来源：风湿病与关节炎,2019,8（11）:20-24.

基于阴阳辨证看血瘀证目征在神经精神狼疮中的特征性改变（临床研究）

夏　强，刘泽阳，石林红，龙　伟，吴　锐

　　【摘　要】目的：探讨血瘀证目征在神经精神狼疮（NPSLE）中医阴证与阳证中的不同表现，明确其对NPSLE血管病理改变、病情预后的评估作用。方法：选取NPSLE患者50例（NPSLE组），同时根据分层随机选取100例无神经精神损害的系统性红斑狼疮患者（non-NPSLE组）。对2组患者分别进行中医辨证，分为阴证组、阳证组。采用微循环仪检测血瘀证目征改变并分析各组间的差异。收集临床资料，并对所有患者每3个月进行一次随访，共1年，观察血瘀证目征的动态改变。结果：NPSLE组中血瘀证目征总积分显著高于non-NPSLE组（P < 0.05），并随着病情缓解积分逐渐下降，但在随访1年期间仍高于non-NPSLE组（P < 0.05）。NPSLE阴证组中目征主要表现为血管扭曲、血管瘤、报伤点改变比阳证组更为显著（P < 0.05），出现抗心磷脂抗体阳性、雷诺现象高于阳证组（P < 0.05）；而阳证组以血管增粗、网状畸形、出血为主要表现（P < 0.05），抗核糖体P蛋白抗体阳性率、补体下降更为明显（P < 0.05）。结论：血瘀证目征特征性改变可用于NPSLE阴证与阳证分型诊断，并可提示NPSLE不同血管病变，用于指导治疗、预测预后。

　　【关键词】　神经精神狼疮；血瘀证目征；阴阳辨证；特征性改变

The Characteristic Changes of Eye-signs in Blood Stasis Syndrome in Neuropsychiatric Lupus Based on Yin and Yang Syndrome Differentiation

XIA Qiang,LIU Ze-yang,SHI Lin-hong,LONG Wei,WU Rui

【ABSTRACT】Objective:To explore the different manifestations of eye-signs in blood stasis syndrome in neuropsychiatric lupus（NPSLE）based on yin and yang syndrome differentiation,and to clarify their evaluating effect on vascular pathological changes and prognosis of NPSLE.Methods:Fifty patients with NPSLE（the NPSLE group）and one hundred patients with systemic lupus erythematosus and without neuropsychiatric impairment（the non-NPSLE group）were randomly selected.The two groups were respectively divided into the Yin Syndrome group and the Yang syndrome group.Microcirculation instrument was used to detect the changes of the eye-signs of blood stasis syndrome and analyze the differences between the groups.Clinical data were collected and all patients were followed up every three months for one year.Results:The total score of eye-signs in blood stasis syndrome in the NPSLE group was significantly higher than that in the non-NPSLE group（P < 0.05）,and gradually decreased with the remission score,but it was still higher than that in the non-NPSLE group（P < 0.05）during one-year follow-up.The main manifestations of eye-signs in the NPSLE Yin Syndrome group were vascular distortion,hemangioma and change of reported injury points（P < 0.05）compared with those in the NPSLE Yang Syndrome group,and the presence of anticardiolipin antibody and Raynaud phenomenon were higher than those in the Yang syndrome group（P < 0.05）,while in the Yang syndrome group,the main manifestations were vascular thickening,reticular deformity and bleeding（P < 0.05）,and the positive rate of ribosome P protein antibody and the decrease of complement（P < 0.05）were even obvious.Conclusion:The characteristic changes of eye-signs in blood stasis syndrome can be used for the classification diagnosis for Yin and Yang syndromes of NPSLE and to guide treatment and predict prognosis of different vascular lesions of NPSLE.

　　【Keywords】 neuropsychiatric lupus;eye-signs in blood stasis syndrome;Yin and Yang syndrome differentiation;characteristic change