世界中医药

目的:分析类风湿关节炎合并肺间质病变(RA-ILD)患者的中医证候分布规律。方法:回顾分析2011年1月至2018年12月中国中医科学院广安门医院收治的RA-ILD住院患者162例的临床症状、实验室指标、肺功能、胸部高分辨CT(HRCT)征象与中医证候分布规律。结果:根据证候频次由高至低排序前4依次是湿热痹阻、气阴两虚兼湿热痹阻、湿热痹阻兼瘀血阻络、湿热痹阻兼肝肾不足。不同证型间性别、年龄差异无统计学意义。不同证型的患者在发热、皮疹、关节痛、口干、晨僵、胸闷、心悸、气促、乏力、胸闷、气短、喘息症状方面差异无统计学意义,在肌肉痛、眼干症状、咳嗽、咳痰症状差异均有统计学意义(均P<0.05)。各个证型患者的杵状指、肺部爆裂音差异均无统计学意义(均P>0.05),在口唇发绀症状差异有统计学意义(P<0.05),痰瘀痹阻证的口唇发绀症状突出。各个证型患者在白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、抗环瓜氨酸多肽抗体(anti-CCPab)、红细胞沉降率(ESR)、C反应蛋白(CRP)、血气分析氧分压、二氧化碳分压差异均无统计学意义(均P>0.05)。各个证型间在肺通气功能、肺弥散功能的障碍程度及障碍类型差异均无统计学意义(均P>0.05)。不同证型的HRCT影像学特征差异均无统计学意义(均P>0.05)。结论:湿热痹阻证是类风湿关节炎合并肺间质病变患者活动期的主要证候类型,其炎症活动度高,应及早行肺功能及HRCT。

English Summary:

To analyze the distribution of traditional Chinese medicine(TCM) syndromes of patients suffering from rheumatoid arthritis combined with interstitial lung disease(RA-ILD).Methods:Clinical symptoms，laboratory indexes，lung function，high-resolution computed tomography(HRCT) signs and TCM syndrome distribution of 162 RA-ILD patients in Guang'anmen Hospital of China Academy of Chinese Medical Sciences from January 2011 to December 2018 were retrospectively analyzed.Results:According to syndrome frequency，the top four syndromes from high to low were dampness-heat obstruction，qi and yin deficiency combined with dampness-heat obstruction，dampness-heat obstruction combined with static blood obstructing collaterals，dampness-heat obstruction combined with liver and kidney insufficiency，and there were no significant differences in gender and age of patients with different syndromes.Additionally，there were no distinct differences in symptoms of fever，rash，joint pain，dry mouth，morning stiffness，chest tightness，palpitation，shortness of breath，fatigue，and wheezing among patients with different syndromes，but marked differences were observed in muscle pain，dry eyes，cough，and sputum(all P<0.05).Patients with different syndromes had no remarkable differences in clubbed finger and inspiratory crackles(both P>0.05)，while remarkable difference was found in cyanosis(P<0.05)，and cyanosis in patients with phlegm-stasis obstruction was prominent.Moreover，there were no marked differences among patients with different syndromes in white blood cell(WBC)，red blood cell(RBC)，hemoglobin(HGB)，immunoglobulin A(IgA)，IgG，IgM，anti-cyclic peptide containing citrulline(anti-CCP)，erythrocyte sedimentation rate(ESR)，C-reactive protein(CRP)，partial pressure of oxygen，and partial pressure of carbon dioxide(all P>0.05)，in degree and type of pulmonary ventilation dysfunction and pulmonary diffusion dysfunction(all P>0.05)，and in HRCT imaging features(all P>0.05).Conclusion:Dampness-heat obstruction was the main syndrome type of RA-ILD patients in the active stage，with high inflammatory activity.Thus lung function examination and HRCT should be performed as soon as possible.

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