系统性硬化症合并肺动脉高压中医证型分布及中药用药规律研究  

A Preliminary Study on the Distribution of Traditional Chinese Medicine Syndrome Types and Medication Rules of Chinese Medicine for Systemic Sclerosis Complicated with Pulmonary Hypertension

作　　者：李淑瑶 王馨玉 何家颖 关彤[2] LI Shu-Yao;WANG Xin-Yu;HEJia-Ying;GUAN Tong(The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of Rheumatology,the First Affiliated 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临床医学院,广东广州510405 [2]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》2023年第1期15-21,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:81573850)。

摘　　要：【目的】探讨系统性硬化症(systemic sclerosis,SSc)合并肺动脉高压(pulmonary hypertension,PH)的临床特征、中医证型分布及中药用药规律。【方法】收录2016年1月1日至2021年12月31日广州中医药大学第一附属医院收治的67例SSc患者,根据超声心动图测定的肺动脉收缩压(PASP)是否≥37 mmHg,将患者分为系统性硬化症合并肺动脉高压组(SSc-PH组)34例和系统性硬化症不合并肺动脉高压组(SSc-nPH组)33例。收集患者的一般情况、临床症状、实验室指标等资料,分析SSc-PH的危险因素和中医证型分布,并运用中医传承辅助平台V2.5分析中药的用药规律。【结果】(1)SSc-PH患者常伴有心脏受累,尤其是心脏瓣膜病变、肺动脉内径的增宽及右房面积的增大;更容易出现血红蛋白下降、糖类抗原15-3(CA15-3)升高及抗Ro-52抗体阳性,组间比较,差异均有统计学意义(P<0.05或P<0.01)。(2)多因素Logistic回归分析提示,抗Ro-52抗体阳性及右房面积增大的患者,更容易出现SSc-PH。(3)SSc-PH患者辨证为虚证为主,以肺脾气虚证(44.12%)及脾肾阳虚证(29.41%)多见;SSc-nPH患者以实证为主,以寒湿痹阻证(36.36%)多见。组间比较,差异有统计学意义(P<0.05)。(4)除甘草外,中药用药频次最多的单药为桂枝,用药频次最多的药物组合为“黄芪,当归”。【结论】抗Ro-52阳性、右房面积增大是SSc-PH的危险因素;SSc-PH中药用药以益气健脾为法,兼以活血祛瘀。Objective To explore the clinical features,distribution of traditional Chinese medicine(TCM)syndrome types and the medication rules of Chinese medicine for systemic sclerosis(SSc)complicated with pulmonary hypertension(PH).Methods Sixty-seven patients with SSc admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 1,2016 to December 31,2021 were enrolled into the study.With reference to the pulmonary artery systolic pressure(PASP)≥37 mmHg or not which was detected by echocardiography,the patients were divided into the groups of SSc combined with PH(SSc-PH group,34 patients)and SSc without PH(SSc-nPH group,33 patients).The general conditions,clinical symptoms and laboratory indices of the patients were collected,and then the risk factors for SSc-PH and the distribution of TCM syndrome types were analyzed,and medication rules of the Chinese medicine was analyzed based on Traditional Chinese Medicine Inheritance Support System(TCMISS V2.5)platform.Results(1)Patients with SSc-PH often had cardiac involvement,especially in heart valve lesions,widening of the internal diameter of the pulmonary artery and increased right atrial area.And they were more likely to have decreased hemoglobin,elevated carbohydrate antigen15-3(CA15-3)and positive anti-Ro-52 antibodies,and the differences between the two groups were statistically significant(P<0.05 or P<0.01).(2)Multivariate logistic regression analysis suggested that patients with positive anti-Ro-52 and increased right atrial area were more likely to develop into SSc-PH.(3)Patients with SSc-PH were usually differentiated as deficiency syndrome,and qi deficiency of lung and spleen syndrome(44.12%)and yang deficiency of spleen and kidney syndrome(29.41%)were more commonly seen.The patients with SSc-nPH were usually differentiated as excess syndrome,and cold-damp blockage syndrome(36.36%)was more commonly seen.The differences between the two groups were statistically significant(P<0.05).(4)Except for Glycyrrhizae Radix et Rhizoma,the

关 键 词：系统性硬化症 肺动脉高压 临床特征 危险因素 中医证型 中药用药规律 益气健脾 

分 类 号：R259.932[医药卫生—中西医结合]