来源：风湿病与关节炎,2019,8（4）:11-15.

盗汗是否类风湿关节炎中医阴虚证候关键表现的临床研究（临床研究）

陈永前，王颂歌，娄玉钤

　　【摘　要】目的：探讨盗汗是否是类风湿关节炎中医阴虚证候的关键表现。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例患者按有无盗汗分为有盗汗组和无盗汗组，采用SPSS 24.0软件进行统计分析，运用因子分析、聚类分析的方法分析2组临床表现的区别与联系。结果：有盗汗组与无盗汗组患者数之比约1∶3（105/304）。经因子分析、聚类分析发现，在有盗汗组的聚类结果①中出现了易怒、抑郁、生气后加重等肝郁气滞、瘀血的表现；畏寒肢冷、劳累后加重等阳虚、气虚的表现；②中出现了遇冷痛增遇热痛减、阴雨天加重、全身怕风怕冷等寒湿、虚寒的表现；③中出现了神倦懒动、全身乏力、休息后乏力减轻等气虚的表现。在无盗汗组的聚类结果①中出现了咽痛、关节酸痛等虚热、阴虚的表现；②中出现了患病后体质量减轻、眼干、五心烦热等阴虚的表现；③中出现了口干、口苦、咽干、小便黄、大便干等阴虚的表现。有盗汗组105例患者中有不少非阴虚的表现，如关节遇冷痛增遇热痛减82例（78.10%）、全身乏力80例（76.19%）、全身怕风怕冷79例（75.24%）、阴雨天加重68例（64.76%）、关节疼痛活动后减轻61例（58.10%）、畏寒肢冷60例（57.14%）、易怒58例（55.24%）、生气后加重45例（42.86%）、抑郁44例（41.90%）。无盗汗组304例患者中也有部分阴虚的表现，如口干134例（44.08%）、腰膝酸软80例（26.32%）、患病后体质量减轻72例（23.68%）、五心烦热67例（22.04%）、咽干57例（18.75%）、眼干56例（18.42%）、大便干56例（18.42%）、关节酸痛55例（18.09%）、咽痛30例（9.87%）。结论：有盗汗组患者同时存在阳虚、气虚、寒湿、肝郁气滞、瘀血等表现。盗汗不能作为类风湿关节炎中医阴虚证候的关键表现。

　　【关键词】　类风湿，关节炎；盗汗；中医证候；阴虚；HFRA数据库；因子分析；聚类分析；临床研究

Clinical Study on Whether Night Sweat Is the Key Manifestation of Yin Deficiency Symptom in Rheumatoid Arthritis

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

　　【ABSTRACT】Objective:To explore whether night sweat is the key manifestation of yin deficiency syndrome in rheumatoid arthritis.Methods:Four hundred and nine patients with rheumatoid arthritis recorded in the HFRA database of Henan Rheumatoid Hospital were divided into two groups according to whether they had night sweat or not.The data were processed by the SPSS 24.0 statistical software,and the differences and connections between the two groups were analyzed by factor analysis and cluster analysis.Results:The ratio of the night sweat group to the non-night sweat group was about 1∶3（105/304）.Through factor analysis and cluster analysis,the clustering results of the night sweat group were as follows:①the manifestations of liver depression and blood stasis,such as irritability,depression and aggravation of anger;the manifestations of yang deficiency and qi deficiency,such as fear of cold,cold limbs,aggravation of fatigue;②the manifestations of cold-caused pain reduced by heat,aggravation of cloudy and rainy days,and general fear of wind and cold;③ the manifestations of qi deficiency such as fatigue,and laziness refreshed after rest.The clustering results of the non-night sweat group were as follows:① deficiency-heat and yin-deficiency such as sore throat,joint soreness;②yin-deficiency such as weight loss,dry eyes,vexing heat in the five centers（chest,palms and soles）;③yin-deficiency such as dry mouth,bitter mouth,dry throat,yellow urine and dry stool.Among 105 patients in the night sweat group,there were many manifestations which didn’t belong to yin deficiency,such as joint pain aggravated by cold and relieved by warmth（82 cases,78.10%）,general fatigue（80 cases,76.19%）,general fear of wind and cold（79 cases,75.24%）,aggravation in rainy days（68 cases,64.76%）,relief of joint pain after exercise（61 cases,58.10%）,extreme chilliness（60 cases,57.14%）,irritability（58 cases,55.24%）,anger-caused aggravation（45 cases,42.86%）and depression（44 cases,41.90%）.In the non-night sweat group,there were manifestations of yin deficiency,such as dry mouth（134 cases,44.08%）,soreness and weakness of waist and knees（80 cases,26.32%）,losing weight（72 cases,23.68%）,vexing heat in the five centers（chest,palms and soles）（67 cases,22.04%）,dry throat（57 cases,18.75%）,dry eyes（56 cases,18.42%）of,dry stool（56 cases18.42%）,joint ache（55 cases,18.09%）and sore throat（30 cases,9.87%）.Conclusion:Patients in the night sweat have manifestations such as yang deficiency,qi deficiency,cold and dampness,liver depression and qi stagnation,and blood stasis.Night sweat can not be regarded as the key manifestation of Yin deficiency syndrome in rheumatoid arthritis.

　　【Keywords】 arthritis,rheumatoid;night sweat;TCM syndromes;yin deficiency;HFRA database;factor analysis;cluster analysis;clinical research