强直性脊柱炎中医证型的优化及临床指标相关性研究

Optimization of TCM Syndrome Types of Ankylosing Spondylitis and Related Study of Clinical Indicators

目的:探索以“寒热辨证为纲要”,用“主证+一个或多个兼证”概括强直性脊柱炎中医证型的可行性,并讨论中医证型与临床指标的联系。方法:随机收集符合纳入标准的强直性脊柱炎患者临床中医证候资料,对其进行中医证型分类,并评估患者中医证型与炎症指标、骨代谢指标、疾病活动度的相关性。结果:共收集121例患者,强直性脊柱炎主证分为肾虚督寒证、阴虚督亏证,兼证分为寒湿证、湿热证、痰瘀证。运用“寒热辨证为纲要”理论进行辨证可行率为94.21%。阴虚督亏证的红细胞沉降率(ESR)、C反应蛋白(CRP)水平均比肾虚督寒证高,差异有统计学意义(P<0.01);兼证与主证之间,兼证的ESR、CRP水平均比主证高(P<0.01)。兼证中,湿热证ESR、CRP最高,其次痰瘀证,寒湿证最低(P<0.01)。骨代谢方面,随着25-羟维生素D水平减少、HLA-B27阳性、病程变长,骨密度减少越明显(P<0.05)。结论:以寒热辨证为纲要,用“主证+一个或多个兼证”概括强直性脊柱炎中医证型具有一定的可行性;且不同中医证型强直性脊柱炎患者的临床指标是有差异的。

Objective:To explore the feasibility of summarizing the TCM syndrome types of ankylosing spondylitis with"main syndrome+one or more concurrent syndromes"based on the syndrome differentiation of cold and heat as an essential,and discuss the relationship between TCM syndrome types and clinical indicators.Methods:The clinical TCM syndrome data of ankylosing spondylitis patients who met the inclusion criteria were randomly collected and classified.The correlation between TCM syndrome type and inflammatory index,bone metabolism index and disease activity index was evaluated.Results:A total of 121 cases were collected.The main syndromes of ankylosing spondylitis were mainly divided into kidney-deficiency and Du-cold syndrome,yin and Du deficiency syndrome,and the concurrent syndromes were divided into cold-damp syndrome,damp-heat syndrome,phlegm and blood stasis syndrome.The feasibility rate of syndrome differentiation based on the theory of"syndrome differentiation of cold and heat as an essential"is 94.21%.The levels of ESR and CRP in yin and Du deficiency syndrome were higher than those in the kidney-deficiency and Du-cold syndrome(P<0.01).The levels of ESR and CRP of the concurrent syndromes were higher than those of the main syndromes(P<0.01).Among the concurrent syndromes,ESR and CRP of the damp-heat syndrome were the highest,followed by phlegm and blood stasis syndrome,and the cold-damp syndrome was the lowest(P<0.01).In terms of bone metabolism,with the decrease of 25-hydroxyvi-tamin D level and HLA-B27 positive,the longer course of disease,the more obvious the decrease of bone mineral density(P<0.05).Conclusion:It is feasible to generalize the syndrome types of ankylosing spondylitis in TCM with"main syndrome+one or more concurrent syndromes"based on the syndrome differentiation of cold and heat.And the clinical indicators of patients with ankylosing spondylitis of different TCM syndromes are different.