膝骨关节炎中医证型分布的流行病学研究  

Epidemiological study on Chinese medical syndrome of knee osteoarthritis

作　　者：向珍蛹[1,2] 茅建春[1] 徐先国[3] 曲环汝[1] 胡劲松[3] 徐翔峰[1] 宋花玲[4] 赵蓓俊[1] 顾军花[1] 许一[1] 杨晔影[1] 苏励[1] 

机构地区：[1]上海中医药大学附属龙华医院风湿科,上海200032 [2]广东省增城市中医院重症医学科,广东增城511300 [3]上海市浦东新区上钢社区卫生服务中心,上海200126 [4]上海中医药大学,上海201203

出　　处：《上海中医药杂志》2012年第12期5-8,共4页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市浦东新区社会发展局卫生科技项目(PW2009D-3)

摘　　要：目的探索膝骨关节炎的中医证型分布特征。方法采用整群、分层、随机的多阶段抽样方法,随机抽取上海市浦东新区某社区≥40岁的居民进行流行病学调查,收集其中膝骨关节炎患者的中医学四诊资料;根据研究内容及研究对象设计"中医证候因素调查表",结合膝骨关节炎的临床特点选取主症,并按阴阳、气血、虚实、表里归纳16个病机因子,对中医证型分布进行统计学分析。结果①在1 499例调查对象中,膝骨关节炎确诊患者499例,患病率为33.3%。②在完成有效问卷的442例膝骨关节炎患者中,肾虚、寒、湿、肝虚、阴虚、气虚、阳虚、瘀血是出现频率最高的病机因子;其中将肾虚、阳虚、寒、气虚、湿聚类为第一类,将肝虚、瘀血、阴虚聚类为第二类,其余为第三类。③寒湿阻滞、肾阳虚、肾气虚、肾阴虚、瘀阻脉络、肝阴虚是出现频率最高的证型;通过证型分析将膝骨关节炎患者聚为三类,其中肾阳虚、寒湿阻滞证210例(47.5%),肾虚、肝阴虚、虚寒湿瘀滞证153例(34.6%),五脏虚、寒湿痰瘀气滞证79例(17.9%)。结论①肾虚、寒、湿、肝虚、阴虚、气虚、阳虚、瘀血是膝骨关节炎常见的病机因子,肾虚、阳虚、寒、气虚、湿是膝骨关节炎的基本病机因子;②寒湿阻滞、肾阳虚、肾气虚、肾阴虚、瘀阻脉络、肝阴虚是膝骨关节炎的常见证型,肾阳虚、寒湿阻滞证是膝骨关节炎的基本证型,肾阳虚、寒湿是膝骨关节炎的基本辨证要素。Objective To explore the Chinese medical syndrome distribution of knee osteoarthritis（KOA）.Methods By a cluster,stratified,multistage randomized sampling method,1650 native residents over 40 years in a community were epidemiologically surveyed.The relative data of 442 patients with KOA were analyzed by statistical methods.Results Frequency analysis revealed that kidney deficiency,cold,dampness,liver deficiency,yin deficiency,qi deficiency,yang deficiency and blood stasis were the most frequent pathogenic factors of KOA;cold-dampness blocking collaterals,deficiency of kidney yang,deficiency of kidney qi,deficiency of kidney yin,blood stasis blocking skeletons and deficiency of liver yin were the most frequent syndromes of KOA.Cluster analysis revealed that the pathogenic factors of KOA were divided into three categories： the first category included kidney deficiency,yang deficiency,cold,qi deficiency and dampness;the second category included liver deficiency,blood stasis and yin deficiency;the third category included the others;the patients with KOA were divided into three categories by syndromes： 210 patients（47.5%） with the syndrome combining deficiency of kidney yang and cold-dampness blocking collaterals;153 patients（34.6%） with the syndrome combining kidney deficiency,deficiency of liver yin,cold-dampness blocking collaterals and blood stasis blocking skeletons;79 patients（17.9%） with the syndrome combining all deficiency,cold-dampness,phlegm,blood stasis,and qi stagnation.Conclusions Kidney deficiency,cold,dampness,liver deficiency,yin deficiency,qi deficiency,yang deficiency and blood stasis are the most frequent pathogenic factors of KOA;kidney deficiency,yang deficiency,cold,qi deficiency and dampness are the basic factors.Cold-dampness blocking collaterals,deficiency of kidney yang,deficiency of kidney qi,deficiency of kidney yin,blood stasis blocking skeletons and deficiency of liver yin are the most frequent syndromes of KOA;the syndrome combining deficiency of kidney yang and cold-

关 键 词：膝骨关节炎 中医证型 流行病学 

分 类 号：R274.9[医药卫生—中西医结合]