痛风急性发作期中医证候特征的临床研究  

Clinical Study on the Characteristics of Traditional Chinese Medicine Syndromes in Gout Patients with Acute Attack

作　　者：刘明岭[1] 陈靖雯[1] 何家颖 刘敏莹 徐强[1] 林昌松[1] LIU Ming-Ling;CHEN Jing-Wen;HE Jia-Ying;LIU Min-Ying;XU Qiang;LIN Chang-Song(Dept.of Rheumatology,the First Affliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院风湿病科,广东广州510405

出　　处：《广州中医药大学学报》2022年第7期1482-1486,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81774262);广东省中医药局科研项目(编号:20191113)。

摘　　要：【目的】探讨痛风性关节炎急性发作期的临床特点及中医证候特征。【方法】收集80例在风湿病科住院治疗的痛风性关节炎急性发作患者,根据中医辨证分型分为湿热蕴结证组与瘀热阻滞证组,每组各40例。设计临床观察表,收集患者的性别、年龄、体质量、体质量指数(BMI)、身高、既往病史、痛风病史、症状、体征、中医舌脉、血沉(ESR)、C反应蛋白(CRP)、血小板计数(PLT)、D-二聚体(D-Dimer)等信息。比较分析2组患者的一般资料、痛风发作特点、中医脉症及相关炎症指标的差异。【结果】(1)与瘀热阻滞证组比较,湿热蕴结证组患者的年龄较大,病程较长,BMI较高,关节肿痛数目较多,肘关节受累较明显,口苦、舌红、苔黄腻、脉滑较突出,ESR、CRP、D-Dimer水平升高更明显;而瘀热阻滞组患者的舌质暗、脉细涩较明显,PLT水平升高更明显,差异均有统计学意义(P<0.05或P<0.01)。【结论】湿热蕴结证多见于中老年体胖、病程长的患者,临床表现为热像明显,关节肿痛数目多且上肢关节易受累,炎症指标更高;而瘀热阻滞证以血瘀征象突出,炎症较轻。Objective To explore the clinical features and traditional Chinese medicine(TCM)syndrome characteristics of gouty arthritis patients with acute attack.Methods Eighty gouty arthritis patients with acute attack who were hospitalized in the department of rheumatology of the First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected and divided into the group of damp-heat accumulation syndrome and the group of stagnant-heat obstruction syndrome according to the TCM syndrome classification,with 40 cases in each group.A clinical observation form was designed for collecting the information of patients’gender,age,body mass,body mass index(BMI),body height,previous medical history,history of gout,symptoms,signs,TCM tongue and pulse manifestations,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),platelet(PLT)count and D-dimer(D-Dimer)level.The differences in general information,gout attack characteristics,TCM pulse and symptoms,and related inflammatory indexes between the two groups were compared and analyzed.Results Compared with the group with blood stasis and heat obstruction syndrome,patients in the group with damp-heat accumulation syndrome were elderly,and had a long duration of illness,high BMI,large number of swollen and painful joints,obvious affection of the elbow joint,prominent tongue and pulse manifestations of bitterness in the mouth,red tongue,yellowish coating,and slippery pulse as well as the increased levels of ESR,CRP and D-Dimer.The patients in the group with blood stasis and heat obstruction syndrome had a darker tongue,more obvious thin and astringent pulse,and more obvious elevation of PLT levels than the group with damp-heat accumulation syndrome.The differences of the above indexes between the two groups were statistically significant(P<0.05 or P<0.01).Conclusion Damp-heat accumulation syndrome is commonly seen in middle-aged and elderly fat patients with long course of disease,which presents the clinical manifestations of obvious heat syndrome,large number of

关 键 词：痛风性关节炎 急性发作 中医证型 湿热蕴结证 瘀热阻滞证 临床研究 

分 类 号：R259.897[医药卫生—中西医结合]