摘要
目的:探讨膝骨关节炎中医证型、膝关节Kellgren-Lawrence的X线分级(K-L分级)与关节液白细胞介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及视觉模拟量表(visual analogue scale,VAS)评分的关系,为中医辨证分型提供参考依据。方法:326例膝骨关节炎患者采用WF文峰-Ⅲ中医辅助诊疗软件进行证型诊断,并分析中医证型与两组患者膝关节VAS评分,关节液中IL-1β、IL-6、TNF-α水平的相关性。结果:①共326例KOA患者纳入研究,根据证素诊断结果,其中医证型诊断主要为气滞血瘀证、寒湿痹阻证、风湿热痹证、肝肾亏虚证4个基本证型,并存在不同兼并证。②K-L分级中Ⅰ级、Ⅱ级主要为基本证型,如寒湿痹阻证、气滞血瘀证、风湿热痹证,Ⅲ级、Ⅳ级主要为复合证型。各K-L分级的中医证型分布比较,差异有统计学意义(P<0.05)。③不同K-L分级KOA患者关节液IL-1β、IL-6、TNF-α水平及VAS评分存在统计学差异,其中Ⅲ级患者以上指标最低,Ⅳ级患者最高,两者患者以上指标比较,差异均有统计学意义(P<0.05);将不同K-L分级与关节液IL-1β、IL-6、TNF-α水平及VAS评分绘制散点图,提示无直线相关趋势。④风湿热痹、气滞血瘀证患者关节液IL-1β、IL-6、TNF-α水平及VAS评分高于寒湿痹阻证、肝肾亏虚证患者(P<0.05),且风湿热痹证患者最高(P<0.05)。膝关节VAS评分与关节液IL-1β、IL-6、TNF-α的呈直线相关(相关系数分别为0.830、0.837和0.821,P<0.05)。结论:KOA基本证型包括气滞血瘀证、寒湿痹阻证、风湿热痹证、肝肾亏虚证。K-L分级中Ⅰ级、Ⅱ级主要为基本证型,Ⅲ级、Ⅳ级主要为复合证型。同时,不同中医证型、不同K-L分级KOA膝关节液IL-1β、IL-6、TNF-α水平及VAS评分均不相同,但无明显相关性。关节液IL-1β、IL-6、TNF-α水平与膝关节VAS评分呈正向直线相关。
Objective:To investigate the relationship between knee osteoarthritis(KOA)TCM syndrome types,Kellgren-Lawrence X-ray grading of the knee joint(K-L grading),and synovial fluid IL-1β,IL-6,tumor necrosis factor-α(TNF-α),and visual analog scale(VAS)score,so as to provide a basic reference for TCM syndrome differentiation.Methods:326 KOA patients were diagnosed by syndrome type using WF Wenfeng-ⅢTCM auxiliary diagnosis and treatment software.The correlations between TCM syndrome types and knee joint VAS scores and levels of IL-1β,IL-6,and TNF-αin synovial fluid were analyzed.Results:①A total of 326 KOA patients were included in the study.According to the diagnosis results of syndrome elements,the TCM syndromes are mainly diagnosed as Qi stagnation and Blood stasis syndrome,Cold-dampness arthralgia syndrome,rheumatism-heat arthralgia syndrome,and Liver-Kidney deficiency syndrome,and there are different concurrent syndromes.②In the K-L grading,grades I and II are mainly basic syndromes,such as Cold-dampness arthralgia syndrome,Qi stagnation and Blood stasis syndrome,and rheumatism-heat arthralgia.Grades III and IV are mainly compound syndromes.The distribution of TCM syndrome types in each K-L grade was compared,and the difference was statistically significant(P<0.05).③There were statistical differences in the levels of IL-1β,IL-6,TNF-α,and VAS score in the synovial fluid of KOA patients with different K-L grades.Among them,the patients with grade III and above had the lowest index,and the patients with grade IV had the highest index.There were significant differences in the above indexes between the two patients(P<0.05).Scatter plots were drawn between different K-L grades and the levels of IL-1β,IL-6,TNF-α,and VAS score in synovial fluid,indicating that there was no linear correlation trend.④The levels of IL-1β,IL-6,TNF-α,and VAS score in the synovial fluid of patients with rheumatic-heat arthralgia,Qi stagnation and Blood stasis syndrome were higher than those of patients with Cold-dampness arthr
作者
刘鑫
谭旭仪
邝高艳
卢敏
LIU Xin;TAN Xuyi;KUANG Gaoyan;LU Min(The First Hospital of Hunan University of Chinese Medicine,Changsha Hunan China 410007;Hunan Academy of Chinese Medicine,Changsha Hunan China 410006)
出处
《中医学报》
CAS
2022年第12期2681-2687,共7页
Acta Chinese Medicine
基金
国家自然科学基金项目(81874476)
第六批名老中医药专家学术经验继承指导项目(rsk-011-14)
长沙市科技局项目(kq2004049)。
