类风湿关节炎不同中医证型与血清趋化素水平相关性研究

Discussion on Relationship Between Level of Chemerin in Serum and Chinese Medicine Syndrome Types in Patients with Rheumatoid Arthritis

目的:探讨类风湿关节炎患者血清脂肪因子趋化素(Chemerin)水平与中医证型的关系。方法:选取2016年5月—2019年4月收治的157例类风湿关节炎患者(疾病组),对疾病组患者进行中医辨证分型,比较不同中医证型一般资料[性别、年龄、体质量指数(BMI)、病程、类风湿关节炎患者病情评价(DAS28评分)、中医证候积分、X线分期]及血清Chemerin水平。另选取同期体检健康者129例(健康组)检测血清Chemerin水平作对照。结果:疾病组血清Chemerin水平高于健康组,差异有统计学意义(P<0.05)。157例风湿关节炎患者中,寒湿痹阻证、湿热痹阻证、瘀血痹阻证、肝肾阴虚证、肾气虚寒证分别占22.93%(36/157)、36.31%(57/157)、16.56%(26/157)、15.92%(25/157)、8.28%(13/157);寒湿痹阻证、湿热痹阻证、瘀血痹阻证、肝肾阴虚证、肾气虚寒证在性别、年龄、BMI、病程、中医证候积分及X线分期方面比较,差异无统计学意义(P>0.05)。各证型的DAS28评分中湿热痹阻证评分最高,肝肾阴虚证评分最低,除肝肾阴虚证与肾气虚寒证比较,差异无统计学意义(P>0.05),其他证型两两比较,差异均有统计学意义(P<0.05);各证型血清Chemerin水平中湿热痹阻证水平最高,肝肾阴虚证水平最低,除肝肾阴虚证与肾气虚寒证比较,差异无统计学意义(P>0.05),其他证型两两比较,差异均有统计学意义(P<0.05)。结论:类风湿关节炎患者血清Chemerin水平较正常人明显升高,病例中湿热痹阻证占比最高,其次为寒湿痹阻证,再次为瘀血痹阻证及肝肾阴虚证,最后为肾气虚寒证;且血清Chemerin水平以湿热痹阻证最高,寒湿痹阻证次之,肝肾阴虚证与肾气虚寒证大体相当。

Objective:To discuss the relationship between the level of adipokinechemerin in serum and Chinese medicine syndrome types in patients with rheumatoid arthritis.Methods:A total of 157 cases of patients with rheumatoid arthritis who were admitted and treated from May 2016 to April 2019 in our hospital were selected and enrolled in the disease group.The disease group was differentiated based on Chinese medicine syndrome types;level ofchemerin in serum and general data[gender,age,body mass index(BMI),course of disease,Disease Activity Score in 28 joints(DAS28)for evaluating patients with rheumatoid arthritis,Chinese medicine syndrome score,X-ray stages]were compared among patients with different Chinese medicine syndrome types.Another 129 cases who received health examination at the same period were selected as the health group,and level of chemerin in serum was detected for comparing with the disease group.Results:The level of chemerinin serum in the disease group was higher than that in the health group,the difference being significant(P<0.05).Among a total of 157 cases of patients with rheumatoid arthritis,cold-dampness obstruction syndrome accounted for 22.93%(36/157),dampness-heat obstruction syndrome 36.31%(57/157),static blood obstruction syndrome 16.56%(26/157),liver-kidney yin deficiency syndrome 15.92%(25/157),kidney-qi deficiency cold syndrome 8.28%(13/157);when compared gender,age,BMI,course of disease,Chinese medicine syndrome score,and X-ray stages among patients with the syndrome types above,there was no significance in the difference(P>0.05).Among scores of DAS28 of different Chinese medicine syndrome types,dampness-heat obstruction syndrome scored the highest,liver-kidney yin deficiency syndrome the lowest;there was no significant difference in the comparison of the score between liver-kidney yin deficiency syndrome and kidney-qi deficiency cold syndrome(P>0.05);except for liver-kidney yin deficiency syndrome and kidney-qi deficiency cold syndrome,pairwise comparison of scores of other syndrome types showed significance in differences(P<0.05).Among levels of chemerin in serum of different Chinese medicine syndrome types,dampness-heat obstruction syndrome had the highest level,liver-kidney yin deficiency syndrome the lowest level;there was no significant difference in the comparison of the level between liver-kidney yin deficiency syndrome and kidney-qi deficiency cold syndrome(P>0.05);except for liver-kidney yin deficiency syndrome and kidney-qi deficiency cold syndrome,pairwise comparison of levels of other syndrome types showed significance in differences(P<0.05).Conclusion:Patients with rheumatoid arthritis had obviously higher levels of chemerinin serum than normal people.Among cases of patients with rheumatoid arthritis,dampness-heat obstruction syndrome had the highest proportion of high-level chemerin,followed by cold-dampness obstruction syndrome,static blood obstruction syndrome,liver-kidney yin deficiency syndrome,and kidney-qi deficiency cold syndrome;dampness-heat obstruction syndrome had the highest level of chemerinin serum,followed by cold-dampness obstruction syndrome,liver-kidney yin deficiency syndrome,and kidney-qi deficiency cold syndrome,and the last two syndromes were similar in the level.