[1]高阳鹭,叶敏兰,唐晓颇,等.207例膝骨关节炎患者中医证型与炎症指标及高频超声影像改变的关系[J].中国中医骨伤科杂志,2024,32(04):34-38.[doi:10.20085/j.cnki.issn1005-0205.240407]
　GAO Yanglu,YE Minlan,TANG Xiaopo,et al.The Correlation between Traditional Chinese Medicine Syndrome Types,Inflammatory Indicators,and High-Frequency Ultrasound Changes in 207 Patients with Knee Osteoarthritis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(04):34-38.[doi:10.20085/j.cnki.issn1005-0205.240407]
点击复制

207例膝骨关节炎患者中医证型与炎症指标及高频超声影像改变的关系()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年04期
页码:
34-38
栏目:
临床研究
出版日期:
2024-04-15

文章信息/Info

Title:
The Correlation between Traditional Chinese Medicine Syndrome Types,Inflammatory Indicators,and High-Frequency Ultrasound Changes in 207 Patients with Knee Osteoarthritis
文章编号:
1005-0205(2024)04-0034-05
作者:
高阳鹭1; 叶敏兰1; 唐晓颇1; 王建1△
1中国中医科学院广安门医院(北京,100053)
Author(s):
GAO Yanglu1; YE Minlan1; TANG Xiaopo1; WANG Jian1△
1Guang'anmen Hospital of China Academy of Chinese Medical Sciences,Beijing 100053,China.
关键词:
膝骨关节炎;  证型;  炎症指标;  关节超声
Keywords:
knee osteoarthritis;  type of syndrome;  indicators of inflammation;  joint ultrasound
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.240407
文献标志码:
A
摘要:
目的:探讨膝骨关节炎(KOA)患者不同中医证型与炎症指标及高频超声影像改变的关系。方法:采用回顾性、横断面调查研究方法,依据中医辨证分型标准将膝骨关节炎患者辨证分为肝肾亏虚证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、气血虚弱证5个证型,分析不同中医证型与炎症指标红细胞沉降率(ESR)、C反应蛋白(CRP)、超敏C反应蛋白(hs-CRP)以及高频超声影像改变之间的相关性。结果:最终纳入207例膝骨关节炎患者,其中湿热痹阻证71例,肝肾亏虚证60例,寒湿痹阻证31例,痰瘀痹阻证28例,气血虚弱证17例。湿热痹阻证的红细胞沉降率和C反应蛋白表达水平高于其他4种证型,差异有统计学意义(P<0.05)。湿热痹阻证的红细胞沉降率和超敏C反应蛋白的表达水平高于其他4种证型,差异有统计学意义(P<0.05)。湿热痹阻证较肝肾亏虚证滑膜血流信号阳性率更高,差异有统计学意义(P<0.05)。湿热痹阻证滑膜增生评分较其他4个证型高(P<0.05)。寒湿痹阻证和湿热痹阻证患者较肝肾亏虚证和气血亏虚证患者关节积液阳性率及超声影像改变更多。结论:膝骨关节炎患者以湿热痹阻证和肝肾亏虚证为主要证型,且炎症指标水平和高频超声下表现与中医证型有一定的关系。炎症指标结合高频超声影像改变可为膝骨关节炎中医辨证分型提供参考。
Abstract:
Objective:To investigate the relationship between different TCM syndrome types and inflammation index and high-frequency ultrasound changes in patients with knee osteoarthritis(KOA).Methods:Retrospective and cross-section investigation was conducted to classify KOA patients into five types according to TCM syndrome differentiation criteria:deficiency of liver and kidney,cold-dampness obstruction,damp-heat obstruction,phlegm-stasis obstruction and Qi-blood weakness.The correlation between different TCM syndrome types and inflammatory indicators erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),hypersensitive C-reactive protein(hs-CRP)and changes under high-frequency ultrasound was analyzed.Results:207 KOA patients were included in the study,including 71 cases of damp-heat obstruction,60 cases of liver and kidney deficiency,31 cases of cold-dampness obstruction,28 cases of phlegm-stasis obstruction,and 17 cases of Qi-blood weakness.The expression levels of ESR and CRP in damp-heat impediment syndrome were higher than those in other 4 syndrome types(P<0.05).The expression levels of ESR and hs-CRP in damp-heat impediment syndrome were higher than those in other 4 syndrome types(P<0.05).The positive rate of synovial blood flow signal was higher in damp-heat Bi syndrome than in liver and kidney deficiency syndrome(P<0.05).The synovial hyperplasia score of damp-heat obstruction syndrome was higher than that of the other 4 syndrome types(P<0.05).Conclusion:The main syndromes of patients with KOA are dampness-heat obstruction syndrome,liver and kidney deficiency syndrome,and the level of inflammation indicators and the manifestations of high-frequency ultrasound have a certain relationship with TCM syndromes.Inflammation index combined with high-frequency ultrasound can provide a certain objective basis for TCM syndrome differentiation and classification of KOA.

参考文献/References:

[1] KATZ J N,ARANT K R,LOESER R F.Diagnosis and treatment of hip and knee osteoarthritis:a review[J].Journal of the American Medical Association,2021,325(6):568-578.
[2] 中国中医药研究促进会骨伤科分会.膝骨关节炎中医诊疗指南(2020年版)[J].中医正骨,2020,32(10):1-14.
[3] 中华中医药学会.中医骨伤科临床诊疗指南·膝痹病(膝骨关节炎)[J].康复学报,2019,29(3):1-7.
[4] 陈卫衡,赵岩.从病证结合到证症结合:探讨突出疗效优势环节的诊疗模式[J].环球中医药,2021,14(5):917-919.
[5] MIKA T N,ANTTI PEKKA U,SIMO S.The ultrasound assessment of osteoarthritis:the current status[J].Skeletal Radiology,2023,52(11):2271-2282.
[6] AMANDA E N.Turning the page in osteoarthritis assessment with the use of ultrasound[J].Curr Rheumatol Rep,2020,22(10):66.
[7] 胡立胜,周强.中医临床研究设计与SAS编程统计分析[M].北京:学苑出版社,2004:80.
[8] 中华医学会骨科学分会关节外科学组.中国骨关节炎诊疗指南(2021年版)[J].中华骨科杂志,2021,41(18):1291-1314.
[9] 姜泉,罗成贵,巩勋,等.骨关节炎病证结合诊疗指南[J].中华中医药杂志,2021,36(2):929-933.
[10] 张莹莹,李旭东,杨佳娟,等.中国40岁及以上人群骨关节炎患病率的Meta分析[J].中国循证医学杂志,2021,21(4):407-414.
[11] 谢珏,杨功旭,徐嘉祺,等.杨功旭六经辨证治疗膝骨关节炎的经验[J].中国中医骨伤科杂志,2021,29(12):79-81.
[12] 施彦龙,李应福,谢兴文,等.中医药治疗膝骨关节炎研究现状[J].风湿病与关节炎,2022,11(1):56-59.
[13] 张印霞,郭山山,李楠楠,等.膝骨关节炎中医证候与影像学的关系[J].实用中医内科杂志,2021,35(3):76-78.
[14] 王悦,叶超,刘向春,等.膝关节骨性关节炎中医证型与外周血炎症指标的相关性研究[J].江苏中医药,2021,53(10):34-37.
[15] 周鑫淼,叶超,李祥,等.膝骨关节炎不同证候关节液MMP-9、TIMP-1含量相关性研究[J].辽宁中医药大学学报,2020,22(6):108-111.
[16] 田代华.黄帝内经素问[M].北京:人民卫生出版社,2005:37.
[17] DAINESE P,WYNGAERT K V,MITS S D,et al.Association between knee inflammation and knee pain in patients with knee osteoarthritis:a systematic review[J].Osteoarthritis and Cartilage,2022,30(4):516-534.
[18] WEN L,SHIN M H,KANG J H,et al.The value of high-sensitivity C-reactive protein in hand and knee radiographic osteoarthritis:data from the Dong-gu Study[J].Clin Rheumatol,2018,37(4):1099-1106.
[19] 陈浩殷,李依帆,汤沁淇,等.湿邪侵袭机体不同部位的病机异同及西医学认识[J].北京中医药大学学报,2023,46(7):954-959.
[20] SPAKOVA T.Soluble and EV-associated diagnostic and prognostic biomarkers in knee osteoarthritis pathology and detection[J].Life,2023,13(2):342.
[21] 张璐.张氏医通[M].北京:人民卫生出版社,2020:240.

备注/Memo

备注/Memo:
基金项目:中国中医科学院科技创新工程项目(CI2021A01511)
△通信作者 E-mail:wangjian8904@126.com
更新日期/Last Update: 2024-04-15