男性强直性脊柱炎肾虚督寒证及肾虚湿热证与脊柱骨化的相关性

Correlation of Kidney Deficiency and Back Cold Syndrome and Kidney Deficiency and Dampness-Heat Syndrome with Pyogenic Vertebral Osteomyelitis in Male Patients with Ankylosing Spondylitis

目的 探讨男性强直性脊柱炎(Ankylosingspondylitis, AS)患者中医证型与脊柱骨化的关系及AS脊柱骨化的危险因素。方法 采用双向队列研究方法,回顾性采集2013年12月—2017年8月期间中日友好医院中医风湿病科门诊及住院收治初诊为AS的患者临床资料,纳入2017年8月—2021年4月期间中日友好医院中医风湿病科门诊及住院收治初诊为AS的患者,依据事先设计的病例报告表进行临床资料收集,并对全部纳入的连续性病例进行定期随访、观察,从中选取性别为男且影像学资料齐全者的初次就诊临床资料进行研究,分析不同证型的男性AS患者的临床资料,采用Logistic回归分析男性AS患者脊柱骨化的危险因素。结果 325例男性AS患者中肾虚督寒证组203例,肾虚湿热证组122例。肾虚督寒证组脊柱骨化评分mSASSS明显高于肾虚湿热证组,差异有统计学意义(P<0.01),肾虚督寒证组病程、红细胞沉降率(Erythrocyte sedimentation rate, ESR)、AS疾病活动评分(AS disease activity score-CRP,ASDAS-CRP)高于肾虚湿热证组,差异有统计学意义(P<0.05),且Schober评分明显低于肾虚湿热证组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示病程、体质量指数(Bodymassindex, BMI)≥24、肾虚督寒证、吸烟史、BASDAI≥4、髋关节受累与较高的脊柱骨化评分发生相关,差异有统计学意义(P<0.05),病程、吸烟史、BASDAI≥4、髋关节受累是肾虚督寒证患者较高脊柱骨化评分的危险因素,差异有统计学意义(P<0.05);病程、吸烟史、髋关节受累是肾虚湿热证患者较高脊柱骨化评分的危险因素,差异有统计学意义(P<0.05)。结论 男性肾虚督寒证患者脊柱骨化评分明显高于男性肾虚湿热证患者;病程、肾虚督寒证、吸烟史、BASDAI≥4、髋关节受累是男性AS患者脊柱骨化的危险因素。

Objective To explore the relationship between traditional Chinese medicine(TCM)syndromes and pyogenic vertebral osteomyelitis in male patients with ankylosing spondylitis(AS)and identify the risk factors for pyogenic vertebral osteomyelitis in AS.Methods A retrospective cohort study was conducted.Clinical data of AS outpatients and inpatients initially diagnosed and treated at the Department of TCM Rheumatology of China-Japan Friendship Hospital be-tween December 2013 and August 2017 were collected.AS inpatients and outpatients who were initially diagnosed and trea-ted at the Department of TCM Rheumatology of China-Japan Friendship Hospital between August 2017 and April 2021 were included.Clinical data were collected using a pre-designed case report form,and regular follow-ups and observa-tions were performed for all consecutive cases.Clinical data from the initial visit of male patients with complete imaging da-ta were analyzed to study the clinical characteristics of male AS patients with different TCM syndromes.Logistic regression analysis was used to identify the risk factors for pyogenic vertebral osteomyelitis in male AS patients.Results Among the 325 male AS patients,203 had kidney deficiency and back cold syndrome and 122 had kidney deficiency and dampness-heat syndrome.The modified Stoke Ankylosing Spondylitis Spine Score(mSASSS)in the kidney deficiency and back cold syndrome group was higher than that in the kidney deficiency and dampness-heat syndrome group(P<0.01).The kidney deficiency and back cold syndrome group had a longer disease duration,higher erythrocyte sedimentation rate(ESR),and higher AS disease activity score-CRP(ASDAS-CRP)than the kidney deficiency and dampness-heat syndrome group(P<0.05).Additionally,the Schober score in the kidney deficiency and back cold syndrome group was significantly lower than that in the kidney deficiency and dampness-heat syndrome group(P<0.05).Multivariable logistic regression analy-sis showed that disease duration,body mass index(BMI)≥24,kidney deficiency and back cold syndrome,smoking history,BASDAI≥4,and hip joint involvement were significantly associated with higher mSASSS(P<0.05).Disease duration,smoking history,BASDAI≥4,and hip joint involvement were identified as risk factors for higher mSASSS in patients with kidney deficiency and back cold syndrome(P<0.05).Disease duration,smoking history,and hip joint involvement were identified as risk factors for higher mSASSS in patients with kidney deficiency and dampness-heat syndrome(P<0.05).Conclusion Male AS patients with kidney deficiency and back cold syndrome have significantly mSASSS than those with kidney deficiency and dampness-heat syndrome.Disease duration,kidney deficiency and back cold syndrome,smoking history,BASDAI≥4,and hip joint involvement are risk factors for pyogenic vertebral osteomyelitis in male AS patients.