基于真实世界研究类风湿关节炎患者的中医证候与临床特点  

Analysis of TCM Syndromes and Clinical Manifestations of Rheumatoid Arthritis Patients Based on Real-world Study

作　　者：李琇莹 金晔华 姜婷 范晓蕾 沈杰 钱奕 章渊源 古英 胡春蓉[4] 苏晓[5] 薛鸾[6] 方勇飞 苏励[8] 高明利[9] 薛愉[10] 彭江云 魏强华[12] 刘红霞[13] 黄清春[14] 汪荣盛 朱琦 何东仪 LI Xiuying;JIN Yehua;JIANG Ting;FAN Xiaolei;SHEN Jie;QIAN Yi;ZHANG Yuanyuan;GU Ying;HU Chunrong;SU Xiao;XUE Luan;FANG Yongfei;SU Li;GAO Mingli;XUE Yu;PENG Jiangyun;WEI Qianghua;LIU Hongxia;HUANG Qingchun;WANG Rongsheng;ZHU Qi;HE Dongyi(Shanghai Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Institute of Arthritis Research in Integrative Medicine,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200052,China;Mianyang Hospital of Traditional Chinese Medicine,Mianyang 621000,China;The Ninth People's Hospital of Chongqing,Chongqing 400700,China;Shanghai Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;The First Hospital Affiliated to AMU(Southwest Hospital),Chongqing 400038,China;Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;The First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110000,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,China;The First People's Hospital Affiliated with Shanghai Jiao Tong University,Shanghai 200080,China;Center of Drug Clinical Research,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]上海中医药大学附属光华医院,上海200052 [2]上海市中医药研究院中西医结合关节炎研究所,上海200052 [3]绵阳市中医院,四川绵阳621000 [4]重庆市第九人民医院,重庆400700 [5]上海中医药大学附属市中医医院,上海200071 [6]上海中医药大学附属岳阳中西医结合医院,上海200437 [7]陆军军医大学第一附属医院,重庆400038 [8]上海中医药大学附属龙华医院,上海200032 [9]辽宁中医药大学第一附属医院,辽宁沈阳110000 [10]复旦大学附属华山医院,上海200040 [11]云南省中医院,云南昆明650021 [12]上海交通大学附属第一人民医院,上海200080 [13]上海中医药大学药物临床研究中心,上海201203 [14]广东省中医院,广东广州510120

出　　处：《中国中医药信息杂志》2023年第4期122-128,共7页Chinese Journal of Information on Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82074234);国家重点研发计划(2018YFC1705203);国家中医药管理局区域中医(专科)诊疗中心建设项目-风湿病科(2018年);国家中医药管理局国家中医药循证医学研究建设项目(2019年);华东片区中西医结合关节病专科联盟(2021年)。

摘　　要：目的 基于真实世界研究我国类风湿关节炎(RA)患者的证候分型及临床特点。方法 收集2015年9月-2020年1月全国10家医院2 650例RA患者临床资料,分析其临床特点。结果 2 650例RA患者肝肾阴虚证最多(1 280例,48.3%);平均发病年龄(51.33±14.20)岁,男女比例1∶4.4;有风湿病相关家族史者135例(5.1%),肝肾阴虚证(81例,6.3%)与湿热痹阻证(18例,3.1%)比较差异有统计学意义(P=0.003)。RA患者多于春季发病,不同证型RA患者发病季节比较差异无统计学意义(P>0.05)。中位病程72(28,145)月,其中湿热痹阻证病程在各证型中最短,与肝肾阴虚证及痰瘀互结证比较差异有统计学意义(P<0.005)。RA患者中位晨僵时间30(2,60)min,寒湿阻络证晨僵时间30(10,60)min,与其他证型比较差异有统计学意义(P<0.005)。中位红细胞沉降率(ESR)28.0 mm/h,湿热痹阻证ESR最高。类风湿因子(RF)有效数据811例,其中RF阳性患者680例(83.8%),气血亏虚证患者RF阳性率最高(32例,88.9%)。抗环瓜氨酸肽抗体(抗CCP抗体)有效数据699例,抗CCP抗体阳性患者574例(82.1%),湿热痹阻证患者抗CCP抗体阳性率最高(118例,83.1%)。各证型RF和抗CCP抗体阳性率比较差异无统计学意义(P>0.05)。中位28个关节的疾病活动度(DAS28-ESR)评分4.10(3.17,5.08)分,DAS28-ESR达标(DAS28-ESR评分≤3.2分)685例(25.8%)。结论 目前RA患者大多为中年起病,女性比例较高,多数RA患者处于疾病活动期,以中高疾病活动度为主,肝肾阴虚证最常见,寒湿阻络证晨僵时间最长,不同证型间抗CCP抗体、RF差异无统计学意义。Objective To investigate the syndrome classification and clinical manifestations of Chinese patients with rheumatoid arthritis(RA) in the real world.Methods The clinical data of 2 650 patients with RA in 10 hospitals in China from September 2015 to January 2020 were collected and their clinical manifestations were analyzed.Results Among the 2 650 RA patients,the maximum syndrome is liver-kidney yin deficiency(1 280 cases,48.3%);the average age at onset was(51.33±14.20) years old,and the male to female ratio is 1∶ 4.4;there are 135 cases(5.1%) with a family history of rheumatism,and there is a statistically significant difference between the liver-kidney yin deficiency syndrome(81 cases,6.3%) and damp-heat impediment syndrome(18 cases,3.1%),with significant difference(P=0.003).Although the incidence of RA is mostly in spring,but there is no significant difference in the incidence of RA with different syndromes in different seasons(P>0.05).The median course of disease are 72(28,145) months,and the duration of damp-heat impediment syndrome is the lowest among the five groups,which is significantly different from that of liver-kidney yin deficiency syndrome and phlegm-blood stasis syndrome(P<0.005).The median duration of morning stiffness is 30(2,60) min,and the median duration of cold-damp impediment syndrome is 30(10,60) min and the longest,which is significantly different from other syndrome(P<0.005).The median level of ESR in patients is 28.00 mm/h,and the level of ESR in patients with damp-heat impediment syndrome is the highest.There are 811 patients with RF valid data,including 680 patients with RF positive(83.8%),Qi-blood deficiency syndrome patients with positive RF rate is the highest(32 cases,88.9%).There are 699 patients with anti-CCP antibody valid data,including 574 patients with anti-CCP antibody positive(82.1%).Dampness-heat impediment syndrome with positive anti-CCP antibody rate is the highest(118 cases,83.1%).There is no significant difference in positive RF and anti-CCP antibody rate of RA with

关 键 词：类风湿关节炎 真实世界研究 中医证候 临床特点 

分 类 号：R259.932.2[医药卫生—中西医结合] R24[医药卫生—中医内科学]