来源：风湿病与关节炎,2022,11（7）:24-27.

冬季加重的类风湿关节炎中医证候规律分析（临床研究）

陈永前¹，娄玉钤²，王颂歌²

　　【摘　要】目的：探讨冬季加重的类风湿关节炎的中医证候规律，为其中医辨证论治提供依据。方法：将河南风湿病医院类风湿关节炎数据库（HFRA数据库）中收录的409例患者，按冬季加重提取患者的一般资料、临床表现等信息，运用因子分析、聚类分析，从“虚邪瘀”理论及其辨证方法的角度进行分析。结果：冬季加重的类风湿关节炎患者共142例，占34.72%。简化数据缩减变量后，因子分析得到9个公因子，得出以下证素：气虚、肝郁、阳虚、阴虚、瘀血、肾虚、热邪、寒邪、气滞、湿邪。聚类分析将9个公因子聚为3类，结合类风湿关节炎共有表现、因子分析及聚类分析结果，从“虚邪瘀”理论及其辨证方法的角度将冬季加重的类风湿关节炎中医证候分为3类：第1类，气阴两虚、邪瘀痹阻证；第2类，肾虚肝郁、寒湿瘀阻证；第3类，正虚夹瘀、寒湿痹阻证。结论：冬季加重的类风湿关节炎中医证候可以分为气阴两虚、邪瘀痹阻证，肾虚肝郁、寒湿瘀阻证，正虚夹瘀、寒湿痹阻证，这3类证候均包含虚、邪、瘀等因素，只是不同的证候虚、邪、瘀轻重程度有所不同，故本病治疗时应扶正、祛邪、活血三者兼顾。

　　【关键词】　类风湿关节炎；冬季加重；中医证候；辨证论治；HFRA数据库；因子分析；聚类分析；临床研究

Analysis of Traditional Chinese Medicine Syndrome Pattern of Rheumatoid Arthritis Aggravated in Winter

CHEN Yong-qian,LOU Yu-qian,WANG Song-ge

　　【ABSTRACT】Objective:To explore the TCM syndrome pattern of rheumatoid arthritis aggravated in winter,and to provide basis for its TCM syndrome differentiation and treatment.Methods:Four hundred and nine patients in the rheumatoid arthritis database（HFRA database）of Henan Rheumatic Hospital were extracted according to the general information and clinical manifestations of patients in winter.Factor analysis and cluster analysis were used to analyze them from the perspective of the "deficiency,pathogen and blood stasis" theory and its syndrome differentiation methods.Results:There were 142 cases of rheumatoid arthritis aggravated in winter,accounting for 34.72%.After simplifying the data and reducing the variables,factor analysis obtained 9 common factors,and obtained the following syndrome elements:qi deficiency,liver depression,yang deficiency,yin deficiency,blood stasis,kidney deficiency,heat pathogen,cold pathogen,qi stagnation and dampness pathogen.The 9 common factors were grouped into 3 categories by cluster analysis.Combined with the common manifestations of rheumatoid arthritis,factor analysis and cluster analysis results,the TCM syndromes of rheumatoid arthritis aggravated in winter were divided into 3 categories from the perspective of the "deficiency,pathogen and blood stasis" theory and its syndrome differentiation Methods:The first category was the syndrome of qi and yin deficiency,pathogen and blood stasis obstruction;the second category was the syndrome of kidney deficiency and liver depression,cold dampness and blood stasis;and the third category was the syndrome of healthy qi and deficiency with blood stasis and cold dampness blockage.Conclusion:The TCM syndromes of RA aggravated in winter can be divided into the syndrome of qi and yin deficiency,pathogen and blood stasis obstruction,the syndrome of kidney deficiency and liver depression,cold dampness and blood stasis and the syndrome of healthy qi and deficiency with blood stasis and cold dampness blockage.These three types of syndromes all contain deficiency,pathogen and blood stasis,but the degree of deficiency,pathogen and blood stasis is different in different syndromes.Therefore,the treatment of this disease should take into account the three aspects of strengthening healthy qi,eliminating pathogen and promoting blood circulation.

　　【Keywords】 rheumatoid arthritis;aggravation in winter;TCM syndrome;syndrome differentiation and treatment;HFRA database;factor analysis;cluster analysis;clinical study