“类风湿关节炎患者湿热及寒湿痹阻证辨识系统”的建立及在临床实践中的应用

Establishment and Clinical Application of the Identification System for Damp Heat and Cold Damp Obstruction Syndromes in Patients with Rheumatoid Arthritis

目的:建立“类风湿关节炎(RA)患者湿热及寒湿痹阻证辨识系统”(简称:RA证候辨识系统),并通过该系统的Logistic回归方程在临床实践中辨识湿热痹阻证与寒湿痹阻证RA。方法:根据2018版《类风湿关节炎病证结合诊疗指南》,采用传统的主症,次症及舌脉象,在陆军军医大学附属西南医院门诊收集湿热痹阻证及寒湿痹阻证RA患者342例。同时,基于Logistic回归方程建立移动端和个人电脑端的“RA证候辨识系统”,对RA患者进行证型判定及疾病活动度评分。结果:与《类风湿关节炎病证结合诊疗指南》标准相比,342例RA患者的“RA证候辨识系统”判对率可达93.5%。湿热痹阻证多见于高疾病活动度的RA患者,寒湿痹阻证以中低活动度RA患者为主(P<0.001)。湿热痹阻证RA的红细胞沉降率及C反应蛋白水平均较寒湿痹阻证明显增高(P<0.001),而抗环瓜氨酸肽抗体及类风湿因子水平在2组证型之间差异无统计学意义(P>0.05)。结论:“RA证候辨识系统”有助于临床实践中湿热痹阻证与寒湿痹阻证RA的分型识别与数据研究,值得推广使用。

Objective:To establish an Identification System for Damp Heat and Cold Damp Obstruction Syndromes in Patients with Rheumatoid Arthritis(RA Syndrome Identification System),and to identify damp heat obstruction syndrome and cold damp obstruction syndrome in RA patients in clinic through the logistic regression equation of the system.Methods:According to The Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis Syndrome(2018 edition),342 RA patients of damp heat obstruction and cold damp obstruction were collected from the outpatient department of Southwest Hospital affiliated with the Army Medical University in terms of traditional main symptoms,secondary symptoms,and tongue and pulse conditions.At the same time,a RA Syndrome Identification System was established based on logistic regression equations for mobile and personal computer devices to determine the syndrome types and disease activity scores for these RA patients.Results:Compared with The Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis Syndrome,the accuracy rate of the RA Syndrome Identification System judging the 342 RA patients reached 93.5%.Damp heat obstruction syndrome was more common in RA patients with high disease activity,while cold dampness obstruction syndrome was mainly present in those with low or moderate activity(P<0.001).The erythrocyte sedimentation rate and C-reactive protein values in RA patients with damp heat obstruction syndrome were significantly higher than those with cold dampness obstruction syndrome(P<0.001),while there was no statistically significant difference in the levels of anti cyclic citrullinated peptide antibodies and rheumatoid factor between the two syndrome types(P>0.05).Conclusion:The RA Syndrome Identification System is helpful for the classification and data research of damp heat obstruction syndrome and cold damp obstruction syndrome in RA patients in clinic,worth promotion and application.