气血两虚证比较差异有统计学意义(P<0.05);湿热痹阻证患者ESR最高,与其他证型相比差异有统计学意义(P<0.05);不同证型患者CRP差异无统计学意义(P>0.05);各证型患者DAS28-ESR评分等级比较显示,风湿痹阻证、气血两虚证患者以中活动度为主,其余均以高活动度为主,差异有统计学意义(P<0.05)。结论不同证型RA患者疾病活动度存在差异,其中以湿热痹阻证疾病活动度最高。

Objective To explore the characteristics of disease activity in rheumatoid arthritis(RA)patients with different traditional Chinese medicine(TCM)syndromes.Methods A cross-sectional study assessing 1388 RA patients from 18 centers was performed,through a predesigned TCM syndrome questionnaire for RA.TCM syndromes for RA included wind-damp obstruction,cold-damp obstruction,damp-heat obstruction,phlegm and blood stasis obstruction,qi-blood deficiency,and liver-kidney insufficiency.The number of swollen joints,the number of tender joints,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and disease activity score 28(DAS28)were analyzed.Results There were 135 RA patients with wind-damp obstruction syndrome,272 with cold-damp obstruction syndrome,613 with damp-heat obstruction,142 with phlegm and blood stasis obstruction,47 with qi-blood deficiency,and 179 with liver-kidney insufficiency.Patients with damp-heat obstruction syndrome had a higher number of tender joints and a higher score of DAS28-ESR(4)than patients with other syndromes except for liver-kidney insufficiency(P<0.05).There were significant differences in the numbers of swollen joints between patients with damp-heat obstruction syndrome,and wind-damp obstruction syndrome,and qi-blood deficiency syndrome(P<0.05).Patients with damp-heat obstruction syndrome had the highest ESR(P<0.05).There was no significant difference in CRP between different syndromes(P>0.05).According to DAS28-ESR scores,patients with wind-damp obstruction syndrome and qi-blood deficiency syndrome were mainly at moderate activity,while the other syndromes were mainly at high activity(P<0.05).Conclusion The disease activity of RA patients varies with different TCM syndromes,and patients with damp-heat obstruction syndrome has the highest disease activity.