基于Logistic回归探究类风湿关节炎患者寒热证候的临床特征差异

Clinical characteristics differences of cold and heat patterns in patients with rheumatoid arthritis based on Logistic regression

目的:探究类风湿关节炎(RA)患者寒证和热证患者临床特征的差异,为RA的寒热辨证客观化提供依据。方法:将符合RA诊断标准的134例RA患者分为寒证组与热证组。收集患者一般资料、免疫指标、抗体水平、疾病活动度评估及临床常规指标等41项指标,探究两组间相关指标的差异。进一步结合临床选取具有代表性的因素,使用多因素Logistic回归模型进行分析,明确RA寒热证候的临床特征因素。结果:热证组较之于寒证组28关节压痛数目、28关节肿胀数目、VAS、类风湿因子、超声下28关节的滑膜炎数目、超声下28关节多普勒血流信号数目、超声下28关节骨侵蚀关节数目、红细胞沉降率、C-反应蛋白、白细胞计数、血免疫球蛋白A、血免疫球蛋白G、谷氨酰转肽酶、28关节疾病活动度评分指标更高,差异具有统计学意义(P<0.01,P<0.05);血红蛋白、高密度脂蛋白胆固醇指标更低,差异具有统计学意义(P<0.01,P<0.05)。多因素Logistic回归结果表明28关节疾病活动度(DAS28)、28关节超声下多普勒血流信号数是RA寒热证候的独立预测因子,RA患者随着28关节疾病活动度数值增高及28关节超声下多普勒血流信号数目增多,其热证概率明显升高。结论:RA患者寒证、热证与临床指标间存在一定差异,28关节多普勒超声下血流信号数目与DAS28数值是预测寒热证型的独立预测因子。

Objective:To explore the difference in clinical characteristics between patients with cold or heat patterns in rheumatoid arthritis(RA),and to provide a basis for the objectification of RA cold-heat patterns differentiation.Methods:A total of 134 RA patients meeting the diagnostic criteria of RA were divided into cold pattern group and heat pattern group.A total of 41 indicators were collected,including general patient data,immune indicators and antibody levels,disease activity assessment and clinical routine indicators,to explore the difference of related indicators between the two groups.Furthermore,the representative factors,selected in combination with clinical knowledge,were analyzed by multivariate Logistic regression model to clarify the clinical characteristics of RA cold pattern and heat pattern.Results:Compared with the cold pattern group,the number of 28 joint tenderness,the number of 28 joint swelling,the patient’s VAS assessment of disease activity,rheumatoid factor,the number of synovitis of 28 joints under ultrasound,and the number of 28 joint Doppler blood flow signals under ultrasound,the number of bone erosion of 28 joints under ultrasound,erythrocyte sedimentation rate,C-reactive protein,white blood cell,blood immunoglobulin A,blood immunoglobulin G,γ-glutamyl transpeptidase,28 joint disease Activity(DAS28)indexes were higher,and the difference was statistically significant(P<0.01,P<0.05).Hemoglobin and high-density lipoprotein cholesterol were lower,and the difference was statistically significant(P<0.01,P<0.05).The results of multivariate Logistic regression showed that DAS28 and Doppler blood flow signal number under 28 joint ultrasound were independent predictors of RA cold-heat patterns.With the increase of the DAS28 value and the increase of the number of Doppler blood flow signals under the 28 joint ultrasound,the probability of the heat pattern increased significantly.Conclusion:There are certain differences and clinical indicators between the cold pattern and heat pattern in RA patients.The number of blood flow signals under 28-joint Doppler ultrasound and DAS28 value are independent predictors of cold-heat pattern.