膝骨关节炎中医证素与膝关节疼痛及软骨损伤的关系研究  

A clinical study on the relationship between TCM syndrome factors and knee pain and the relationship between TCM syndrome factors and cartilage injury in patients with knee osteoarthritis

作　　者：李言杰[1] 孙振双 蔡西国[1] 王文伟[1] LI Yanjie;SUN Zhenshuang;CAI Xiguo;WANG Wenwei(Henan Provincial People’s Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院,河南郑州450003

出　　处：《中医正骨》2020年第9期9-11,17,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨膝骨关节炎(knee osteoarthritis,KOA)的中医证素与膝关节疼痛及软骨损伤的关系。方法:参照《证素辨证学》,从KOA患者的中医四诊资料中提取中医证素,主要包括病位(五脏六腑)及病性(实证、虚证)证素。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价膝关节疼痛程度,采用Kazam超声评级标准评价膝关节软骨损伤程度。统计患者的中医证素数据;以中医证素为自变量,分别以膝关节疼痛VAS评分(≥4分)和膝关节软骨超声评级(≥Ⅰ级)为因变量,进行Logistic回归分析。结果:共纳入符合要求的KOA患者200例,男80例、女120例,年龄(58.40±9.56)岁,病程(2.65±1.20)年。病位证素依次是肾(180例,90%)、肝(174例,87%)、脾(90例,45%)、胃(90例,45%),实证证素依次是寒(192例,96%)、血瘀(184例,92%)、气滞(150例,75%)、风(102例,51%)、湿(88例,44%)、痰(78例,39%)、热(40例,20%),虚证证素依次是阳虚(196例,98%)、气虚(158例,79%)、血虚(86例,43%)、阴虚(10例,5%)。Logistic回归分析结果显示,肾、寒、血瘀是KOA患者膝关节疼痛的主要影响因素(P=0.031,P=0.020,P=0.030),肾、血瘀是KOA患者膝关节软骨损伤的主要影响因素(P=0.020,P=0.030)。结论:KOA的中医证素以肾、寒、阳虚为主,肾、寒、血瘀是影响膝关节疼痛的重要中医证素,肾、血瘀是影响膝关节软骨损伤的重要中医证素。Objective:To explore the relationship between TCM syndrome factors and knee pain and the relationship between TCM syndrome factors and cartilage injury in patients with knee osteoarthritis(KOA).Methods:The TCM syndrome factors including disease locations(five Zang-organs and six Fu-organs)and disease natures(excess syndrome and deficiency syndrome)were extracted from TCM four diagnostic data of KOA patients according to Syndrome element syndrome differentiation(SESD).The degrees of knee pain and cartilage injury were evaluated by using pain visual analogue scale(VAS)scores and Kazam ultrasonic rating standard respectively.The patients’TCM syndrome factors data were obtained by collation and statistics.The Logistic regression analysis was conducted by taking TCM syndrome factors as the independent variables and taking knee pain VAS scores(≥4 points)and knee cartilage ultrasonic rating(≥gradeⅠ)as dependent variables respectively.Results:Two hundred KOA patients were enrolled in the study and they consisted of 80 males and 120 females and ranged in age of 58.40+/-9.56 years and in disease course of 2.65+/-1.20 years.The syndrome factors of disease location included kidney(180 cases,90%),liver(174 cases,87%),spleen(90 cases,45%)and stomach(90 cases,45%)in turn.The excess syndrome factors included cold(192 cases,96%),blood stasis(184 cases,92%),qi stagnation(150 cases,75%),wind(102 cases,51%),dampness(88 cases,44%),phlegm(78 cases,39%)and heat(40 cases,20%)in turn.The deficiency syndrome factors included yang deficiency(196 cases,98%),qi deficiency(158 cases,79%),blood deficiency(86 cases,43%)and yin deficiency(10 cases,5%).The results of Logistic regression analysis demonstrated that the main influencing factors of knee pain were kidney,cold and blood stasis and the main influencing factors of knee cartilage injury were kidney and blood stasis respectively in KOA patients(P=0.031,P=0.020,P=0.030;P=0.020,P=0.030).Conclusion:The TCM syndrome factors of KOA are mainly kidney,cold and yang deficiency.The importan

关 键 词：骨关节炎 膝 辨证 证素 疼痛 软骨损伤 回归分析 

分 类 号：R274.9[医药卫生—中西医结合]