来源：风湿病与关节炎,2018,7（1）:10-14.

有家族史与无家族史的强直性脊柱炎临床表现异同的研究

（临床研究）

陈永前，娄玉钤

　　【摘　要】目的：探讨有家族史与无家族史的强直性脊柱炎临床表现的异同及对强直性脊柱炎中医辨证的临床意义。方法：将河南风湿病医院强直性脊柱炎数据库（HFAS数据库）中收录的379例患者按有无家族史分为有家族史组和无家族史组，采用SPSS 19.0统计软件分析2组在关节表现、关节外表现及体格检查方面的区别与联系。结果：379例强直性脊柱炎患者中，有家族史组166例，无家族史组213例，其中有家族史组占患者总数的43.80%，且病程较无家族史组更长。通过对2组185个关节表现及关节外表现、7项体格检查进行统计分析，2组间差异有统计学意义（P < 0.05）的临床表现共7项，其中腰背僵硬，影响疼痛因素（昼轻夜重、夜间加重晨起明显、活动后减轻），自觉身热，有家族史组 > 无家族史组；全身畏寒喜暖，疼痛性质（凉痛），有家族史组 < 无家族史组。结论：有家族史的强直性脊柱炎患者在“瘀血、阴虚”的临床表现上较无家族史明显，而无家族史的强直性脊柱炎患者在“阳虚、寒邪”的临床表现上较有家族史明显。故对有家族史的强直性脊柱炎，在祛邪的同时，更应重视活血及补肾阴；而无家族史的强直性脊柱炎，在活血的同时，更应重视补肾阳及祛寒邪。

　　【关键词】　脊柱炎，强直性；家族史；遗传；临床表现；HFAS数据库；中医辨证；临床研究

On Clinical Similarities and Differences of Ankylosing Spondylitis with Family History and Without Family History

CHEN Yong-qian,LOU Yu-qian

　　【ABSTRACT】Objective:To explore clinical similarities and differences of ankylosing spondylitis with family history and without family history and their clinical significance for TCM syndrome differentiation.Methods:Three hundred and seventy-nine cases of ankylosing spondylitis selected from the ankylosing spondylitis database of Henan Rheumatism Hospital（HFAS database）were divided into a family history group and a non-family history group,using SPSS 19.0 statistical software to analyze the difference and relation between the two groups on the aspects of articular manifestation,extra-articular manifestation and physical examination.Results:Among the included patients,166 cases had family history,accounting for 43.80% and the other 213 cases hadn’t.The disease course of the former was longer that the latter.According to the statistical analysis for 185 articular and extra-articular manifestations and 7 physical examinations,the differences of 7 clinical manifestations were statistically significant between the two groups（P < 0.05）,among which back stiffness,pain impact factors（being relieved at night and aggravated in the morning,being relieved after activity）feeling hot consciously were more common in the group with family history than the other group.Conclusion:Clinical manifestations “blood stasis and yin deficiency” are more obvious in the group with family history than the other group whose clinical manifestations “yang deficiency and pathogenic cold” were more outstanding than the former.Thus for the former,activating blood and tonifying kidney-yin should be focused while dispelling pathogenic cold.For the latter,more attention is expected to be paid to tonifying kidney-yang and dispelling pathogenic cold while activating blood.

　　【Keywords】 spondylitis,ankylosing;family history;heredity;clinical manifestation;HFAS database;TCM syndrome differentiation;clinical study