基于病证结合对类风湿关节炎临床表现的横断面描述及其证候探讨(1)
【摘 要】目的：对类风湿关节炎的临床表现进行全面系统且具有循证依据的横断面描述，并探讨其证候规律。方法：HFRA数据库是一个“病证结合”的对类风湿关节炎的西医表现和中医表现“一网打尽”的数据库。利用这一数据库，将本病“关节表现”的多项内容纳入一个表格中进行全面系统的展示；将“关节外表现”按发生频率高低排列后进行全面系统的展示。接着，将“关节表现”和“关节外表现”先行融合后，再按中医的虚、邪、瘀进行分类展示。结果：“关节表现”包括近端指间关节、掌指关节、腕关节、膝关节、踝关节、跖趾关节、肘关节、肩关节、远端指间关节、颞颌关节、颈椎、胸锁关节、肩锁关节的肿胀、疼痛、压痛、波动感、柔韧感、活动受限、畸形、最痛的一个关节、最肿的一个关节的分布情况及频率；还包括关节晨僵、关节疼痛性质、影响关节疼痛的因素等情况及频率。“关节外表现”有110项，频率超過50%的有全身怕风怕冷(68.22%)、健忘(64.06%)、全身乏力(62.35%)、神倦懒动(56.72%)、易怒(51.83%)。“虚邪瘀”中医表现，气虚项目多，频率高，阳虚、阴虚、血虚项目相对较少，肾虚项目多，频率高，心、脾、肝、肺虚项目相对较少；湿邪项目多，频数高，寒邪、燥邪项目少，但频数不低，热邪项目多，但频率不高，风邪项目少，频率也低；瘀血项目多，频率高，痰凝项目少，但频率不低，气滞项目多，频率不低。本病局部(关节)为实，整体多虚。“实”主要为湿痰瘀滞，“虚”主要为气虚肾虚。结论：全面系统地对类风湿关节炎横断面的临床表现进行了具有循证依据的描述，这些临床表现远远超过了现有中、西医教科书上的内容，为进一步探索本病的诊疗规律打下了基础；初步认为，本病局部多湿痰瘀滞，整体多气虚肾虚；本研究也为现代中医各科疾病的“病证结合”临床研究提供了可资借鉴的方法。
【关键词】 关节炎，类风湿；病证结合；关节表现；关节外表现；“虚邪瘀”中医表现；横断面；HFRA数据库；证候探讨
Cross Sectional Description of Clinical Manifestations of Rheumatoid Arthritis and Its Syndrome Based on the Combination of Disease and Syndrome
LOU Yu-qian，CHEN Yong-qian，LI Man-yi，WANG Song-ge，CHEN Xiao-peng，LI Yuan-wei，ZHANG Zi-yang，DING Lin-lin
【ABSTRACT】Objective：To make a comprehensive，systematic and evidence-based cross-sectional description of the clinical manifestations of rheumatoid arthritis(RA)and to investigate the rule of its syndromes.Methods：The HFRA database is a database of "disease syndrome combination"，comprehensively including manifestations of rheumatoid arthritis in western medicine and TCM.In this paper，this database was used to incorporate a number of contents on "joint manifestations" into a comprehensive and systematic table to display.The "extra-articular manifestations"
were comprehensively and systematically displayed according to their frequency of occurrence.Then after mixing together the "joint manifestations" and "extra-articular manifestations"，they were classified and displayed according to "deficiency"，"pathogen(evil)" and "stasis".Results：The "joint manifestations" include swelling，pain，tenderness，fluctuation，flexibility，activity limitation，deformity，and the distribution and frequency of the most painful one and most swelling one of the proximal interphalangeal joints，metacarpophalangeal joints，wrist joints，knee joints，ankle joints，metatarsophalangeal joints，elbow joints，shoulder joints，distal interphalangeal joints，temporomandibular joints，cervical vertebra，sternoclavicular joints，and acromioclavicular joints.They also include joint morning stiffness，nature of joint pain，factors and frequency effecting joint pain.There are 110 items of "extra-articular manifestations".Those whose frequency are over 50% are as follows：aversion to wind and cold of the whole body(68.22%)，forgetfulness(64.06%)，general weakness(62.35%)，lassitude and laziness(56.72%)，and irritability(51.83%).The TCM manifestations of deficiency，pathogen and stasis include high frequency of qi deficiency，and comparatively low frequency of yang deficiency，yin deficiency and blood deficiency.Kidney deficiency is high，and heart，liver and lung deficiency is relatively low.Pathogenic damp is high in frequency，and pathogenic cold and dry are less but their frequency is not low.There are many items of pathogenic heat without high frequency.Items of pathogenic wind are less with low frequency.Items of blood stasis are more with high frequency.Items of phlegm coagulation are less with high frequency.Items of qi stagnation are more with high frequency.The local(joint)of the disease is excessive，while the whole body is deficient.The "excess" is mainly blood stasis and qi stagnation caused by dampness and phlegm.The "deficiency" mainly refers to qi and kidney deficiency.Conclusion：This paper systematically described the clinical manifestations of the cross section of rheumatoid arthritis based on evidence，which were all beyond the content in TCM and Western medicine textbooks，and laid a foundation for further exploring the rule of diagnosis and treatment of this disease.The study gave a preliminary picture that the disease manifested as blood stasis and qi stagnation caused by dampness and phlegm in the local part，and qi and kidney deficiency of the whole body.This study also provided reference for the clinical studies of modern diseases—"combination of disease and syndrome". (娄玉钤 陈永前 李满意 王颂歌 陈小朋 李院魏 张子扬 丁琳琳)
【关键词】 关节炎，类风湿；病证结合；关节表现；关节外表现；“虚邪瘀”中医表现；横断面；HFRA数据库；证候探讨
Cross Sectional Description of Clinical Manifestations of Rheumatoid Arthritis and Its Syndrome Based on the Combination of Disease and Syndrome
LOU Yu-qian，CHEN Yong-qian，LI Man-yi，WANG Song-ge，CHEN Xiao-peng，LI Yuan-wei，ZHANG Zi-yang，DING Lin-lin
【ABSTRACT】Objective：To make a comprehensive，systematic and evidence-based cross-sectional description of the clinical manifestations of rheumatoid arthritis(RA)and to investigate the rule of its syndromes.Methods：The HFRA database is a database of "disease syndrome combination"，comprehensively including manifestations of rheumatoid arthritis in western medicine and TCM.In this paper，this database was used to incorporate a number of contents on "joint manifestations" into a comprehensive and systematic table to display.The "extra-articular manifestations"
were comprehensively and systematically displayed according to their frequency of occurrence.Then after mixing together the "joint manifestations" and "extra-articular manifestations"，they were classified and displayed according to "deficiency"，"pathogen(evil)" and "stasis".Results：The "joint manifestations" include swelling，pain，tenderness，fluctuation，flexibility，activity limitation，deformity，and the distribution and frequency of the most painful one and most swelling one of the proximal interphalangeal joints，metacarpophalangeal joints，wrist joints，knee joints，ankle joints，metatarsophalangeal joints，elbow joints，shoulder joints，distal interphalangeal joints，temporomandibular joints，cervical vertebra，sternoclavicular joints，and acromioclavicular joints.They also include joint morning stiffness，nature of joint pain，factors and frequency effecting joint pain.There are 110 items of "extra-articular manifestations".Those whose frequency are over 50% are as follows：aversion to wind and cold of the whole body(68.22%)，forgetfulness(64.06%)，general weakness(62.35%)，lassitude and laziness(56.72%)，and irritability(51.83%).The TCM manifestations of deficiency，pathogen and stasis include high frequency of qi deficiency，and comparatively low frequency of yang deficiency，yin deficiency and blood deficiency.Kidney deficiency is high，and heart，liver and lung deficiency is relatively low.Pathogenic damp is high in frequency，and pathogenic cold and dry are less but their frequency is not low.There are many items of pathogenic heat without high frequency.Items of pathogenic wind are less with low frequency.Items of blood stasis are more with high frequency.Items of phlegm coagulation are less with high frequency.Items of qi stagnation are more with high frequency.The local(joint)of the disease is excessive，while the whole body is deficient.The "excess" is mainly blood stasis and qi stagnation caused by dampness and phlegm.The "deficiency" mainly refers to qi and kidney deficiency.Conclusion：This paper systematically described the clinical manifestations of the cross section of rheumatoid arthritis based on evidence，which were all beyond the content in TCM and Western medicine textbooks，and laid a foundation for further exploring the rule of diagnosis and treatment of this disease.The study gave a preliminary picture that the disease manifested as blood stasis and qi stagnation caused by dampness and phlegm in the local part，and qi and kidney deficiency of the whole body.This study also provided reference for the clinical studies of modern diseases—"combination of disease and syndrome". (娄玉钤 陈永前 李满意 王颂歌 陈小朋 李院魏 张子扬 丁琳琳)