常规临床检验指标对类风湿关节炎中医证型的鉴别诊断价值  

The Values of Clinical Laboratory Indicators in the Differential Diagnosis of TCM Syndrome Types for Patients with Rheumatoid Arthritis

作　　者：马红叶 郭宏林[1] 马丛[2] 黄晓霞 桂红[1] MA Hongye;GUO Honglin;MA Cong;HUANG Xiaoxia;GUI Hong(Department of Clinical Laboratory,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Rheumatology,Beijing Hospital ofTraditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院检验科,北京100010 [2]首都医科大学附属北京中医医院风湿病科,北京100010

出　　处：《标记免疫分析与临床》2024年第8期1400-1406,共7页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨常规临床检验指标对类风湿关节炎中医证型的鉴别诊断价值。方法回顾性收集2023年1月至2023年12月在首都医科大学附属北京中医医院风湿病科住院诊治的182例类风湿关节炎(RA)患者,按照中医辨证分型,分为痰瘀痹阻证30例、湿热痹阻证80例、寒热错杂证19例、肝肾亏虚证53例。分别比较不同中医证型患者白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、血小板(PLT)、类风湿因子(RF)、C反应蛋白(CRP)、总胆固醇(CHO)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平差异,绘制受试者工作特征曲线(ROC曲线)评价各检验指标对中医证型的诊断价值。结果CRP水平在4组之间差异具有统计学意义,进一步两两比较,显示湿热痹阻证组CRP水平高于痰瘀痹阻证组,肝肾亏虚证组CRP水平低于湿热痹阻证组,差异具有统计学意义(P<0.05);Hb、CHO、CRP、PLT单独检测对RA不同中医证型均具有一定的鉴别诊断价值,对于痰瘀痹阻证与肝肾亏虚证的鉴别诊断,CHO指标的灵敏度为73.33%,对于湿热痹阻证与寒热错杂证的鉴别诊断,Hb指标的特异性为78.95%,对于痰瘀痹阻证与寒热错杂证的鉴别诊断,Hb指标的ROC曲线下面积为0.703。对于痰瘀痹阻证与湿热痹阻证的鉴别诊断,CRP和LDL联合检测的灵敏度为93.33%,对于湿热痹阻证与寒热错杂证的鉴别诊断,CHO和Hb联合检测的特异性为94.74%,对于痰瘀痹阻证与寒热错杂证的鉴别诊断,CHO和Hb联合检测的ROC曲线下面积为0.747。结论Hb、CHO、CRP、PLT可为RA中医辩证分型及治疗预后提供量化参考,尤其是CHO和Hb联合检测对于鉴别RA痰瘀痹阻证与寒热错杂证具有较高的诊断价值。Objective To evaluate the value of clinical laboratory indicators in the differential diagnosis of traditional Chinese medical syndrome types for patients with rheumatoid arthritis.Methods A total of 182 patients with rheumatoid arthritis who were hospitalized in the Department of Rheumatology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from January,2023 to December,2023 were selected as the study subjects.Among these subjects,30 patients were phlegm syndrome,80 cases were damp-heat syndrome,19 cases were syndrome of combined with cold and heat,and 53 cases were deficency syndrome.Levels of rheumatoid factor(RF),C-reactive protein(CRP),white blood cell(WBC),red blood cell(RBC),hemoglobin(Hb),platelet(PLT),total cholesterol(CHO),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)in patients with different syndrome types were compared,and the receiver operating characteristic curve(ROC)was then drawn to evaluate the diagnostic value of the indicators for different syndrome types.Results Levels of CRP in damp-heat syndrome were significantly higher than those in phlegm syndrome,while levels of CRP in deficency syndrome was significantly lower than those in damp-heat syndrome(P<0.05).When Hb,CHO,CRP,PLT were used as single indicators,they all showed certain differential diagnostic values for TCM syndromes of rheumatoid arthritis.The sensitivity of CHO in the differential diagnosis of phlegm syndrome from deficency syndrome was 73.33%,while the differential diagnosis specificity of Hb to damp-heat syndrome and syndrome of combined with cold and heat was 78.95%,and the area under the curve(AUC)was 0.703 when Hb was used as a single indicator in the differential diagnosis of phlegm syndrome from syndrome of combined with cold and heat.The sensitivity of CRP combined with LDL in differential diagnosis of phlegm syndrome and damp-heat syndrome was 93.33%,while the specificity of combined detection of CHO and Hb in the differential diagnosis of damp-heat syndrome and syndrome of

关 键 词：中医证型 类风湿关节炎 检验指标 

分 类 号：R593.22[医药卫生—内科学]