来源：风湿病与关节炎,2024,13（3）:7-12.

类风湿关节炎合并焦虑抑郁患者中医证型分布及与凝血指标相关性分析（临床研究）

赵　会¹，赵鸿芳¹，王　淼¹，朱　艳²

　　【摘　要】目的：探讨类风湿关节炎（RA）合并焦虑抑郁患者中医证型分布特点，并分析其与凝血指标的相关性。方法：筛选100例RA并焦虑抑郁患者，比较各证型一般资料、焦虑抑郁评分（SAS、SDS评分）、炎症指标［红细胞沉降率（ESR）、C反应蛋白（CRP）］、DAS28评分、凝血指标［血小板计数（PLT）、凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（DD）、纤维蛋白原降解产物（FDP）］，Pearson相关分析SAS、SDS评分与凝血指标的相关性。结果：①不同焦虑抑郁程度分级上，轻度焦虑抑郁以湿热痹阻证、痰瘀痹阻证为主，中度至重度皆以肝肾亏虚证为主。②4种证型中，痰瘀痹阻证PLT水平高于寒湿痹阻证、湿热痹阻证（P < 0.05）；湿热痹阻证、肝肾亏虚证PT高于痰瘀痹阻证（P < 0.05）。③相关性分析发现，湿热痹阻证SAS、SDS评分与FDP呈正相关，与PT、APTT、TT呈负相关。寒湿痹阻证SAS评分与DD呈正相关，SDS评分与PLT呈正相关。痰瘀痹阻证SAS评分与DD呈正相关。肝肾亏虚证SAS评分与PLT呈正相关，与PT、APTT呈负相关；SDS评分与PLT、FIB、DD呈正相关，与PT呈负相关。结论：类风湿关节炎合并焦虑抑郁患者凝血指标水平与其不同中医证型有关，临床应在辨证论治的基础上配合活血化瘀法。

　　【关键词】　类风湿关节炎；焦虑抑郁；凝血指标；中医证型；相关性分析

Analysis of the Correlation Between Distribution of TCM Syndrome Types and Coagulation Indicators in Patients with Rheumatoid Arthritis Combined with Anxiety and Depression

ZHAO Hui,ZHAO Hong-fang,WANG Miao,ZHU Yan

　　【ABSTRACT】Objective:To explore the distribution characteristics of traditional Chinese medicine（TCM）syndrome types in patients with rheumatoid arthritis（RA）combined with anxiety and depression,and analyze their correlation with coagulation indicators.Methods:One hundred RA patients with anxiety and depression were screened,and the general information,anxiety and depression scores（SAS,SDS）,inflammatory indicators（ESR,CRP）,DAS28,the levels of coagulation indicators（PLT,PT,INR,APTT,TT,FIB,DD,FDP）of each group were compared.Pearson was used to analyze the correlation between SAS,SDS,and coagulation indicators.Results:①According to the levels of anxiety and depression,the mild anxiety and depression were mainly characterized by damp heat obstruction syndrome and phlegm stasis obstruction syndrome;the moderate and severe characterized by liver and kidney deficiency syndrome.②Among the four syndrome types,the PLT level of phlegm stasis obstruction syndrome was higher than that of cold dampness obstruction syndrome and damp heat obstruction syndrome（P < 0.05）;the PT of damp heat obstruction syndrome and liver kidney deficiency syndrome was higher than that of phlegm stasis obstruction syndrome（P < 0.05）.③Correlation analysis found that in damp heat obstruction syndrome,SAS and SDS score were positively correlated with FDP and negatively correlated with PT,APTT,and TT;in cold dampness obstruction syndrome,SAS score was positively correlated with DD,while SDS score was positively correlated with PLT;in phlegm stasis obstruction syndrome,there is a positive correlation between SAS score and DD;in liver and kidney deficiency syndrome,SAS score is positively correlated with PLT and negatively correlated with PT and APTT,and SDS score is positively correlated with PLT,FIB,DD and negatively correlated with PT.Conclusion:The coagulation index levels in patients with rheumatoid arthritis combined with anxiety and depression are related to different TCM syndrome types.Clinical practice should be combined with the method of promoting blood circulation and removing stasis based on syndrome differentiation and treatment.

　　【Keywords】 rheumatoid arthritis;anxiety and depression;coagulation indicators;TCM syndrome types;correlation analysis