类风湿关节炎中医证型与肌骨超声改变的关系  

The Relationship between Traditional Chinese Medicine Syndrome Types and Changes of Muscle and Bone Ultrasound in Rheumatoid Arthritis Patients

作　　者：姜萍 马洪美 蒋雪梅[3] 陶燕楠 庞爱梅[5] JIANG Ping;MA Hong-mei;JIANG Xue- mei;TAO Yah-nan;and PANG Ai-mei(Division of Rheumatology, First Clinical College, Shandong University of Traditiona/ Chinese Medicine, Jinan 250014;Division of Rheumato/ogy, Shandong Prov- ince Tengzhou /-/ospita/ of Traditiona/ Chinese Medicine, Shandong 277599;Department of U/trasonog- raphy, Affiliated Hospital Shandong University of Traditiona/ Chinese Medicine, Jinan 250011;College of TCM, Shandong University of Traditiona/ Chinese Medicine, Jinan 250014;Department of Laboratory Test, Affiliated Hospital Shandong University of -/-raditiona/ Chinese Medicine, Jinan 250011)

机构地区：[1]山东中医药大学第一临床医学院风湿科,济南250014 [2]山东省滕州市中医院风湿免疫科,山东277599 [3]山东中医药大学附属医院超声科,济南250011 [4]山东中医药大学中医学院,济南250014 [5]山东中医药大学附属医院检验科,济南250011

出　　处：《中国中西医结合杂志》2018年第6期658-661,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：山东省高等学校科技计划项目(No.J12LK09);山东省科技发展计划项目(No.2014GSF119017)

摘　　要：目的探讨类风湿关节炎(RA)不同中医证型与肌骨超声改变的关系。方法将87例RA患者按中医证候分型标准分为湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾亏虚证、肝郁脾虚证5型。应用超声技术探测关节的滑膜厚度、滑膜血流、关节软骨及软骨下骨质破坏、关节积液、肌腱炎或腱鞘炎等情况,分析RA不同证型与超声改变的关系。结果湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾亏虚证、肝郁脾虚证的滑膜增厚阳性率分别为88.46%(92/104)、77.78%(28/36)、86.67%(52/60)、61.90%(52/84)、62.50%(40/64);滑膜血流阳性率分别为84.62%(88/104)、55.56%(20/36)、46.67%(28/60)、47.62%(40/84)、25.00%(16/64);软骨及软骨下骨破坏阳性率分别为15.38%(16/104)、11.11%(4/36)、26.67%(16/60)、42.86%(36/84)、25.00%(16/64);关节积液的阳性率分别为80.77%(84/104)、55.56%(20/36)、73.33%(44/60)、66.67%(64/84)、62.50%(40/64);肌腱炎或腱鞘炎的阳性率15.38%(16/104)、11.11%(4/36)、46.67%(20/60)、9.52%(8/84)、18.75%(8/64)。湿热痹阻证的滑膜增厚阳性率、血流阳性率、关节积液阳性率均高于肝肾亏虚证、肝郁脾虚证(P<0.05,P<0.01);肝肾亏虚证的软骨及软骨下骨破坏阳性率最高(P<0.01);痰瘀痹阻证的肌腱炎或腱鞘炎的阳性率最高(P<0.01)。结论 RA患者的关节超声变化与中医证型存在一定的相关性,湿热痹阻证滑膜增生明显,血流较丰富,易产生关节积液;肝肾亏虚证患者易出现骨破坏;痰瘀痹阻证易出现肌腱炎或腱鞘炎,为RA的辨证分型提供了一定的客观依据。Objective To observe the relationship between different traditional Chinese medicine（ TCM） syndrome types of rheumatoid arthritis（ RA） patients and the changes of muscle and bone ultrasound. Methods Totally 87 RA patients were assigned to five types groups according to TCM syndrome differentiation： damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome. By using ultrasonic technique,a comparative observation of synovium thickness,synovium blood flow,destructions of arthrodial cartilage and subchondral bone,effusion of joint,tendonitis or tenosynovitis were performed in all patients to ana-lyze correlation between different TCM syndrome types and ultrasonic changes of muscle and bone in RA patients. Results The synovium thickness positive rate of damp-heat obstruction syndrome,cold-damp obstruction syndrome,phlegm-stasis obstruction syndrome,Gan-Shen deficiency syndrome,and Gan depression Pi deficiency syndrome were respectively 88. 46%（ 92/104）,77. 78%（ 28/36）,86. 67%（ 52/60）,61. 90%（ 52/84）,62. 50%（ 40/64）; the synovium blood flow positive rate were respectively 84. 62%（ 88/104）,55. 56%（ 20/36）,46. 67%（ 28/60）,47. 62%（ 40/84）,25. 00%（ 16/64）; the positive rate of cartilage and subchondral bone destructions were respectively 15. 38%（ 16/104）,11. 11%（ 4/36）,26. 67%（ 16/60）,42. 86%（ 36/84）,25. 00%（ 16/64）; the positive rate of effusion of joint were respectively 80. 77%（ 84/104）,55. 56%（ 20/36）,73. 33%（ 44/60）,66. 67%（ 64/84）,62. 50%（ 40/64）; the positive rate of tendonitis or tenosynovitis were respectively 15. 38%（ 16/104）,11. 11%（ 4/36）,46. 67%（ 20/60）,9. 52%（ 8/84）,18. 75%（ 8/64）. The synovium thickness positive rate,the synovium blood flow positive rate,and the positive rate of effusion of joint in Damp-heat obstruction syndrome were higher than those in Gan-Shen deficiency syndrome and Gan

关 键 词：类风湿关节炎 超声 中医证型 

分 类 号：R259[医药卫生—中西医结合]