1191例寒湿痹阻证类风湿关节炎患者的证候演变特点及相关性分析

Syndrome Evolution Characteristics and Correlation Analysis in 1 191 Patients withRheumatoid Arthritis of Cold Dampness Obstruction Syndrome

目的 纵向分析寒湿痹阻证类风湿关节炎(rheumatoid arthritis,RA)患者证候演变相关因素及不同证候演变方向人群差异,为临床提供参考。方法 依托“中国中医风湿病注册研究信息平台”,收集2019年10月1日至2022年10月1日期间登记的基线辨证为寒湿痹阻的RA患者资料。以《类风湿关节炎病证结合诊疗指南》为辨证分型参考,根据随访期间证候是否发生演变将研究人群分为演变组与非演变组,比较演变组与非演变组人群特征,及不同演变方向人群特征差异。结果 本研究共纳入1 191例寒湿痹阻证RA患者,中位随访时间为7个月,期间638例发生证候变化。演变组中湿热痹阻199例、风湿痹阻178例、肝肾不足102例、气血两虚58例、痰瘀痹阻53例、瘀血阻络30例、气阴两虚18例。演变组疾病活动相关指标显著高于非演变组,差异有统计学意义(P<0.05)。主要演变方向组(>10%)人群特征差异无统计学意义。Kaplan-Meier曲线分析显示证候演变率与疾病活动程度呈正相关,不同疾病活动期证候演变率依次为缓解期38.5%、低活动度期50.4%,中活动度期60.9%,高活动度期63.2%,差异有统计学意义(P<0.001)。寒湿痹阻证在不同季节演变方向存在差异性。春、夏、冬季,演变组向湿热痹阻证方向演变人数最多,占比依次为38.2%、31.5%、36.1%。秋季,演变组向风湿痹阻证方向演变人数最多,占秋季演变人群的44.3%。结论 随着疾病的发展,寒湿痹阻证RA半数以上会发生证候演变,湿热痹阻证、风湿痹阻证、肝肾不足证是主要的证候演变方向。病情活动影响寒湿痹阻证RA证候是否发生演变,季节影响寒湿痹阻证RA的证候演变方向。

Objective To investigate the related factors of syndrome evolution in patients with rheumatoid arthritis with cold-damp obstruction syndrome and the differences in the population with different main syndrome evolution direction,so as to provide reference for clinical practice.Methods Based on“CERTAIN”platform,the clinical data of RA patients with cold-damp obstrction syndrome at baseline registered from October 1,2019 to October 1,2022 were collected.Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis of Combination of Disease and Syndrome was used for differentiation of syndrome.The study population was divided into an evolving group and a non-evolving group according to whether the syndrome had evolved during the follow-up period.The characteristics of the evolving group and the non-evolving group were compared,and the characteristics of the population with different evolution directions were compared.Results A total of 1191 RA patients with cold-damp obstruction syndrome were enrolled in this study.During a median follow-up period of 7 months,638 patients developed changes into others.In the evolution group,there were 199 cases of damp-heat obstruction,178 cases of wind-dampness obstruction,102 cases of liver and kidney insufficiency,58 cases of Qi and blood deficiency,53 cases of phlegm and blood stasis obstruction,30 cases of blood stasis obstruction,and 18 cases of Qi and Yin deficiency.The indicators related to disease activity in the evolving group were significantly higher than those in the non-evolving group,and the difference was statistically significant(P<0.05).The main evolutionary direction group(>10%)was not statistically significant.K-M curve analysis showed that there was a positive correlation between the syndrome evolution rate and the degree of disease activity.The syndrome evolution rate was 38.5%,50.4%,60.9%and 63.2%in the remission stage,the low activity stage,the moderate activity stage and the high activity stage,respectively(P<0.001).The evolution of cold-damp obstruction syndrome varies in different seasons.In spring,summer,and winter,the number of patients evolving to the direction of damp-heat obstruction syndrome was the largest,accounting for 38.2%,31.5%,and 36.1%,respectively.In autumn,the number of patients evolving to wind-dampness obstruction syndrome was the largest,accounting for 44.3%of the patients in autumn.Conclusion With the development of the disease,more than half of RA patients with cold-dampness obstruction syndrome will undergo syndrome evolution,and damp-heat obstruction syndrome,wind-dampness obstruction syndrome,liver and kidney insufficiency syndrome are the main syndrome evolution directions.The disease activity affects the evolution of RA syndrome of cold-damp obstruction,and the season affects the evolution direction of RA syndrome of cold-damp obstruction.