膝骨性关节炎湿热证分布规律及诊断标准探讨
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摘要
1 目的 探讨膝骨性关节炎(Knee Osteoarthritis,Knee OA)湿热证分布规律,初步建立膝OA湿热证的诊断标准,完善其辨证论治体系,为中医骨痹的诊疗研究提供思路和方法。
2 方法
2.1 文献研究:对《内经》至清代600余本古代文献及1994年至今的中国期刊网中有关膝OA湿热证文献进行整理分析,总结古代、现代医家对膝OA湿热证产生的病因病机认识、治则治法;湿热证常见中医症状。
2.2 临床研究:运用现代流行病学横断面调查方法,在文献研究基础上,初步建立膝OA中医证候调查表,收集患者的四诊资料,采用Spss12.0统计软件包,进行数据处理,具体运用频数分布、卡方检验、Binary Logistic回归分析、Bayes判别方法分析膝OA湿热证证候分布规律;不同分期疾病寒热、虚实转化规律;湿热证相关影响因素;湿热证诊断标准的初步建立。
3 结果
3.1 文献研究结果:40篇古代文献及10篇现代文献纳入本病湿热证研究,为临床研究提供理论指导。湿热证病因繁杂,主要由于感受湿热之邪或脏腑蕴热,感受风寒湿邪以从热化或邪郁日久以生湿化热;治疗以清热利湿为主,兼以它法;湿热证常见症状:膝关节疼痛、肿胀、扪之发热、压痛、屈伸不利、全身发热或自觉发热、口干口苦、咽干或痛、心中烦闷、手足心热、尿黄、便干,舌质多为红或紫红或紫暗,苔多黄腻或薄黄,脉多沉、弦、滑。
3.2 临床研究结果:1 一般情况:女性多于男性,男女比例为1:5.26,以中老年患者较为多见。有86.5%患者超重,体质中燥红质和晦涩质最为多见,饮食方面以喜食甜者和喜食辣者为多。2 疾病特点:膝OA患者均出现膝关节疼痛,以轻、中度为主,疼痛性质以酸痛、刺痛多见,始动痛与负重痛是膝OA的疼痛特点,疼痛多在阴雨天及劳累后出现或加重。多出现单侧或双侧膝关节肿胀,以轻度为主。晨僵多见,但<30分钟。可出现不同程度的活动受限,以双膝关节为主。压痛点主要集中在内侧副韧带、外侧副韧带、半月板及髌上囊部位。多数患者髌骨研磨试验及骨摩擦感阳性。病情严重或病程长者出现股四头肌萎缩,膝关节畸形,
1 ObjectiveTo discuss the method of damp-heat syndrome distribution of knee OA , establish initially diagnostic criteria of damp-heat syndrome ,consummate system of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs in order to provide thinking and means of TCM Pa disease's diagnosing and treating study.2 Method2.1 Literature Study :By sorting and analysising the literature of the damp-heat syndrome of knee OA ,which include six hundreds the literature of antiquity and cnki from 1994 to now ,to summarize archaic and modem doctor 's the thinking of the cause and disease and pathogenesis,therapeutical principle. To summarize the normal symptome of damp-heat syndrome.2.2 Clinical Study :To apply the methods of cross -sectional study of modem epidemiology and establish initially the TCM syndrome questionnaire of knee OA at biasis of the literature study ,then collect the information. To utilize Spss 12.0 to administer the data, apply specificly frequency distribution,Chi-square test,Binary logistic regression,Bayes discriminant and analysis the distribution rule of damp-heat syndrome of knee OA,the transformation rule of cold,hot,deficiency and excess in different period,correlated affection factor of damp-heat syndorm and establish initially the diagnostic criteria of damp-heat syndrome.3 Result3.1 The result of literature study:There are fourty chapter antique literature and ten chapter modem literature to fit investigation, to provide theory direction to clinical study. The cause of diease of damp-heat syndorme is complicated. Because damp-heat evil invade body or entrails have hot and make wind-cold damp pathogen change damp-heat or evil keep long time to change damp-heat. Clearing away heat evil and promoting diuresis is the major treatment method and should consider
others methods. The normal of the damp- heat syndrome is blow: pain in knee joint, swelling, the knee joint is hot by palpating, tenderness, flexion and extend is inactive, all over the body is febrile or to feel febrile by self-consciousness, dry mouth and bitter taste of mouth, dry pharynx or pharyngalgia, discomfort at heart, feverish palms and soles, brown urine, dry stool, body of tongue is red or purple red, coated tongue is yellowish greasy or light yellow, pulse is deep or wiry or slippery. 3.2 The result of clinical study :1 General state of health: The femal more than the male .Middle-old aged patients are common .86.5% patients is hypergravitation, the,hot and blood stasis are common in the physical capacity.Patients like to eat peppery and sweet food.2 The feature of disease: The patients both display pain of knee joint,the degree of pain mainly concentrate light and midrange.The nature of ache is mostly aching pain and pricking pain.To produce ache when the patients start to active and after weight loading.The motivation of ache is mainly cloudy-rainy weather and exertion.Half or double knee joint have light degree swlling.Morning stiffness is normal,but the time is below thirty minutes.The patients both show limitaion of motion in double knee joint. Pressure pain point is mainly medial collateral ligament,lateral collateral ligament,menisci,suprapatellar bursa. Patella grind test and bone friction sense respectively is positive in most patients. When the patient's condition is serious or the course of the disease is long, the patients show quadriceps femoris atrophy and malformation in knee joint.3 The symptom feature of damp-heat syndrome: According to the frequency statististics, high frequency symptom by turns is blow: pain in knee joint, limitation of motion, swelling, obesity, morning stiffness, blurred vision, oral lips cyanochroia, yellow fur, the knee joint is hot by palpating, dry mouth with desire for drinks, spontaneous perspiration, soreness and weakness of lower back and knee, xerophthalmia, febrility, upset, slippery and rapid pulse, irritable tantrum, dizziness, depression and easy to sign, ear noises, thick sublingual vessel, constipation, oliguria with reddish urine, slimy and greasy fur, insomnia. 4 The feature of damp-heat syndrome :Damp-heat syndrome is accompanied with compound syndrome which two and three syndrome combination are the common. The damp-heat blocken syndrome combined with the deficiency in
liver and kidney is the most, the next is the damp-heat blocken syndrome combined with the deficiency in liver and kidney combined with phlegm and blood stasis blocken syndrome > damp-heat blocken syndrome combined with the deficiency in liver and kidney combined with insufficiency of qi and blood. 5 The influencing factor of damp-heat syndrome: The closely correlated factor is below: dry-heat physical capacity,floating patella test,food and drink appetite. 6 The syndrome developing rule: All kinds of pattern of syndrome have nothing to do with by chi square test. 7 The diagnostic criteria of damp-heat syndrome: By the Binary Logistic Regression analysis, the main symptome of damp-heat syndrome is below:the knee joint is hot by palpating,swelling,oliguria with reddish urine,yellow fur,body of tongue is intumescence,febrility. By the fitting text ,the accurate rate is 87.6%. By Bayes Discriminant analysis,to establish fisher's function, as the result is below: febrility,spontaneous perspiration,loose stool,constipation,oliguria with reddish urine,swelling,the knee joint is hot by palpating,body of tongue is intumescence. By validation cross,the accurate rate is 84.8%, sensitivity is 87.6%, the specificity is 83.2%.Conclusion1 Damp-heat syndrome is the one of normal syndrome in knee OA, it is accompanied with compound syndrome, the combined syndrome is blow: the damp-heat blocken syndrome combined with the the deficiency in liver and kidney, the damp-heat syndrome combined with the deficiency in liver and kidney combined with phlegm and blood stasis blocken syndrome, the damp-heat syndrome combined with the deficiency in liver and kidney combined with insufficiency of qi and blood.2 The diagnostic criteria of the damp-heat syndrome is blow: Main syndrome: knee joint is hot by palpating, swelling. Minor syndrome: oliguria with reddish urine, febrility, spontaneous perspiration, enlarged tongue. To diagnose the damp-heat syndrome need main syndrome combined minor syndrome.3 The cause of disease of damp-heat syndrome is complicated, dry-heat physical capacity, food and drink appetite is closely correlated. The feature of pathogenesis is
deficiency combined with excess, deficiency in origin and excess in superficiality. Clearing away heat evil and promoting diuresis is the major treatment method and should consider others methods.4 Syndrome study is the necessarily tendency to modern TCM , the study apply literature and clinical study to normalize damp-heat syndrome of knee OA , the outcome shown it is feasible and produce thinking and methods of knee OA's syndrome study.
2 方法
2.1 文献研究:对《内经》至清代600余本古代文献及1994年至今的中国期刊网中有关膝OA湿热证文献进行整理分析,总结古代、现代医家对膝OA湿热证产生的病因病机认识、治则治法;湿热证常见中医症状。
2.2 临床研究:运用现代流行病学横断面调查方法,在文献研究基础上,初步建立膝OA中医证候调查表,收集患者的四诊资料,采用Spss12.0统计软件包,进行数据处理,具体运用频数分布、卡方检验、Binary Logistic回归分析、Bayes判别方法分析膝OA湿热证证候分布规律;不同分期疾病寒热、虚实转化规律;湿热证相关影响因素;湿热证诊断标准的初步建立。
3 结果
3.1 文献研究结果:40篇古代文献及10篇现代文献纳入本病湿热证研究,为临床研究提供理论指导。湿热证病因繁杂,主要由于感受湿热之邪或脏腑蕴热,感受风寒湿邪以从热化或邪郁日久以生湿化热;治疗以清热利湿为主,兼以它法;湿热证常见症状:膝关节疼痛、肿胀、扪之发热、压痛、屈伸不利、全身发热或自觉发热、口干口苦、咽干或痛、心中烦闷、手足心热、尿黄、便干,舌质多为红或紫红或紫暗,苔多黄腻或薄黄,脉多沉、弦、滑。
3.2 临床研究结果:1 一般情况:女性多于男性,男女比例为1:5.26,以中老年患者较为多见。有86.5%患者超重,体质中燥红质和晦涩质最为多见,饮食方面以喜食甜者和喜食辣者为多。2 疾病特点:膝OA患者均出现膝关节疼痛,以轻、中度为主,疼痛性质以酸痛、刺痛多见,始动痛与负重痛是膝OA的疼痛特点,疼痛多在阴雨天及劳累后出现或加重。多出现单侧或双侧膝关节肿胀,以轻度为主。晨僵多见,但<30分钟。可出现不同程度的活动受限,以双膝关节为主。压痛点主要集中在内侧副韧带、外侧副韧带、半月板及髌上囊部位。多数患者髌骨研磨试验及骨摩擦感阳性。病情严重或病程长者出现股四头肌萎缩,膝关节畸形,
1 ObjectiveTo discuss the method of damp-heat syndrome distribution of knee OA , establish initially diagnostic criteria of damp-heat syndrome ,consummate system of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs in order to provide thinking and means of TCM Pa disease's diagnosing and treating study.2 Method2.1 Literature Study :By sorting and analysising the literature of the damp-heat syndrome of knee OA ,which include six hundreds the literature of antiquity and cnki from 1994 to now ,to summarize archaic and modem doctor 's the thinking of the cause and disease and pathogenesis,therapeutical principle. To summarize the normal symptome of damp-heat syndrome.2.2 Clinical Study :To apply the methods of cross -sectional study of modem epidemiology and establish initially the TCM syndrome questionnaire of knee OA at biasis of the literature study ,then collect the information. To utilize Spss 12.0 to administer the data, apply specificly frequency distribution,Chi-square test,Binary logistic regression,Bayes discriminant and analysis the distribution rule of damp-heat syndrome of knee OA,the transformation rule of cold,hot,deficiency and excess in different period,correlated affection factor of damp-heat syndorm and establish initially the diagnostic criteria of damp-heat syndrome.3 Result3.1 The result of literature study:There are fourty chapter antique literature and ten chapter modem literature to fit investigation, to provide theory direction to clinical study. The cause of diease of damp-heat syndorme is complicated. Because damp-heat evil invade body or entrails have hot and make wind-cold damp pathogen change damp-heat or evil keep long time to change damp-heat. Clearing away heat evil and promoting diuresis is the major treatment method and should consider
others methods. The normal of the damp- heat syndrome is blow: pain in knee joint, swelling, the knee joint is hot by palpating, tenderness, flexion and extend is inactive, all over the body is febrile or to feel febrile by self-consciousness, dry mouth and bitter taste of mouth, dry pharynx or pharyngalgia, discomfort at heart, feverish palms and soles, brown urine, dry stool, body of tongue is red or purple red, coated tongue is yellowish greasy or light yellow, pulse is deep or wiry or slippery. 3.2 The result of clinical study :1 General state of health: The femal more than the male .Middle-old aged patients are common .86.5% patients is hypergravitation, the,hot and blood stasis are common in the physical capacity.Patients like to eat peppery and sweet food.2 The feature of disease: The patients both display pain of knee joint,the degree of pain mainly concentrate light and midrange.The nature of ache is mostly aching pain and pricking pain.To produce ache when the patients start to active and after weight loading.The motivation of ache is mainly cloudy-rainy weather and exertion.Half or double knee joint have light degree swlling.Morning stiffness is normal,but the time is below thirty minutes.The patients both show limitaion of motion in double knee joint. Pressure pain point is mainly medial collateral ligament,lateral collateral ligament,menisci,suprapatellar bursa. Patella grind test and bone friction sense respectively is positive in most patients. When the patient's condition is serious or the course of the disease is long, the patients show quadriceps femoris atrophy and malformation in knee joint.3 The symptom feature of damp-heat syndrome: According to the frequency statististics, high frequency symptom by turns is blow: pain in knee joint, limitation of motion, swelling, obesity, morning stiffness, blurred vision, oral lips cyanochroia, yellow fur, the knee joint is hot by palpating, dry mouth with desire for drinks, spontaneous perspiration, soreness and weakness of lower back and knee, xerophthalmia, febrility, upset, slippery and rapid pulse, irritable tantrum, dizziness, depression and easy to sign, ear noises, thick sublingual vessel, constipation, oliguria with reddish urine, slimy and greasy fur, insomnia. 4 The feature of damp-heat syndrome :Damp-heat syndrome is accompanied with compound syndrome which two and three syndrome combination are the common. The damp-heat blocken syndrome combined with the deficiency in
liver and kidney is the most, the next is the damp-heat blocken syndrome combined with the deficiency in liver and kidney combined with phlegm and blood stasis blocken syndrome > damp-heat blocken syndrome combined with the deficiency in liver and kidney combined with insufficiency of qi and blood. 5 The influencing factor of damp-heat syndrome: The closely correlated factor is below: dry-heat physical capacity,floating patella test,food and drink appetite. 6 The syndrome developing rule: All kinds of pattern of syndrome have nothing to do with by chi square test. 7 The diagnostic criteria of damp-heat syndrome: By the Binary Logistic Regression analysis, the main symptome of damp-heat syndrome is below:the knee joint is hot by palpating,swelling,oliguria with reddish urine,yellow fur,body of tongue is intumescence,febrility. By the fitting text ,the accurate rate is 87.6%. By Bayes Discriminant analysis,to establish fisher's function, as the result is below: febrility,spontaneous perspiration,loose stool,constipation,oliguria with reddish urine,swelling,the knee joint is hot by palpating,body of tongue is intumescence. By validation cross,the accurate rate is 84.8%, sensitivity is 87.6%, the specificity is 83.2%.Conclusion1 Damp-heat syndrome is the one of normal syndrome in knee OA, it is accompanied with compound syndrome, the combined syndrome is blow: the damp-heat blocken syndrome combined with the the deficiency in liver and kidney, the damp-heat syndrome combined with the deficiency in liver and kidney combined with phlegm and blood stasis blocken syndrome, the damp-heat syndrome combined with the deficiency in liver and kidney combined with insufficiency of qi and blood.2 The diagnostic criteria of the damp-heat syndrome is blow: Main syndrome: knee joint is hot by palpating, swelling. Minor syndrome: oliguria with reddish urine, febrility, spontaneous perspiration, enlarged tongue. To diagnose the damp-heat syndrome need main syndrome combined minor syndrome.3 The cause of disease of damp-heat syndrome is complicated, dry-heat physical capacity, food and drink appetite is closely correlated. The feature of pathogenesis is
deficiency combined with excess, deficiency in origin and excess in superficiality. Clearing away heat evil and promoting diuresis is the major treatment method and should consider others methods.4 Syndrome study is the necessarily tendency to modern TCM , the study apply literature and clinical study to normalize damp-heat syndrome of knee OA , the outcome shown it is feasible and produce thinking and methods of knee OA's syndrome study.
引文
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