摘要
目的:探讨类风湿关节炎的中医辨证分型与血清淀粉样蛋白A(SAA)、微小RNA(miR)-146a、瘦素、趋化素水平相关性.方法:选取2021 年5 月～2023 年5 月我院风湿科收治的类风湿关节炎患者240 例为研究对象,根据中医辨证标准分为寒湿痹阻证、风湿痹阻证、痰瘀痹阻证、湿热痹阻证、肝肾阴虚证、气虚血亏证 6 个证型.比较不同中医辨证分型类风湿关节炎患者血清SAA、miR-146a、瘦素、趋化素水平及 28 个关节疾病活动度(DAS28)评分,采用Spearman相关性分析血清SAA、miR-146a、瘦素、趋化素水平与DAS28 评分的相关性.结果:不同中医辨证分型类风湿关节炎患者DAS28 评分从大到小依次为湿热痹阻证组、风湿痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾阴虚证、气虚血亏证,各证型评分比较,差异具有统计学意义(P＜0.05).6 种证型患者血清SAA、miR-146a、瘦素、趋化素水平比较,差异具有统计学意义(P＜0.05).血清SAA水平变化趋势为:湿热痹阻证组＞风湿痹阻证＞寒湿痹阻证＞痰瘀痹阻证＞肝肾阴虚证＞气虚血亏证,miR-146a、瘦素、趋化素水平变化趋势为:湿热痹阻证组＞寒湿痹阻证＞风湿痹阻证＞痰瘀痹阻证＞肝肾阴虚证＞气虚血亏证.Spearmen相关性分析结果显示,血清SAA、miR-146a、瘦素、趋化素水平均与DAS28 评分呈正相关(P＜0.05).结论:类风湿关节炎患者中湿热痹阻证占比最高,其次为风湿痹阻证,再次为痰瘀痹阻证、肝肾阴虚证及寒湿痹阻证,最后为气虚血亏证;且血清SAA、miR-146a、瘦素、趋化素水平与类风湿关节炎的中医辨证分型及疾病活动度存在一定联系,可做为湿热痹阻证、风湿痹阻证的中医辨证参考指标.
Abstract
Objective To investigate the correlation between the syndrome differentiation of rheumatoid arthritis and the levels of serum amyloid A(SAA),microrna(miR)-146a,leptin and chemokine.Methods 240patients with rheumatoid arthritis treated in Rheumatology Department of our hospital from May 2021to May 2023were selected as the research objects.According to the TCM syn-drome differentiation standard,they were divided into 6syndrome types:cold-dampness obstruction,wind-dampness obstruction,phlegm-stasis obstruction,damp-heat obstruction,deficiency of liver and kidney and deficiency of qi and blood.Serum levels of SAA,miR-146a,leptin,chemokine and 28joint disease activity scores(DAS28)were compared in patients with rheumatoid arthritis of different TCM syndrome differentiation types,and the correlation between serum levels of SAA,miR-146a,leptin,chemokine and DAS28scores was analyzed by Spearman correlation analysis.Results The DAS28scores of patients with rheumatoid arthritis of different TCM syndrome differentiation types were successively from large to small,namely,dampness-heat obstruction group,wind-damp-ness-obstruction,cold-dampness-obstruction,phlegm-stasis obstruction,deficiency of liver and kidney syndrome,and deficiency of qi and blood syndrome.The difference among the scores of each syndrome type was statistically significant(P＜0.05).The serum lev-els of SAA,miR-146a,leptin and chemoattractant in patients with 6syndrome types were compared,and the differences were statisti-cally significant(P＜0.05).The change trend of serum SAA level was as follows:dampness-heat obstruction grouP＞wind-damp-ness obstruction syndrome＞cold-dampness obstruction syndrome＞Phlegm-stasis obstruction syndrome＞deficiency of liver and kid-ney syndrome＞deficiency of qi and blood syndrome.The change trend of miR-146a,letin and chemokine level was as follows:dampness-heat obstruction grouP＞cold-dampness obstruction syndrome＞wind-dampness obstruction syndrome＞Phlegm-stasis ob-struction syndrome＞deficiency of liver and kidney syndrome＞deficiency of qi and blood deficiency syndrome.Spearmen correlation analysis showed that serum levels of SAA,miR-146a,leptin and chemokine were positively correlated with DAS28scores(P＜0.05).Conclusion The proportion of dampness-heat obstruction in patients with rheumatoid arthritis is the highest,followed by wind-damp-ness obstruction,phlegm-stasis obstruction,deficiency of liver and kidney and cold-dampness obstruction,and finally Qi-blood defi-ciency syndrome.The serum levels of SAA,miR-146a,leptin and chemokine are related to the TCM syndrome differentiation and dis-ease activity of rheumatoid arthritis,which can be used as a reference index for TCM syndrome differentiation of damp-heat obstruction and wind-dampness obstruction.
维普
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