
浏览全部资源
扫码关注微信
1.广州中医药大学第二临床医学院(广东 广州 510120)
2.广州中医药大学第二附属医院风湿免疫科(广东 广州 510120)
3.广州中医药大学第二附属医院省部共建中医湿证国家重点实验室(广东 广州 510120)
梁琪,女,硕士,主要从事中医药治疗风湿免疫病研究工作
黄闰月,主任医师,博士研究生导师;E-mail:ryhuang@gzucm.edu.cn
纸质出版日期:2024-12-10,
收稿日期:2024-06-25,
移动端阅览
梁琪,杨智华,梁祐邦,等.基于关联规则构建类风湿关节炎湿证的辨证证据[J].上海中医药杂志,2024,58(12):1-7.
LIANG Qi,YANG Zhihua,LIANG Youbang,et al.Constructing syndrome differentiation evidence for dampness syndrome in rheumatoid arthritis based on association rules[J].Shanghai Journal of Traditional Chinese Medicine,2024,58(12):1-7.
梁琪,杨智华,梁祐邦,等.基于关联规则构建类风湿关节炎湿证的辨证证据[J].上海中医药杂志,2024,58(12):1-7. DOI: 10.16305/j.1007-1334.2024.z20240625009.
LIANG Qi,YANG Zhihua,LIANG Youbang,et al.Constructing syndrome differentiation evidence for dampness syndrome in rheumatoid arthritis based on association rules[J].Shanghai Journal of Traditional Chinese Medicine,2024,58(12):1-7. DOI: 10.16305/j.1007-1334.2024.z20240625009.
目的
2
挖掘类风湿关节炎湿证文献,确定核心湿证类型并构建相应证候的辨证证据。
方法
2
通过系统文献回顾,提取并规范所纳文献中的湿证诊断和四诊信息。对湿证诊断进行频数统计以明确类风湿关节炎的核心湿证类型,结合频率分析和Apriori关联规则挖掘核心湿证相关的四诊信息规律,讨论四诊信息的辨证参与度和关联性。以高频、强关联为评价依据确定辨证的关键证据条目,并依据权重法评估条目在辨证中的重要程度。
结果
2
类风湿关节炎湿证类型共计41种,根据频率降序排列,前3种依次为寒湿痹阻证、湿热痹阻证和风寒湿痹证,对应频率分别为26.71%、24.78%和16.89%。其中,寒湿痹阻证和湿热痹阻证是其核心湿证类型。寒湿痹阻证辨证的关键证据共17项,权重范围3~10,中位数为4,证据条目包括关节疼痛、遇寒加重、关节肿胀、关节屈伸不利、关节冷痛、舌质淡、脉弦紧、关节晨僵、舌苔白、阴雨天加重、肢体困重、口不渴、恶风、恶寒、口淡、关节畸形和舌苔白腻。湿热痹阻证辨证的关键证据共16项,权重范围为3~10,中位数为6,证据条目包括关节疼痛、关节肿胀、舌质红、脉滑数、舌苔黄腻、发热、疼痛关节皮肤触之发热、疼痛关节皮色发红、小便黄赤、关节晨僵、关节屈伸不利、口渴、心烦、关节热痛、大便干和渴不欲饮。
结论
2
类风湿关节炎核心湿证类型为寒湿痹阻证和湿热痹阻证,辨证证据包括关节症状、其他症状及舌脉象3个方面,寒湿痹阻证辨证“重关节,衡舌脉”,而湿热痹阻证辨证则“重舌脉,衡关节”。
Objective
2
To explore the literature on dampness syndrome in rheumatoid arthritis, determine the core types of dampness syndrome, and construct corresponding evidence for syndrome differentiation.
Methods
2
Through systematic literature review, the dampness syndrome diagnosis and four diagnostic methods information was extracted and standardized from the included literature. The frequency of dampness syndrome diagnosis was analyzed to identify the types of core dampness syndrome of rheumatoid arthritis. Combined with frequency analysis and Apriori association rules, the information rules of the four diagnostic methods related to the core wet syndrome were mined, and the syndrome differentiation participation and correlation of the four diagnostic methods information were discussed. By identifying high-frequency and strongly associated items, key diagnostic evidence was determined, and their importance levels were assigned using a weighting method.
Results
2
There were 41 types of dampness syndromes in rheumatoid arthritis. According to the descending order of frequency, the top three syndromes were cold dampness obstruction syndrome, damp heat obstruction syndrome, and wind-cold-dampness impediment syndrome, with frequencies of 26.71%, 24.78%, and 16.89%, respectively. Among these, cold dampness obstruction syndrome and damp heat obstruction syndrome were the core types of dampness syndromes. There were 17 key evidence items for syndrome differentiation of cold dampness obstruction syndrome, with a weight range of 3~10 and a median of 4. These evidence items include arthralgia, exacerbated by exposure to cold, joint swelling, motion difficulty in joints, cold pain in joints, pale tongue, stringy and tight pulse, morning joint stiffness, white fur, exacerbated by rainy weather, body trapped, lack of thirst, aversion to wind, aversion to cold, bland taste in the mouth, joint deformity and greasy white fur. There were 16 key evidence items for syndrome differentiation of damp heat obstruction syndrome, with a weight range of 3~10 and a median of 6. These evidence items include arthralgia, joint swelling, red tongue, slippery and rapid pulse, greasy yellow fur, fever, heat sensation upon touching painful joints, redness of the skin over painful joints, deep-colored urine, morning joint stiffness, motion difficulty in joints, thirst, heat and depression in the heart, hot pain in joints, dry stool, and reluctance to drink due to thirst.
Conclusions
2
The core dampness syndromes of rheumatoid arthritis are cold dampness obstruction syndrome and damp heat obstruction syndrome. The syndrome differentiation evidence includes joint symptoms, other symptoms, and tongue-pulse manifestations. In the syndrome differentiation of cold dampness obstruction syndrome, emphasis is placed on joint symptoms while evaluating tongue and pulse manifestations. Conversely, in the syndrome differentiation of damp heat obstruction syndrome, emphasis is placed on tongue and pulse manifestations while evaluating joint symptoms.
类风湿关节炎湿证中医诊断证候辨证论治关联规则
rheumatoid arthritisdampness symptomstraditional Chinese medicine diagnosissyndrometreatment based on syndrome differentiationassociation rules
HANNAWI S M, HANNAWI H, AL S I. Cardiovascular risk in rheumatoid arthritis: literature review[J]. Oman Med J, 2021, 36(3): e262.
耿研,谢希,王昱,等. 类风湿关节炎诊疗规范[J]. 中华内科杂志, 2022, 61(1): 51-59.
BARBIERI M A, CICALA G, CUTRONEO P M, et al. Safety profile of biologics used in rheumatology: an Italian prospective pharmacovigilance study[J]. J Clin Med, 2020, 9(4): 7-8.
MERCER L K, ASKLING J, RAASCHOU P, et al. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers[J]. Ann Rheum Dis, 2017, 76(2): 386-391.
MA V Y, CHAN L, CARRUTHERS K J. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain[J]. Arch Phys Med Rehabil, 2014, 95(5): 986-995.
刘健,章平衡,曹永贺. 新风胶囊通过调控凋亡相关蛋白促进类风湿关节炎患者外周血CD4+T细胞凋亡[J]. 风湿病与关节炎, 2019, 8(1): 15-20.
章平衡,刘健,万磊,等. 304例类风湿关节炎患者免疫球蛋白的变化及新风胶囊对其影响[J]. 风湿病与关节炎, 2018, 7(7): 10-16.
王春芳,刘娟云. 尪痹胶囊联合小剂量甲氨蝶呤治疗类风湿关节炎临床研究[J]. 光明中医, 2019, 34(18): 2876-2878.
屈祥科,孙建荣,罗静,等. 尪痹制剂联合西药治疗类风湿关节炎疗效及安全性的系统评价和Meta分析[J]. 中医杂志, 2022, 63(2): 129-136.
吴金联,苏励,黄清春,等. 尪痹胶囊治疗活动性类风湿关节炎多中心、随机双盲、平行对照研究[J]. 中国中西医结合杂志, 2023, 44(1): 44-48.
何婷,代云,吴慧玲,等. 中医治疗难治性类风湿关节炎有效性和安全性Meta分析[J]. 湖南中医杂志, 2023, 39(11): 116-123.
唐璇,赵越,黄闰月. 从“湿”论治类风湿关节炎探析[J]. 江苏中医药, 2021, 53(3): 14-16.
刘蔚翔,姜泉. 姜泉治疗类风湿关节炎经验[J]. 中华中医药杂志,2019, 34(5): 2198-2200.
刘蔚翔,巩勋,姜泉,等. 类风湿关节炎湿热与寒湿证候的病情特点分析[J]. 中华中医药杂志, 2021, 36(2): 1088-1091.
魏海华. 活动期类风湿关节炎中医证型分布与实验室指标的相关性分析[D]. 沈阳:辽宁中医药大学, 2023.
张富渊,姜泉,王瑶,等. 类风湿关节炎患者功能状态与湿热痹阻证候的相关性研究[J]. 北京中医药大学学报, 2023, 46(6): 820-825.
程增玉,徐浩东,李达,等. 从湿热瘀互结探讨类风湿关节炎相关性疲劳的病机特点[J]. 北京中医药大学学报, 2023, 46(1): 115-119.
王晨彤,姜德友. 我国类风湿性关节炎中医证候分布频率Meta分析[J]. 浙江中医药大学学报, 2022, 46(4): 439-450.
国家市场监督管理总局,国家标准化管理委员会. 中医临床诊疗术语 第2部分:证候:GB/T 16751.2—2021[S]. 北京:中国标准出版社, 2021.
中医药学名词审定委员会. 中医药学名词(2004)[M]. 北京:科学出版社, 2005.
国家中医药管理局.中医病证诊断疗效标准:ZY/T001.1—1994 [M]. 南京:南京大学出版社, 1994: 30.
国家药品监督管理局. 中药新药临床研究指导原则(试行)[M]. 北京:中国医药科技出版社, 2002: 116.
姜泉,王海隆,巩勋,等. 类风湿关节炎病证结合诊疗指南[J]. 中医杂志, 2018, 59(20): 1794-1800.
赵浩,李运伦,孔立. 原发性高血压肝火上炎证诊断量表编制研究[J]. 山东中医药大学学报, 2014, 38(5): 423-426.
0
浏览量
0
下载量
0
CSCD
0
CNKI被引量
关联资源
相关文章
相关作者
相关机构
沪公网安备 31011502015228号