基于多元统计分析的类风湿关节炎中医证候研究

发布时间：2018-02-10 15:29

本文关键词： 类风湿性关节炎多元统计分析证候实验室指标　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过调查和收集类风湿关节炎(RA)患者的临床症状、体征及相关实验室指标,应用统计分析,探讨RA的主要证型,拟确立RA各主要证型所包含的主次症,并探讨相关实验室指标与各证型的关系,以期为中医药治疗RA提供更多辨证依据。方法:通过查阅文献及专家组讨论,制定RA相关的证候调查表,选取2012年5月-2014年5月北京军区总医院的RA患者,共计606例。收集患者的年龄、性别、症状和体征等资料,并抽血化验每位患者的血沉(ESR)、血小板(PLT)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽抗体(anti-CCP)。对所有调查资料进行数据整理,应用SPSS16.0、SAS9.1.3统计软件对证候信息进行多元统计分析确立RA的主要证型,建立RA证候诊断体系;最后分析所观察的实验室指标与各证型的关系。结果:1)收集的606份病例中,男135例,女471例,男女比例约为1:3.5;年龄最小21岁,最大70岁,平均年龄为44.13±13.74岁,发病年龄45-59岁组有311人发病,占总人数的51.32%,比例最高;病程最短为6个月,最长为492个月,平均病程为113.2±63.44月。关节畸形的患者有188人(31.02%),女性163人,男性25人。2)经聚类分析及专家组结合临床分析得到RA 6种主要证型,分别为气血两虚证、寒湿痹阻证、湿热痹阻证、肝肾亏虚证、瘀血阻络证、痰浊阻络证。经Logistic回归分析及因子分析后得到各证型证候因素及主次症。3)此研究样本中有312例ESR阳性,328例PLT计数升高,392例RF阳性,331例CRP阳性,335例anti-CCP阳性。采用卡方检验分别对5项实验室指标在各证型的分布进行分析,其中PLT升高在各证型间的分布有统计学差异,χ2=11.329,P=0.0450.05,按照阳性频率顺序由高到低依次为瘀血阻络证湿热痹阻证气血两虚证痰浊阻络证肝肾亏虚证寒湿痹阻证。其他实验室指标在证型中的分布没有统计学差异。结论:通过多元统计分析得到RA的6个基本证型:气血两虚证、寒湿痹阻证、湿热痹阻证、肝肾亏虚证、瘀血阻络证、痰浊阻络证。不同证型的患者PLT阳性率有差异且瘀血阻络证最高,其他4项指标无统计学差异。
[Abstract]:Objective: to investigate and collect the clinical symptoms, signs and related laboratory indexes of patients with rheumatoid arthritis (RA), and to explore the main syndromes of RA by statistical analysis, and to establish the primary and secondary syndromes included in the main syndromes of RA. In order to provide more evidence of syndrome differentiation for the treatment of RA by traditional Chinese medicine (TCM), the relationship between the related laboratory indexes and the types of syndromes was discussed. Methods: by consulting the literature and discussing the expert group, we formulated the questionnaire of syndromes related to RA. A total of 606 RA patients from May 2012 to May 2014 in Beijing military region General Hospital were selected. The age, sex, symptoms and signs of the patients were collected. Blood samples were taken from each patient for ESR, PLT C reactive protein, rheumatoid factor, anti-CCPP and anti-CCP.All the data were collected. The statistical software SPSS 16.0 / SAS9.1.3 was used to establish the main syndromes of RA, to establish the diagnosis system of RA, and to analyze the relationship between the laboratory indexes observed and the syndromes. Results: among 606 cases collected, 135 cases were males. There were 471 females, the ratio of male to female was about 1: 3.5; the youngest 21 years old, the oldest 70 years old, the average age was 44.13 卤13.74 years old. The onset age group 45-59 years old had 311 cases, accounting for 51.32% of the total, the shortest course of disease was 6 months and the longest was 492 months. The average course of disease was 113.2 卤63.44 months. 188 patients with joint deformity were divided into three groups: female 163, male 25. 2) by cluster analysis and expert group analysis, six main syndromes of RA were obtained, namely qi and blood deficiency syndrome, cold and dampness obstruction syndrome, damp-heat obstruction syndrome, respectively. Liver and kidney deficiency syndrome, blood stasis blocking collaterals syndrome, By Logistic regression analysis and factor analysis, the factors of syndromes and main and secondary syndromes of each syndrome type were obtained. (3) in this study, 312 cases of ESR positive and 328 cases of increased PLT count were found in 392 cases of RF positive cases with CRP positive and 335 cases of CRP positive cases with anti-CCP positive. The distribution of five laboratory indexes in each syndrome type was analyzed by square test. There was statistical difference in the distribution of PLT among the different syndrome types, 蠂 ~ 2 ~ 2 ~ 2 ~ (11) 329 ~ (1) P ~ (1) 0. 05. According to the order of positive frequency, the order of positive frequency was blood stasis, blood stasis, obstruction of collaterals, dampness, arthralgia, stagnation of qi and blood, stagnation of phlegm and stagnation of collaterals, liver and kidney deficiency, cold and dampness. There was no statistical difference in the distribution of ventricular indexes in the syndromes. Conclusion: six basic syndromes of RA were obtained by multivariate statistical analysis: Qi and blood deficiency syndrome, The positive rate of PLT in patients with different types of syndrome was different and the syndrome of stagnation of collaterals with blood stasis was the highest, but there was no statistical difference among the other four indexes.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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