来源：风湿病与关节炎,2019,8（5）:9-11,16.

病程2年以内类风湿关节炎临床表现随病程演变规律的研究（临床研究）

丁琳琳^1,2，娄玉钤¹

　　【摘　要】目的：观察病程2年以内类风湿关节炎临床表现随病程的演变规律。方法：从河南风湿病医院类风湿关节炎数据库（HFRA数据库）收录的409例患者中，选取病程为2年以内的患者共140例，以病程半年划分为4组，分别为半年以内组（A组）、半年到 < 1年组（B组）、1年到 < 1年半组（C组）、1年半到 < 2年组（D组），两两进行组间比较，得出4组患者在关节表现及关节外表现方面的区别和联系。结果：①左近指受限，A组 > B组；左近指疼痛、右腕受限、左腕受限、关节畸形，A组 < B组。②左肘疼痛，C组 > D组；右踝肿胀，C组 < D组。③左肘疼痛、神倦懒动、患病后体质量减轻，A组 < C组。④关节畸形、患病后体质量减轻，A组 < D组。⑤劳累后加重、渴喜热饮，B组 > C组；左肘疼痛、右趾指疼痛、颈椎疼痛、左踝受限、神倦懒动、动则汗出，B组 < C组。⑥抑郁、渴不欲饮，D组 < B组；左踝柔韧感、易感冒、痰多，D组 > B组。结论：随着病程延长，关节表现逐渐加重，并由上肢逐渐发展到下肢，下肢关节的破坏多出现在1年以后，证候由虚过渡为虚、痰、湿均明显，时间间隔大概1年。

　　【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

Study on the Evolution of Clinical Manifestations of Rheumatoid Arthritis with the Course of Disease within 2 Years

DING Lin-lin,LOU Yu-Qian

　　【ABSTRACT】Objective:To investigate the evolution of clinical manifestations of rheumatoid arthritis with the course of disease within 2 years.Methods:Four hundred and nine patients with rheumatoid arthritis in the database of Henan Rheumatism Hospital（HFRA database）,a total of 140 patients with a course of less than 2 years were selected,then divided into four groups according to the course of disease for half a year:group A（within half a year）,group B（from half a year to less than a year）,group C（from a year to less than a year and a half）and group D（from a year and a half to less than 2 years）.Two groups of them were respectively compared and differences and connections in joint and extraarticular manifestations of the four groups were obtained.Results:①The left proximal finger was limited more in group A than in group B（group A > group B）,and as for pain in the left proximal finger,limitation of the right wrist,limitation of the left wrist and joint deformity,group A was better than group B（group A < group B）.②The left elbow was more painful in group C than group D（group C > group D）,and the right ankle swelling was less severe in group C than in group D（group C < group D）.③Group A was better than Group C on the aspects of the left elbow pain,mental fatigue and laziness,and the reduction of body weight after the illness（group A < group C）.④Group A was better than group D in the joint deformity and the reduction of body weight after disease（Group A < Group D）.⑤Group B was worse than group C on the aspects of aggravation after fatigue and thirst for hot drink（Group B > Group C）,while group B was better than group C in left elbow pain,right toe pain,cervical pain,left ankle limitation,fatigue and laziness,sweating while moving（Group B < Group C）.⑥Group D was better than group B in depression and thirst without desire to drink（group D < group B）,while group D was better than group B on the aspects of left ankle flexibility,susceptibility to cold and more phlegm（group D > group B）.Conclusion:With the prolongation of the course of disease,the joint manifestations gradually aggravate,and develop from upper limbs to lower limbs.The destruction of lower limb joints occurs more than one year later.The transition time to deficiency and phlegm-dampness is about one year.

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