379例强直性脊柱炎是否受风寒湿发病与其临床表现异同的研究

Study on the Similarities and Differences Between the Onset of 379 Cases of Ankylosing Spondylitis and Their Clinical Manifestations

目的:研究强直性脊柱炎患者受风寒湿和不受风寒湿与其临床表现的异同,了解不同发病诱因在中医辨证治疗强直性脊柱炎患者中的作用。方法:选取河南风湿病医院强直性脊柱炎数据库(HFAS数据库)中收录的379例强直性脊柱炎患者,按发病诱因分为受风寒湿组和不受风寒湿组,并采用SPSS 19.0软件分析2组在关节表现及关节外表现的异同。结果:通过对2组179个关节表现及关节外表现进行χ^(2)检验,2组间差异有统计学意义(P < 0.05)的临床表现共18项,其中遇风加重、喝酒加重、夜尿频、面色萎黄、唇甲色淡、鼻干、夜间肢体喜放被外、口黏腻、肌肤干燥少泽、唇甲暗红,受风寒湿组 > 不受风寒湿组;颈部疼痛、酸痛、僵痛、疼痛性质不明、肿胀部位(左踝、左足跟)、腰膝酸软、性情急躁易怒,受风寒湿组 < 不受风寒湿组。结论:强直性脊柱炎受风寒湿发病患者风邪、虚较明显,不受风寒湿发病者湿邪、瘀较明显。在辨证论治时受风寒湿发病患者祛邪时更应注重加大祛风药物的比例,扶正次之,兼以化瘀;不受风寒湿发病者祛邪时更应注重加大祛湿药物的比例,化瘀次之,兼以扶正。

Objective:To study the similarities and differences between patients with ankylosing spondylitis and their clinical manifestations,in order to probe the role of different inducements in TCM syndrome differentiation and treatment.Methods:Three hundred and seventy-nine patients with ankylosing spondylitis in the HFAS database of Henan Rheumatology Hospital were selected.They were divided into a wind-cold-dampness group and a non-wind-cold-dampness group according to the causes of onset.The similarities and differences of joint manifestation and extraarticular manifestation between the two groups were analyzed by software SPSS 19.0.Results:The χ^(2) test for 179 joint manifestations and extraarticular manifestations in the two groups showed that there were 18 clinical manifestations with statistically significant difference(P < 0.05),among which the following clinical manifestations were more frequently seen in the wind-cold-dampness group:aggravation due to wind,aggravation due to drinking,frequent urination at night,yellowish complexion,light color of lip and nail,dry nose,preference for exposing body outside the quilt at night,sticky mouth,dry and less glossy skin,and dark red lip and nail;and the following clinical manifestations were less frequently seen in the wind-cold-dampness group:neck pain,soreness,stiff pain,unknown nature of pain,swollen parts(left ankle and left heel),weak waist and knee,and irritable temperament.Conclusion:Wind evil and deficiency are more obvious in patients with ankylosing spondylitis caused by wind,cold and dampness;dampness evil and blood stasis are more obvious in those who are not affected by wind,cold and dampness.In syndrome differentiation and treatment for patients with wind cold and dampness,pay more attention to increasing the proportion of removing wind,strengthening rightness,followed by removing blood stasis;for those who are not affected by wind cold and dampness,pay more attention to increasing the proportion of dampness elimination,followed by removing blood stasis and strengthening rightness.