260例类风湿关节炎患者中医证型聚类分析  

Cluster Analysis on Chinese Medicine Syndromes of 260 Rheumatoid Arthritis Patients

作　　者：刘维[1] 王朝旭[2] 吴沅皞[1] 

机构地区：[1]天津中医药大学第一附属医院 [2]天津中医药大学研究生院

出　　处：《中医杂志》2016年第6期508-511,共4页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81273709);天津市教育委员会科研计划(20120220)

摘　　要：目的应用变量聚类分析方法对类风湿关节炎(RA)进行中医辨证分型探讨。方法根据RA患者的中医临床表现设计调查表,采集260例RA患者中医症状、体征、舌象和脉象等四诊信息,统计各临床症状的频数和频率,对患者四诊资料进行K-均值聚类分析,并结合临床专业知识归类总结RA患者的中医证型。结果 260例RA患者临床表现主要以关节疼痛(频数257,频率98.8%,下同)、肢体困重(220,84.6%)、关节肿胀(204,78.5%)、关节压痛(181,69.6%)最为突出;全身症状可见神疲乏力(179,68.8%)、畏寒(168,64.6%)、畏风(160,61.5%)等表现。聚类分析结果显示,RA可分为湿热痹阻、寒湿痹阻、风湿痹阻、肾气虚寒、肝肾亏虚5种证型类别,所有类别患者均有不同程度的关节疼痛、关节肿胀、关节压痛,除风湿痹阻类别外均可见腰膝酸软、神疲乏力、烦闷不安表现,除湿热痹阻类别外均可见畏寒及自汗表现。结论采用聚类分析法可将RA患者分为湿热痹阻、寒湿痹阻、风湿痹阻、肾气虚寒,肝肾亏虚5个证型,与既往临床研究结果较一致。Objective To explore the Chinese medicine syndrome types of rheumatoid arthritis（ RA） by the method of variable cluster analysis. Methods Questionnaires were designed according to RA patients＇ Chinese medicine clinical manifestations. Four-diagnostic information of 260 RA patients,such as Chinese medicine symptoms,signs,tongue picture,pulse was collected. The absolute frequency and relative frequency of all clinical symptoms was calculated. K-means cluster analysis was made on patients＇ four-diagnostic information. Combined with clinical professional knowledge,RA patients＇ Chinese medicine syndromes were classified and summarized. Results The most common clinical manifestations of 260 RA patients were joint pain（ with absolute frequency 257,relative frequency 98. 8%）,heavy cumbersome limbs（ 220,84. 6%）,joint swelling（ 204,78. 5%） and joint tenderness（ 181,69. 6%）. General symptoms included fatigue（ 179,68. 8%）,fear of cold（ 168,64. 6%）,fear of wind（ 160,61. 5%）,etc. Cluster analysis showed that RA could be typed as 5 syndromes,i,e. dampness-heat blockade,cold-dampness blockade,wind-dampness blockade,deficient cold of kidney Qi and deficiency of liver and kidney. Patients of all types had different degrees of joint pain,joint swelling and joint tenderness. All patients had soreness and weakness of waist and knees,fatigue and dysphoria except wind-dampness blockade patients. All patients had fear of cold and spontaneous sweating except dampness-heat blockade patients. Conclusion RA patients could be typed into 5 syndromes,including dampness-heat blockade,cold-dampness blockade,wind-dampness blockade,deficient cold of kidney Qi and deficiency of liver and kidney. It was almost consistent with previous clinical research results.

关 键 词：类风湿关节炎 痹病 中医证型 聚类分析 

分 类 号：R259[医药卫生—中西医结合]