来源：风湿病与关节炎,2018,7（7）:21-25.

类风湿关节炎患者病程5年以内者与5年以上者临床表现差异的研究（临床研究）

丁琳琳^1,2，娄玉钤¹

　　【摘　要】目的：探讨病程5年以内与５年以上类风湿关节炎患者临床表现的区别。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例患者按病程分为5年以内组和5年以上组，并运用SPSS 19.0软件分析2组患者在关节表现及关节外表现方面的区别和联系。结果：通过对疾病发生的诱因、影响疼痛的因素、疼痛的性质、关节表现及关节外表现等2组间差异有统计学意义（P < 0.05）的临床表现比较可知，①游走痛、左近指疼痛、右近指疼痛，5年以内组 > 5年以上组。②5年以内组 < 5年以上组的关节表现和关节外表现较多，关节表现：关节疼痛，右肩、左掌指、右掌指、左膝、右膝；关节肿胀，左掌指、右掌指、右近指、左膝、右膝；关节柔韧感，左掌指、右掌指、左膝、右膝；关节活动受限，左肘、右肘、左腕、右腕、左膝；关节畸形。关节外表现：全身乏力、活动后乏力加重、休息后乏力减轻、口干、心慌、多梦、头晕、视物模糊、阴雨天加重、夜尿频多、耳鸣，唇甲暗红。结论：病程5年以内者，“风邪”痹阻经络不通导致关节疼痛，关节表现及关节外表现少。病程5年以上者，由较少关节受累变为多关节受累，证候多为“虚”，且“虚”“邪”“瘀”均并存，证型愈加复杂，并累及肝肾。

　　【关键词】　关节炎，类风湿；病程；临床表现；辨证；HFRA数据库；临床研究

Differences of Clinical Manifestations Between Rheumatoid Arthritis Patients of Less Than Five Years and More Than Five Years

DING Lin-lin,LOU Yu-qian

　　【ABSTRACT】Objective:To investigate the differences of clinical manifestations between rheumatoid arthritis patients of less than five years and more than five years.Methods:Four hundred and nine patients in the Database of rheumatoid arthritis in Henan Rheumatism Hospital（HFRA database）were divided into a less than five years group and a more than five years group according to the course of disease,and the difference and connection between the articular manifestations and exoarticular manifestations of the two groups were analyzed with SPSS 19.0.Results:According to comparison between clinical manifestations with statistical significance（P < 0.05）in the two groups such as causes of diseases,factors affecting pain,nature of pain,articular manifestations and exoarticular manifestations,the results were as follows:①Walking pain,pain in the left proximal finger and pain in the right proximal finger appeared more frequently in the less than five years group than those in the other group.②Articular manifestations and exoarticular manifestations were less in the less than five years group than those in the other group.Articular manifestations were as follows:joint pain,right shoulder,left metacarpophalangeal,right metacarpophalangeal,left knee,right knee;joint swelling,left metacarpophalangeal,right metacarpophalangeal,right proximal finger,left knee,right knee;joint flexibility,left metacarpophalangeal,right metacar-pophalangeal,left knee,right knee;Joint movement restriction,left elbow,right elbow,left wrist,right wrist,left knee,deformed joint.Exoarticular manifestations were as follows:fatigue,more fatigue after activity,recovery of fatigue after rest,dry mouth,panic,dreaminess,dizziness,blurred vision,aggravation in cloudy and rainy days,more frequent night urine,tinnitus,and dark lip and nail.Conclusion:For those in the less than five years group,"wind evil" has obstructed their meridians,resulting in joint pain,so there are less articular manifestations and exoarticular manifestations.For those in the more than five years group,syndromes are more complex and mostly "deficiency""evil" and "stasis",involving the liver and kidney.

　　【Keywords】 arthritis,rheumatoid;course of disease;clinical manifestation;syndrome differentiation;HFRA database;clinical research