早期类风湿关节炎中医辨证分型与肌骨超声表现相关性研究

Correlation Study on Classification of TCM Syndromes and Musculoskeletal Ultrasound in Patients with Early Rheumatoid Arthritis

目的探讨早期类风湿关节炎(ERA)患者中医辨证分型与肌骨超声表现的相关性。方法选择160例ERA患者,按证型分为寒湿痹阻证61例、湿热痹阻证31例、寒热错杂证68例。记录类风湿关节炎病情活动评分(DAS28),检测患者外周血中C反应蛋白(CRP)、红细胞沉降率(ESR)、类风湿因子(RF)及抗环瓜氨酸肽抗体(抗CCP)水平,对患者进行肌骨超声检查,采用7关节超声评分系统(US7)对滑膜炎、多普勒血流信号、腱鞘滑膜炎、骨侵蚀进行判定,统计滑膜炎、多普勒血流信号阳性率,观察滑膜炎、多普勒血流信号、腱鞘滑膜炎、骨侵蚀半定量分级情况,分析各指标与证型的关系。结果湿热痹阻证患者CRP、ESR、DAS28、RF、抗CCP及肌骨超声表现的滑膜炎阳性率、多普勒血流信号阳性率、骨侵蚀、US7评分均高于其他两证型(P<0.05);除骨侵蚀外,寒热错杂证患者肌骨超声中各项半定量分级均与湿热痹阻证相当;寒热错杂证患者CRP、ESR、DAS28、US7评分均高于寒湿痹阻证(P<0.05),RF、抗CCP及肌骨超声滑膜炎阳性率、多普勒血流信号阳性率与其他两证型比较差异无统计学意义;寒湿痹阻证患者肌骨超声中各项半定量分级均低于另外两证型(P<0.05)。结论ERA患者肌骨超声表现与中医辨证分型具有一定相关性,肌骨超声能为ERA中医辨证论治提供客观参考依据。

Objective To study the correlation between classification of TCM syndromes and musculoskeletal ultrasound in patients with early rheumatoid arthritis(ERA).Methods Totally 160 patients with ERA were classified according to TCM syndromes into cold dampness obstruction syndrome,dampness heat obstruction syndrome and mixed cold and heat syndrome.DAS28,testing CRP,ESR,RF and anti-CCP levels in peripheral blood were recorded.Musculoskeletal ultrasound and the 7-joint ultrasound(US7)score method were used to detect synovitis,Doppler blood flow signals,tendon sheath synovitis,and bone erosion.Positive rates of synovitis and Doppler blood flow signals were counted,and the semi-quantitative classification of synovitis,Doppler blood flow signals,tendon sheath synovitis,and bone erosion were analyzed,and the relationship between various indicators and TCM syndrome types was analyzed.Results CRP,ESR,DAS28,RF,anti-CCP,musculoskeletal ultrasound manifested synovitis positive rate,Doppler blood flow signal positive rate,bone erosion and US7 score in patients with damp heat obstruction syndrome were all higher than the other two syndrome types(P<0.05).Except for bone erosion,the semi-quantitative classifications of musculoskeletal ultrasound in patients with mixed cold heat syndrome were equivalent to those of damp heat obstruction syndrome;CRP,ESR,DAS28,US7 score of patients with mixed cold heat syndrome were higher than those of cold damp obstruction syndrome(P<0.05).There is no difference in RF,anti-CCP,and the positive rate of musculoskeletal ultrasound synovitis,and Doppler blood flow signals.The semi-quantitative classification of musculoskeletal ultrasound in patients with cold damp obstruction syndrome was lower than the other two syndrome types(P<0.05).Conclusion There is a certain correlation between musculoskeletal ultrasound and TCM syndrome differentiation in patients with ERA.Musculoskeletal ultrasound can provide an objective and reliable reference basis for TCM syndrome differentiation and treatment of ERA.