强直性脊柱炎肾虚瘀阻证与湿热瘀阻证患者临床特征的多中心横断面调查

A Multicenter Cross-sectional Survey on the Clinical Characteristics of Patients of Ankylosing Spondylitis with Kidney Deficiency and Stasis Obstruction Syndrome and Damp-heat Stasis Obstruction Syndrome

目的探究强直性脊柱炎(AS)肾虚瘀阻证与湿热瘀阻证的临床特征差异,为临床辨治提供依据。方法2339例AS患者辨证分为肾虚瘀阻证1075例,湿热瘀阻证1264例。入组时收集两种证型患者的基本信息[包括年龄、性别、病程、眼炎史、家族史及人类白细胞抗原B27(HLA-B27)阳性史],Bath强直性脊柱炎疾病活动指数(BASDAI)评分、Bath强直性脊柱炎功能指数(BASFI)评分、Bath强直性脊柱炎测量指数(BASMI)评分、抑郁-焦虑-压力量表(DASS-21)评分,单一症状(包括脊柱痛、外周关节痛、肌腱端压痛、晨僵程度及晨僵时间)评分,患者报告结局指标[包括患者整体评估(PGA)评分、慢性疾病治疗功能-疲劳量表(FACIT-F)评分、夜间痛视觉模拟评分法(VAS)评分],实验室指标[包括血清C反应蛋白(CRP)、红细胞沉降率(ESR)],并进行骶髂关节炎CT分级。比较两组患者上述指标。结果肾虚瘀阻证患者年龄更大、病程更长(P<0.01)。肾虚瘀阻证患者和湿热瘀阻证患者的BASDAI评分分别为(3.84±1.79)、(4.30±1.99)分,BASFI评分分别为(2.78±2.00)、(3.43±2.12)分,BASMI评分分别为(3.42±2.36)、(2.92±1.76)分。湿热瘀阻证患者BASDAI、BASFI、PGA、FACIT-F、脊柱痛、外周关节痛、肌腱端压痛、晨僵程度、抑郁、焦虑、压力评分均高于肾虚瘀阻证患者,晨僵持续时间更长,CRP更高(P<0.05或P<0.01);而肾虚瘀阻证患者BASMI、夜间痛VAS评分高于湿热瘀阻证患者(P<0.01)。两组患者ESR水平及骶髂关节CT分级比较差异无统计学意义(P>0.05)。结论AS肾虚瘀阻证患者脊柱活动度差,湿热瘀阻证患者疾病活动程度高,身体功能差,更易合并不良心理状态。

Objective To compare the differences in clinical characteristics between kidney deficiency and stasis obstruction syndrome and damp-heat stasis obstruction syndrome in patients with ankylosing spondylitis(AS),thereby providing reference for clinical differentiation and treatment.Methods The clinical data of 2339 patients with AS were collected,including 1075 cases of kidney deficiency and stasis obstruction syndrome and 1264 cases of damp-heat stasis obstruction syndrome.The basic information including age,gender,course of disease,history of ophthalmia,family history and human leukocyte antigen B27(HLA-B27)positive history,Bath ankylosing spondylitis disease activity index(BASDAI)score,Bath ankylosing spondylitis functional index(BASFI)score,Bath ankylosing spondylitis measurement index(BASMI)score,Depression Anxiety Stress Scale 21(DASS-21)score,single symptom score in terms of spinal pain,peripheral joint pain,tendon tenderness,morning stiffness degree and morning stiffness time,patient-reported outcomes including patient global assessment(PGA)score,chronic disease therapy function-fatigue scale(FACIT-F)score and night pain visual analog scale(VAS)score,laboratory indicators including serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),and CT grading of sacroiliitis were measured and compared between groups.Results Patients with kidney deficiency and stasis obstruction syndrome were older and had a longer course of disease(P<0.01).The BASDAI,BASFI and BASMI scores of the patients with kidney deficiency and stasis obstruction syndrome were 3.84±1.79,2.78±2.00 and 3.42±2.36,respectively,while those in patients with damp-heat stasis obstruction syndrome were 4.30±1.99,3.43±2.12,and 2.92±1.76.The BASDAI score,BASFI score,PGA score,FACIT-F score,spinal pain score,peripheral arthralgia score,tendon tenderness score,morning stiffness degree score,depression score,anxiety score,and stress score in patients with damp-heat stasis obstruction syndrome were all higher than those with kidney deficiency and stasis obstruction syndrome,with longer duration of morning stiffness and higher CRP(P<0.05 or P<0.01).BASMI score and night pain VAS score were more higher in patients with kidney deficiency and stasis obstruction syndrome(P<0.01).There was no significant difference in the ESR level and CT grading of the sacroiliac joint between the two groups(P<0.05).Conclusion AS patients with kidney deficiency and stasis obstruction syndrome have poorer spinal mobility,while those with damp-heat stasis obstruction syndrome have higher disease activity,poorer physical function,and are more prone to adverse psychological reactions.