真实世界类风湿关节炎湿热痹阻证特征及演变规律研究  

A Study on the Characteristics and Evolutionary Rules of Damp Heat ObstructionSyndrome in Rheumatoid Arthritis in the Real World

作　　者：马协丽 姜泉[1] 巩勋[1] 姚传辉 刘子夏 常甜 尚碧月 杨煜辰 宋梦歌 张富渊 MA Xieli;JIANG Quan;GONG Xun;YAO Chuanhui;LIU Zixia;CHANG Tian;SHANG Biyue;YANG Yuchen;SONG Mengge;ZHANG Fuyuan(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中国中医基础医学杂志》2024年第6期975-980,共6页JOURNAL OF BASIC CHINESE MEDICINE

基　　金：国家自然科学基金项目(82230121);中央高水平中医医院临床科研业务费-中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023087,HLCMHPP2023014)。

摘　　要：目的 基于真实世界类风湿关节炎(rheumatoid arthritis,RA)临床队列探讨湿热痹阻证患者临床特征及演变规律。方法 纳入2019年10月至2023年1月在“中国中医风湿病注册研究信息平台”中随访一年以上且首诊为湿热痹阻证的RA患者,所有患者至少进行过一次随访。收集患者的人口统计学、实验室指标、病情评估等信息,根据随访后证候是否变化分为不变组和演变组,采用logistic回归分析RA患者证候演变的影响因素,并采用Kaplan-Meier法分析不同疾病活动度患者的演变情况。结果 本研究共纳入2 068例首诊属于湿热痹阻证RA患者,其中1 403例(67.84%)随访后仍是湿热痹阻证,665例(32.16%)在随访期发生了证候演变,转化证候前5名依次为湿热痹阻证、痰瘀痹阻证、瘀血阻络证、肝肾不足证、寒湿痹阻证。多因素分析结果表明:年龄<70岁,临床疾病活动指数(clinical disease activity index,CDAI)>2.8,肿胀关节计数(swollen joint count,SJC),血沉(erythrocyte sedimentation rate,ESR),健康评估问卷(health assessment questionnaire,HAQ)是湿热痹阻证RA患者发生证候演变的影响因素。结论 湿热痹阻证贯穿RA始终,证候演变表现出湿热→痰瘀/风寒湿→虚的趋势,年龄与疾病活动度是湿热痹阻证演变的影响因素。Objective To explore the characteristics and evolution of damp heat obstruction syndrome in patients with rheumatoid arthritis(RA)based on real-world clinical data.Methods RA patients with damp heat obstruction syndrome who were followed up for more than one year in the CERTAIN database from October 2019 to January 2023 were enrolled,and all patients were followed up at least once every 3 months.The patients were divided into a stable group and an evolving group according to whether the syndrome changed after follow-up.Logistic regression was used to analyze the influencing factors of RA patients with syndrome evolution,and the Kaplan-Meier method was used to analyze the evolution of patients with different disease activity.Results A total of 2068 RA patients with damp heat obstruction syndrome at initial diagnosis were enrolled in this study.Among them,1403 patients(67.84%)remained damp heat obstruction syndrome after follow-up,and 665 patients(32.16%)changed the syndrome during the follow-up period.The top five transformation syndromes were damp heat obstruction syndrome,phlegm and blood stasis obstruction syndrome,blood stasis syndrome,liver and kidney deficiency syndrome,cold damp obstruction syndrome.Multivariate analysis showed that age<70 years,CDAI>2.8,SJC,ESR,and HAQ were the influencing factors for the evolution of RA patients with damp heat obstruction syndrome.Conclusion Damp heat obstruction syndrome runs through the whole process of RA,and the evolution trend of the syndrome is damp heat→phlegm stasis/wind-cold-dampness→deficiency.Age and disease activity are the influencing factors for the evolution of damp heat obstruction syndrome.

关 键 词：类风湿关节炎 湿热痹阻证 动态演变 真实世界研究 多因素分析 

分 类 号：R259[医药卫生—中西医结合] R241[医药卫生—中医内科学] R593.22[医药卫生—中医学]