膝骨关节炎临床证素研究  

Study on Clinical Syndrome Elements of Knee Osteoarthritis

作　　者：刘鑫[1] 谭旭仪[2] 邝高艳[1] 卢敏[1] LIU Xin;TAN Xuyi;KUANG Gaoyan;LU Min(The First Hospital of Hunan University of Chinese Medicine,Changsha Hunan 410007,China;Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine,Changsha Hunan 410006,China)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410007 [2]湖南省中医药研究院附属医院,湖南长沙410006

出　　处：《中医药导报》2023年第3期106-109,113,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：长沙市科技局项目(kq2004049)。

摘　　要：目的:研究膝骨关节炎(KOA)的临床证素,明确其病位、病性证素,分析证素分布、组合规律。方法:纳入符合标准的膝骨关节炎患者326例,收集临床证素,采用WF文峰-Ⅲ中医辅助诊疗软件分析病位、病性证素,采用频数分析、聚类分析法探讨其证素分布和组合规律。结果:326例KOA患者中男125例,女201例,年龄(61.59±9.32)岁;K-L分级:Ⅰ级52例,Ⅱ级130例,Ⅲ级85例,Ⅳ级59例。KOA病位证素有筋骨、肾、肝、脾、心、肺;其中Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者证素筋骨的频率高于75%;Ⅲ、Ⅳ级患者证素肾、肝、脾的频率明显高于Ⅰ、Ⅱ级。KOA实证病性证素包括痹、血瘀、气滞、湿、寒、风、热、痰、毒;其中Ⅲ、Ⅳ级患者证素痹的频率高于Ⅰ、Ⅱ级;Ⅳ级患者证素血瘀的频率最高;Ⅲ级患者证素寒的频率最高,其次为Ⅰ、Ⅱ级;Ⅱ级患者证素气滞的频率最高;Ⅰ级患者证素湿的频率最高,其次为Ⅲ、Ⅱ级。气虚、阳虚、血虚、阴虚组成了KOA虚证的病性证素,Ⅲ、Ⅳ级患者证素气虚、阳虚、血虚、阴虚的频率高于Ⅰ、Ⅱ级。聚类分析可将证素归纳为气滞血瘀证、寒湿痹阻证、风湿热痹证、肝肾亏虚证4个基本证型及不同的兼证。结论:KOA早期证素主要为气滞、湿、寒等实证证素,后期出现肾、肝、脾的证候,且虚证证素增加,呈虚实夹杂特征,局部症状明显并贯穿疾病的全病程。KOA证素组合形式为气滞血瘀证、寒湿痹阻证、风湿热痹证、肝肾亏虚证4个基本证型。Objective:To study the clinical syndromes of knee osteoarthritis,clarify its disease-location factors and disease-natures factors,and analyze the distribution and combination of syndrome elements.Method:326 patients with knee osteoarthritis who met the criteria were selected,and the clinical syndrome elements were collected.The WF WENFENG-ⅢTCM auxiliary diagnosis and treatment software was used to analyze its disease-location factors and disease-natures factors,and the distribution and combination rules of syndrome elements were discussed by frequency analysis and cluster analysis.Results:A total of 326 KOA patients were included in the study,with 125 male and 201 female,and the mean age was(61.59±9.32)years.K-L classification:GradeⅠ52 cases,GradeⅡ130 cases,GradeⅢ85 cases,GradeⅣ59 cases.The location factors of KOA included sinew and bone,kidney,liver,spleen,heart and lung.The frequency of sinew and bone in gradeⅠ,Ⅱ,ⅢandⅣpatients was higher than 75%.The frequency of kidney,liver and spleen in gradeⅢandⅣpatients was significantly higher than that in gradeⅠandⅡpatients.The excess disease-natures factors included arthralgia,blood stasis,qi stagnation,dampness,cold,wind,heat,phlegm and poison.The frequency of arthralgia in gradeⅢandⅣpatients was higher than that in gradeⅠandⅡpatients.The frequency of blood stasis was the highest in gradeⅣpatients.The frequency of cold was the highest in gradeⅢpatients,followed by gradeⅠand gradeⅡ.The frequency of qi stagnation in gradeⅡpatients was the highest.The frequency of dampness in gradeⅠpatients was the highest,followed by gradeⅢand II.Qi deficiency,Yang deficiency,blood deficiency and Yin deficiency constituted the deficiency disease-natures factors of KOA.The frequency of Qi deficiency,Yang deficiency,blood deficiency and Yin deficiency in patients of gradeⅢandⅣwas higher than that of gradeⅠandⅡ.Cluster analysis could classified the syndrome elements into four basic syndrome types and different concurrent syndromes: Qi

关 键 词：膝骨关节炎 证素 辨证 病性 病位 

分 类 号：R274.32[医药卫生—中医骨伤科学]