基于“虚邪瘀”理论的类风湿关节炎中医证候规范化研究

发布时间：2018-06-17 09:42

本文选题：类风湿关节炎 + 虚邪瘀理论　；参考：《河南中医药大学》2016年硕士论文

【摘要】：目的:本课题通过临床调查研究类风湿关节炎(rheummatoid arthritis,RA)与中医证候分型之间的关系,得出临床中类风湿性关节炎的中医证候分布特点,有利于指导临床中的辩证诊断,进而选择最有利于疾病康复的治疗方案。方法:以娄多峰教授的“虚邪瘀”理论和相关的文献为指导,预调研后形成最终调查表。由于样本量限制,将2013年4月-2014年3月收集的病例与2015年3月-11月来河南风湿病医院就诊的并符合纳入标准的病例进行合并,共计338例。采集RA患者的临床表现包括一般情况、四诊资料等。课题结束后,将搜集到的临床资料录入计算机,运用统计学软件SPSS19.0对资料进行整理得出RA的中医临床证候分型。结果:1、一般资料:RA患者男女比例为1:6.04,年龄最小17岁,最大79岁,平均年龄49.22±11.56岁,患者集中在40~60岁之间。患者病程最长的为40年,最短为2个月,中位数为60个月。2、因子分析结果:通过主成份分析提取20个公因子,分别为湿热、阴虚;气虚;气滞、阳虚;肾虚、血瘀;阳虚;寒湿;阴虚、血瘀;阴虚、气虚;气虚、血瘀;血虚;阴虚、血虚;寒湿;湿热;阳虚、血瘀;实热;肾虚;痰湿;痰瘀;阴虚;阳虚20个证候要素。3、聚类分析结果:对资料进行最大四次方值法旋转后得出的20个公因子用Ward法+Euclidean距离+Z得分进行聚类分析并经专家讨论结合临床,得出9个证候类型。结论:1、类风湿关节炎患者中女性患者比男性患者多;男女患者年龄为正态分布且P0.05有统计学意义;男女患者病程为偏态分布且P0.05有统计学意义;2、因子分析结果,虚因子:气虚;肾虚;阳虚;阴虚;气阴两虚;血虚;邪因子:寒湿;湿热;实热;痰湿;瘀因子:气滞;血瘀;痰瘀;3、聚类分析得出9个证型分别为:气血两虚、痰瘀痹阻型;阴虚内热、痰瘀阻络型;肾阳不足、痰湿内停型;阴虚内热、痰瘀互结型;肾阳不足、寒湿内停;气虚肝郁、湿困脾阳型;寒湿内阻、痰瘀互结型;外寒内热、寒湿痹阻型;气阴两虚、湿邪痹阻型。
[Abstract]:Objective: to study the relationship between rheumatoid arthritis (RA) and TCM syndrome classification through clinical investigation, and to obtain the characteristics of TCM syndromes distribution of rheumatoid arthritis, which is helpful to guide the dialectical diagnosis of rheumatoid arthritis. Then choose the most favorable treatment program for disease rehabilitation. Methods: under the guidance of Professor Lou Duofeng's theory of "deficiency and evil stasis" and related literature, the final questionnaire was formed after preliminary investigation. Because of sample size limitation, 338 cases collected from April 2013 to March 2014 were combined with those that met the inclusion criteria in Henan Rheumatological Hospital from March to November 2015. The clinical manifestations of RA patients were collected, including general information, four diagnosis data and so on. After the project was finished, the collected clinical data were input into the computer, and the data were sorted out by SPSS 19.0. The TCM syndromes classification of RA was obtained. Results the ratio of male to female was 1: 6.04, the youngest was 17 years old, the maximum was 79 years old, the average age was 49.22 卤11.56 years, the patients were mainly between 40 and 60 years old. The longest course of disease was 40 years, the shortest was 2 months, and the median was 60 months. The results of factor analysis showed that 20 common factors were extracted by principal component analysis, which were damp-heat, yin deficiency, qi stagnation, yang deficiency, kidney deficiency, blood stasis, yang deficiency; Keywords cold and dampness; yin deficiency, blood stasis; yin deficiency, qi deficiency; qi deficiency, blood stasis; blood deficiency; yin deficiency, blood deficiency; cold dampness; dampness and heat; yang deficiency, blood stasis; solid heat; kidney deficiency; phlegm and dampness; phlegm and stasis; yin deficiency; Results of cluster analysis: the 20 common factors obtained by the method of maximum quadrilateral value were clustered by Ward's Euclidean distance Z score, and 9 syndromes were obtained by combining with clinical practice after expert discussion. Conclusion: there are more female patients than male patients in rheumatoid arthritis patients, the age of male and female patients is normal distribution and P0.05 has statistical significance, the course of disease of male and female patients is skewed distribution and P0.05 has statistical significance, factor analysis results, deficiency factor: Qi deficiency; Kidney deficiency; Yang deficiency; Yin deficiency; Qi and Yin deficiency; Blood deficiency; pathogenic factors: cold and dampness; damp-heat; solid heat; phlegm-dampness; stasis factor: Qi stagnation; blood stasis; phlegm and blood stasis; 3. Cluster analysis shows that nine syndrome types are: deficiency of qi and blood, stagnation of phlegm and stasis, internal heat of yin deficiency, Phlegm and blood stasis blocking collaterals type; deficiency of kidney yang, phlegm dampness and internal stagnation type; Yin deficiency internal heat type, phlegm and blood stasis mutual junction type; kidney yang insufficiency type, cold dampness internal stop type; Qi deficiency liver depression type, dampness trapped spleen yang type; Cold dampness internal obstruction type, phlegm and blood stasis type; external cold and internal heat type, cold dampness obstruction type; Qi and Yin deficiency type, Dampness evil arthralgia block type.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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