[1]李言杰,孙振双,蔡西国,等.膝骨关节炎中医证素与膝关节疼痛及软骨损伤的关系研究[J].中医正骨,2020,32(09):9-11.
　LI Yanjie,SUN Zhenshuang,CAI Xiguo,et al.A clinical study on the relationship between TCM syndrome factors and knee pain and the relationship between TCM syndrome factors and cartilage injury in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(09):9-11.
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膝骨关节炎中医证素与膝关节疼痛及软骨损伤的关系研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年09期
页码:
9-11
栏目:
临床研究
出版日期:
2020-09-20

文章信息/Info

Title:
A clinical study on the relationship between TCM syndrome factors and knee pain and the relationship between TCM syndrome factors and cartilage injury in patients with knee osteoarthritis
作者:
李言杰; 孙振双; 蔡西国; 王文伟
(河南省人民医院,河南 郑州 450003)
Author(s):
LI Yanjie; SUN Zhenshuang; CAI Xiguo; WANG Wenwei
Henan Provincial People’s Hospital,Zhengzhou 450003,Henan,China
关键词:
骨关节炎; 膝;  辨证;  证素;  疼痛;  软骨损伤;  回归分析
Keywords:
osteoarthritis; knee;  syndrome differentiation;  syndrome factor;  pain;  cartilage injury;  regression analysis
摘要:
目的:探讨膝骨关节炎(knee osteoarthritis,KOA)的中医证素与膝关节疼痛及软骨损伤的关系。方法:参照《证素辨证学》,从KOA患者的中医四诊资料中提取中医证素,主要包括病位(五脏六腑)及病性(实证、虚证)证素。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价膝关节疼痛程度,采用Kazam超声评级标准评价膝关节软骨损伤程度。统计患者的中医证素数据; 以中医证素为自变量,分别以膝关节疼痛VAS评分(≥4分)和膝关节软骨超声评级(≥Ⅰ级)为因变量,进行Logistic回归分析。结果:共纳入符合要求的KOA患者200例,男80例、女120例,年龄(58.40±9.56)岁,病程(2.65±1.20)年。病位证素依次是肾(180例,90%)、肝(174例,87%)、脾(90例,45%)、胃(90例,45%),实证证素依次是寒(192例,96%)、血瘀(184例,92%)、气滞(150例,75%)、风(102例,51%)、湿(88例,44%)、痰(78例,39%)、热(40例,20%),虚证证素依次是阳虚(196例,98%)、气虚(158例,79%)、血虚(86例,43%)、阴虚(10例,5%)。Logistic回归分析结果显示,肾、寒、血瘀是KOA患者膝关节疼痛的主要影响因素(P=0.031,P=0.020,P=0.030),肾、血瘀是KOA患者膝关节软骨损伤的主要影响因素(P=0.020,P=0.030)。结论:KOA的中医证素以肾、寒、阳虚为主,肾、寒、血瘀是影响膝关节疼痛的重要中医证素,肾、血瘀是影响膝关节软骨损伤的重要中医证素。
Abstract:
To explore the relationship between TCM syndrome factors and knee pain and the relationship between TCM syndrome factors and cartilage injury in patients with knee osteoarthritis(KOA).Methods:The TCM syndrome factors including disease locations(five Zang-organs and six Fu-organs)and disease natures(excess syndrome and deficiency syndrome)were extracted from TCM four diagnostic data of KOA patients according to Syndrome element syndrome differentiation(SESD).The degrees of knee pain and cartilage injury were evaluated by using pain visual analogue scale(VAS)scores and Kazam ultrasonic rating standard respectively.The patients’ TCM syndrome factors data were obtained by collation and statistics.The Logistic regression analysis was conducted by taking TCM syndrome factors as the independent variables and taking knee pain VAS scores(≥4 points)and knee cartilage ultrasonic rating(≥gradeⅠ)as dependent variables respectively.Results:Two hundred KOA patients were enrolled in the study and they consisted of 80 males and 120 females and ranged in age of 58.40+/-9.56 years and in disease course of 2.65+/-1.20 years.The syndrome factors of disease location included kidney(180 cases,90%),liver(174 cases,87%),spleen(90 cases,45%)and stomach(90 cases,45%)in turn.The excess syndrome factors included cold(192 cases,96%),blood stasis(184 cases,92%),qi stagnation(150 cases,75%),wind(102 cases,51%),dampness(88 cases,44%),phlegm(78 cases,39%)and heat(40 cases,20%)in turn.The deficiency syndrome factors included yang deficiency(196 cases,98%),qi deficiency(158 cases,79%),blood deficiency(86 cases,43%)and yin deficiency(10 cases,5%).The results of Logistic regression analysis demonstrated that the main influencing factors of knee pain were kidney,cold and blood stasis and the main influencing factors of knee cartilage injury were kidney and blood stasis respectively in KOA patients(P=0.031,P=0.020,P=0.030; P=0.020,P=0.030).Conclusion:The TCM syndrome factors of KOA are mainly kidney,cold and yang deficiency.The important TCM syndrome factors influencing knee pain are kidney,cold and blood stasis; and the important TCM syndrome factors influencing knee cartilage injury are kidney and blood stasis in KOA patients.

参考文献/References:

[1] 中华中医药学会骨伤科分会膝痹病(膝骨关节炎)临床诊疗指南制定工作组.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.
[2] 郭珈宜,李峰,沈素红,等.平乐正骨中药内服及外敷治疗湿热阻络型膝关节炎滑膜炎疗效观察[J].中华中医药杂志,2019,34(4):1799-1802.
[3] 中国中西医结合学会骨伤科专业委员会.膝骨关节炎中西医结合诊疗指南[J].中华医学杂志,2018,98(45):3653-3658.
[4] 朱文锋.证素辨证学[M].北京:人民卫生出版社,2008:100-120.
[5] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[6] KAZAM J K,NAZARIAN L N,MILLER T T,et al.Sonographic evaluation of femoral trochlear cartilage in patients with knee pain[J].J Ultrasound Med,2011,30(6):797-802.
[7] 叶国平,苏美玲,吴明霞,等.不同壮数温针灸对膝骨性关节炎疗效及关节腔积液的影响[J].中华中医药杂志,2017,32(9):4312-4316.
[8] 王琳琳,张玉帛,范重山.韩文朝教授治疗膝骨关节炎经验介绍[J].风湿病与关节炎,2020,9(5):47-49.
[9] 卢敏,蒋梁,段航,等.基于瘀祛新生理论治疗膝骨关节炎的理论研究[J].中医正骨,2019,31(1):23-25.
[10] 叶恒力,高欢欢,傅繁誉,等.基于现代文献的膝骨关节炎中医证型与证素分布规律研究[J].海南医学院学报,2020,26(1):47-52.
[11] 郑梓灌,林涛,吴丽芳.独活寄生汤口服联合二乌红花饮离子导入治疗膝骨关节炎肾虚髓亏证[J].中医正骨,2019,31(5):38-40.
[12] 段航,卢敏,李晨春,等.基于“玄府理论”探究加味独活寄生合剂治疗膝骨关节炎的作用机制[J].湖南中医杂志,2020,36(5):113-114.
[13] 葛伟韬,高云,刘珍珠,等.膝骨关节炎中医病名辨识[J].中医杂志,2016,57(23):1989-1992.
[14] 陈李专,陈斌,林安阳,等.膝骨关节炎中西医疗法的临床研究进展[J].辽宁中医杂志,2020,47(2):203-206.
[15] 曹嘉,周琦,钱齐荣.针灸联合玻璃酸钠关节腔注射与单纯玻璃酸钠关节腔注射治疗膝骨关节炎的临床疗效系统评价[J].中医正骨,2019,31(3):33-37.
[16] 夏聪敏,许波,陈帅,等.膝骨关节炎六经辨治思路探讨[J].山东中医杂志,2020,39(2):113-117.
[17] 陈利军,刘文刚,高伟,等.不同中医证型的膝骨性关节炎的X线平片表现[J].广东医学,2014,35(8):1255-1256.
[18] 万蓉,钟娜.膝骨性关节炎的中医证型与超声声像图的相关性研究[J].广州中医药大学学报,2020,37(4):622-626.
[19] 张栋,王庆甫,杨黎黎,等.膝骨性关节炎的超声表现特点及其相关性研究[J].中国骨伤,2018,31(12):1108-1113.

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更新日期/Last Update: 2020-09-20