痛风性关节炎中医内外合治的临床数据挖掘研究

Clinical data mining research on internal and external treatment of Gout arthritis

关键词:  痛风性关节炎  内治  内外合治  健脾利湿

Key words:  gouty arthritis  endotherapy  endotherapy and external treatment  spleen dampness

摘要:

[目的]对2012年6月-2015年10月安徽省中医药大学第一附属医院风湿科住院期间436例痛风性关节炎患者回顾性研究。从中医辨证用药、外治法、实验室指标、疗效等方面探讨安微中医药大学第一附属医院风湿科痛风性关节炎的治疗特色。[方法]基于临床数据挖掘技术和复杂网络技术，收集上述436例痛风性关节炎患者的中医辨证用药、外用药、实验室指标、疗效等情况，根据是否使用外治法将436例痛风性关节炎患者分为单纯内治组、内外合治组。用SPSS 18.0统计软件，计量资料以均数±标准差（x±s）表示，以t检验对各指标进行统计学分析，分析中医单纯内治、中医内外合治与血常规、代谢、炎症、免疫学指标、肝肾功能的情况，P<0.05或P<0.01为差异具有统计学意义。[结果] 1）436例痛风性关节炎患者分为93例单纯内治组（21%），343例内外合治组（79%）。2）两组患者临床辨证用药可以分为清热解毒药、健脾利湿药、活血化瘀药、祛风除湿药4类，用药总频次以健脾利湿药最高，用药情况所占百分比也以健脾利湿药为主。外治用药主要有芙蓉膏外敷、消瘀接骨散外敷、五味骨疽拔毒散外敷等，以芙蓉膏、消瘀接骨散为主。3）治疗后单纯内治组患者的免疫指标补体C3；炎症指标血沉（ESR）、超敏C反应蛋白（hs-CRP）、α₁-酸性糖蛋白（α₁-AGP）、血尿酸（UA）均有所降低，差异有统计学意义（P<0.05）；内外合治组患者红细胞（RBC）、血红蛋白（HGB）、血小板计数（PLT）均有所上升，差异有统计学意义（P<0.05或P<0.01）；免疫指标C3、C4；炎症指标ESR、hs-CRP、α₁-AGP；UA均有所降低，差异有统计学意义（P<0.05或P<0.01）；两组治疗前后的差值经独立样本t检验分析，内外合治组患者炎症指标（ESR，hs-CR，α₁-AGP）、HGB、PLT、免疫球蛋白A （IgA）、谷丙转氨酶（ALT）相对于单纯内治组患者改善更为明显，差异有统计学意义（P<0.05）。[结论]采用中医内外合治痛风性关节炎有一定的疗效，其机制尚有待进一步研究。

Abstract:

[Objective] Making a retrospective study for 436 cases of gout arthritis patients Who was hospitalized in the department of rheumatism of the first affiliated hospital of Anhui traditional Chinese medicine university,from June 2012 to October 2015.From Chinese medicine, external treatment, laboratory index, efficacy and other aspects of the department of rheumatism in our hospital in the treatment of gouty arthritis.[Methods] Based on clinical data mining technology and complex network technology,collected the 436 cases of gout arthritis inflammation in patients with TCM drugs, medication, laboratory indexes, efficacy, according to whether the use of external treatment will 436 cases of gouty arthritis patients were divided into simple endotherapy group and combined internal and external treatment group. Using SPSS 18.0 statistical software, measurement data to number plus standard difference(x±s) said that by the t-test of the indicators for statistical analysis, analysis of TCM endotherapy simple, inside and outside the Chinese medicine treatment and blood routine, metabolism, inflammation, immunological indexes, liver and kidney function, P<0.05 or P<0.01 difference has statistical significance.[Result] 1)436 cases of gouty arthritis were divided into 93 cases within group (21%), 343 cases of internal and external treatment group (79%); 2) Two groups of patients with clinical syndrome differentiation and treatment can be divided into drug detoxification, spleen dampness, promoting blood circulation to remove blood stasis, expelling wind and removing dampness medicine, medication frequency to spleen dampness drugs the highest use percentage to spleen dampness medicine. External treatment medication Fu rong ointment, Xiao yu Jiegu San for topical, five flavors of caries Sidaszechuensis herbs, with Furong ointment, Xiaoyu jegu San based. (3) Simple immune indexes within group patients after treatment:Complement C3. Inflammation index like ESR、hs-CRP、α₁-AGP;and UA all have been reduced, the difference was statistically significant (P<0.05). Internal and external treatment group patients' RBC, HGB, PLT all have risen,the difference was statistically significant(P<0.05 or P<0.01). Immune index C3, C4. Inflammation index like ESR, hs-CRP、α₁-AGP,and UA all have been reduced, the difference was statistically significant(P<0.05 or P<0.01);The difference between the two groups before and after treatment by the independent samples t test analysis, internal and external treatment group inflammation index (ESR, hs-CR, P, HGB, α₁-AGP) PLT, IgA, ALT compared with in treatment group were improved more significantly, the difference was statistically significant (P<0.05).[Conclusion] The department of rheumatism in our hospital has a certain curative effect on the treatment of gout arthritis by traditional Chinese medicine and medicine, the mechanism is yet to be further studied.