强直性脊柱炎寒热证型超声下外周附着点炎表现的差异研究  

Study on the difference of ultrasonic manifestations of peripheral enthesitis between cold and heat syndrome in ankylosing spondylitis

作　　者：刘扬 沈逸[1,3] 朱琦 何东仪 郭梦如 丁泓百[1,2] 杨阳 LIU Yang;SHEN Yi;ZHU Qi;HE Dongyi;GUO Mengru;DING Hongbai;YANG Yang(Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Shanghai University of Tradition Chinese Medicine,Shanghai 201210,China;Institute of Arthritis of Integrative Chinese and Western Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052,China)

机构地区：[1]上海中医药大学附属光华医院,上海200052 [2]上海中医药大学,上海201210 [3]上海市中医药研究院中西医结合关节炎研究所,上海200052

出　　处：《现代中西医结合杂志》2022年第9期1175-1181,1314,共8页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家中医药管理局区域中医(专科)诊疗中心(风湿病)建设项目;上海市科委科研计划项目(18401901100);上海市卫健委上海市中医专科(专病)联盟建设项目[ZY(2018-2020)-FWTX-4017];上海市卫健委上海市杏林新星计划[ZY(2018-2020)-RCPY-3017]。

摘　　要：目的研究强直性脊柱炎患者寒热证型超声下外周附着点炎表现的差异及其与临床指标的相关性。方法选择2018年12月—2019年12月上海中医药大学附属光华医院关节内科门诊和病房收治的强直性脊柱炎患者58例,收集患者临床信息,检测C反应蛋白(CRP)、血沉(ESR)水平,记录强直性脊柱炎疾病活动评分(ASDAS-CRP、ASDAS-ESR)、Bath AS疾病活动指数(BASDAI)、Bath AS功能指数(BASFI)、Bath AS测量指数(BASMI)及寒热证型中医证候评分;采用肌肉骨骼超声对患者进行外周肌腱附着点扫查,根据MASEI评分系统进行超声下附着点炎病变评分。根据Maastrict强直性脊柱炎附着点炎评分将外周附着点炎患者分为临床附着点炎组和亚临床附着点炎组,比较2组超声下6项病变评分及附着点炎总评分;按照中医辨证将患者分为寒证组与热证组,比较2组超声下6项病变评分及附着点炎总评分;分析58例患者超声下附着点炎总评分与临床指标的相关性、寒热证型患者超声下附着点炎总评分及超声下6项病变评分与临床指标的相关性、寒热证型患者超声下附着点炎总评分与中医证候评分的相关性。结果58例患者中有55例存在超声下附着点炎,其中亚临床附着点炎43例,临床附着点炎12例;中医辨证属于寒证30例,热证28例。临床附着点炎组患者超声下附着点炎总评分及能量多普勒血流评分均明显高于亚临床附着点炎组(P均<0.05);热证组患者超声下附着点炎总评分、肌腱厚度评分、滑囊炎评分均明显高于寒证组患者(P均<0.05)。58例患者超声下附着点炎总评分与CRP、ESR、ASDAS-CRP、ASDAS-ESR、BASDAI、BASFI、BASMI、MASES、病程均呈正相关(P均<0.05)。热证组患者超声下附着点炎总评分与CRP、ASDAS-CRP、BASDAI均呈正相关(P均<0.05),肌腱结构评分与ESR、ASDAS-ESR均呈正相关(P均<0.05),能量多普勒血流评分与CRP、ESR、ASDAS-CRP、ASDAS-ESR、BASDAI均Objective It is to explore the difference of ultrasonic manifestations of peripheral enthesitis between cold and heat syndrome and its correlation with clinical indicators in patients with ankylosing spondylitis(AS).Methods A total of 58 patients with AS who were admitted to the outpatient and ward of joint medicine department of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from December 2018 to December 2019 were selected,the clinical information of the patients was collected,and the levels of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were detected,the scores of AS disease activity(ASDAS-CRP,ASDAS-ESR),Bath AS Disease Activity Index(BASDAI),Bath AS Functional Index(BASFI),Bath AS Measurement Index(BASMI)and scores of TCM syndrome of cold and heat syndrome were recorded.The peripheral tendon attachment points of the patients were scaned by musculoskeletal ultrasound,and the enthesitis lesions under ultrasound were scored according to the MASEI scoring system.According to the Maastrict AS enthesitis scores,the patients with peripheral enthesitis were divided into a clinical enthesitis group and a subclinical enthesitis group,and the scores of 6 lesions and the total enthesitis score under ultrasound were compared between the two groups.According to TCM syndrome differentiation,the patients were divided into a cold syndrome group and a heat syndrome group,and the scores of 6 lesions and the total score of enthesitis under ultrasound were compared between the two groups.The correlation between the total score of enthesitis under ultrasound and clinical indicators,the correlation between the total score of enthesitis under ultrasound and the six lesion scores under ultrasound and clinical indicators in patients with cold syndrome and heat syndrome,and the correlation between the total score of enthesitis under ultrasound and the score of TCM syndromes in patients with cold syndrome and heat syndrome were analyzed.Results Among the 58 patients,55 had enthesiti

关 键 词：强直性脊柱炎 寒热证候 肌骨超声 附着点炎 

分 类 号：R593.23[医药卫生—内科学]