R593.22
目的:探讨类风湿关节炎患者血清脂肪因子趋化素(Chemerin)水平与中医证型的关系。方法:选取 2016 年 5 月—2019 年 4 月收治的 157 例类风湿关节炎患者(疾病组),对疾病组患者进行中医辨证分型,比较不同中医证型一般资料[性别、年龄、体质量指数(BMI)、病程、类风湿关节炎患者病情评价(DAS28 评分)、中医证候积分、X 线分期]及血清 Chemerin 水平。另选取同期体检健康者 129 例(健康组)检测血清 Chemerin 水平作对照。结果:疾病组血清 Chemerin 水平高于健康组,差异有统计学意义(P<0.05)。157 例风湿关节炎患者中,寒湿痹阻证、湿热痹阻证、瘀血痹阻证、肝肾阴虚证、肾气虚寒证分别占 22.93%(36/157)、36.31%(57/157)、16.56%(26/157)、15.92%(25/157)、8.28%(13/157);寒湿痹阻证、湿热痹阻证、瘀血痹阻证、肝肾阴虚证、肾气虚寒证在性别、年龄、BMI、病程、中医证候积分及 X 线分期方面比较,差异无统计学意义(P>0.05)。各证型的 DAS28 评分中湿热痹阻证评分最高,肝肾阴虚证评分最低,除肝肾阴虚证与肾气虚寒证比较,差异无统计学意义(P>0.05),其他证型两两比较,差异均有统计学意义(P<0.05);各证型血清 Chemerin 水平中湿热痹阻证水平最高,肝肾阴虚证水平最低,除肝肾阴虚证与肾气虚寒证比较,差异无统计学意义(P>0.05),其他证型两两比较,差异均有统计学意义(P<0.05)。结论:类风湿关节炎患者血清 Chemerin 水平较正常人明显升高,病例中湿热痹阻证占比最高,其次为寒湿痹阻证,再次为瘀血痹阻证及肝肾阴虚证,最后为肾气虚寒证;且血清 Chemerin 水平以湿热痹阻证最高,寒湿痹阻证次之,肝肾阴虚证与肾气虚寒证大体相当。
Abstract:Objective:TodiscusstherelationshipbetweenthelevelofadipokinechemerininserumandChinesemedicine syndrometypesinpatientswithrheumatoidarthritis. Methods:Atotalof 157 casesofpatientswithrheumatoidarthritiswho wereadmittedandtreatedfromMay 2016 toApril 2019 inourhospitalwereselectedandenrolledinthediseasegroup.The diseasegroupwasdifferentiatedbasedonChinesemedicinesyndrometypes;levelofchemerininserumandgeneraldata [gender,age,bodymassindex(BMI),courseofdisease,DiseaseActivityScorein 28 joints(DAS28)forevaluatingpatients withrheumatoidarthritis,Chinesemedicinesyndromescore,X-raystages]werecomparedamongpatientswithdifferent Chinesemedicinesyndrometypes.Another 129 caseswhoreceivedhealthexaminationatthesameperiodwereselectedas thehealthgroup,andlevelofchemerininserumwasdetectedforcomparingwiththediseasegroup. Results:Thelevelof chemerininseruminthediseasegroupwashigherthanthatinthehealthgroup,thedifferencebeingsignificant(P<0.05). Amongatotalof 157 casesofpatientswithrheumatoidarthritis,cold-dampnessobstructionsyndromeaccountedfor 22.93%(36/157), dampness-heatobstructionsyndrome 36.31%(57/157), staticbloodobstructionsyndrome 16.56% (26/157),liver-kidneyyindeficiencysyndrome 15.92%(25/157),kidney-qideficiencycoldsyndrome 8.28%(13/157);when comparedgender,age,BMI,courseofdisease,Chinesemedicinesyndromescore,andX-raystagesamongpatients withthesyndrometypesabove,therewasnosignificanceinthedifference(P>0.05).AmongscoresofDAS28 ofdifferent Chinesemedicinesyndrometypes,dampness-heatobstructionsyndromescoredthehighest,liver-kidneyyindeficiency syndromethelowest;therewasnosignificantdifferenceinthecomparisonofthescorebetweenliver-kidneyyindeficiency syndromeandkidney-qideficiencycoldsyndrome(P>0.05);exceptforliver-kidneyyindeficiencysyndromeandkidney-qi deficiencycoldsyndrome,pairwisecomparisonofscoresofothersyndrometypesshowedsignificanceindifferences(P< 0.05).AmonglevelsofchemerininserumofdifferentChinesemedicinesyndrometypes,dampness-heatobstruction syndromehadthehighestlevel,liver-kidneyyindeficiencysyndromethelowestlevel;therewasnosignificantdifferencein thecomparisonofthelevelbetweenliver-kidneyyindeficiencysyndromeandkidney-qi deficiencycoldsyndrome(P>0.05); exceptforliver-kidneyyindeficiencysyndromeandkidney-qideficiencycold syndrome,pairwisecomparisonoflevelsof othersyndrometypesshowedsignificanceindifferences(P<0.05). Conclusion: Patientswithrheumatoidarthritishad obviouslyhigherlevelsofchemerininserumthannormalpeople.Amongcasesofpatientswithrheumatoidarthritis, dampness-heatobstructionsyndromehadthehighestproportionofhigh-levelchemerin,followedby cold-dampness obstructionsyndrome, staticbloodobstructionsyndrome, liver-kidneyyindeficiencysyndrome, and kidney-qi deficiencycoldsyndrome;dampness-heatobstructionsyndromehadthehighestlevelofchemerininserum,followedby cold-dampnessobstructionsyndrome,liver-kidneyyindeficiencysyndrome,andkidney-qideficiencycoldsyndrome,and thelasttwosyndromesweresimilarinthelevel.
刘梅娟,王志刚.类风湿关节炎不同中医证型与血清趋化素水平相关性研究[J].新中医,2021,53(8):41-46