强直性脊柱炎中医证型的临床研究

Cluster analysis of traditional Chinese medicine syndrome types of ankylosing spondylitis and analysis of relationship with severity

关键词:  聚类分析  因子分析  强直性脊柱炎  骨代谢

Key words:  cluster analysis  factor analysis  ankylosing spondylitis  bone metabolism

摘要:

[目的] 探究强直性脊柱炎（AS）中医证候的聚类分型特征，分析其与病情严重程度及骨代谢指标的相关性，为中医辨证论治提供科学依据。[方法] 选取2023年4月—2024年4月于第九六四医院就诊诊断为AS的160例患者。运用聚类分析方法对160例AS患者的四诊信息进行研究以获得AS主要中医证型分类及分布规律。收集患者的一般资料以及骨矿代谢指标。比较不同中医证型AS患者的病例资料，简单对应分析AS严重程度与中医证候的关系，Logistic回归分析中医证候与骨代谢指标的相关性，多元回归方程分析骨代谢指标与AS严重程度的关系。[结果] 截取聚类图的不同位置，证型分型不同。其中，以5为划分点截取分为4个证型：瘀血阻络证、肝肾亏虚证、寒湿痹阻证、湿热阻络证。160例AS患者瘀血阻络证45例（28.12%）、肝肾亏虚证21例（13.12%）、寒湿痹阻证22例（13.75%）、湿热阻络证72例（45.00%）。瘀血阻络证、肝肾亏虚证、寒湿痹阻证和湿热阻络证AS患者的Ⅰ型胶原羧基末端肽（ICTP）、Ⅰ型前胶原羧基端肽（PICP）、骨钙素（BGP）水平比较，差异有统计学意义（P<0.05）。瘀血阻络证未偏向AS严重程度某一分级，肝肾亏虚证偏向轻度，湿热阻络证偏向中度，寒湿痹阻证偏向重度。多元回归方程分析表明AS患者的ICTP、PICP、BGP水平与AS严重程度呈正相关（P<0.05）。中医证候与骨代谢的相关性回归分析表明瘀血阻络证和肝肾亏虚证分别与ICTP和PICP呈正相关，与BGP呈负相关；寒湿痹阻证和湿热阻络证分别与ICTP、PICP、BGP呈正相关（P<0.05）。[结论] 聚类分析AS的中医证候主要分为瘀血阻络证、肝肾亏虚证、寒湿痹阻证、湿热阻络证，且与AS严重程度密切相关。

Abstract:

[Objective] To explore the clustering characteristics of traditional Chinese medicine（TCM） syndromes in ankylosing spondylitis（AS），analyze their correlation with disease severity and bone metabolism indicators，and provide a scientific basis for TCM syndrome differentiation and treatment. [Methods] A total of 160 patients diagnosed with AS at the 946th hospital from April 2023 to April 2024 were selected. Cluster analysis was used to study the four diagnostic information of the 160 AS patients to obtain the classification and distribution patterns of major TCM syndromes of AS. General data and bone mineral metabolism indicators of the patients were collected. Clinical data of AS patients with different TCM syndromes were compared. Simple correspondence analysis was performed on the relationship between AS severity and TCM syndromes. Logistic regression was used to analyze the correlation between TCM syndromes and bone metabolism indicators. Multiple regression analysis was used to analyze the relationship between bone metabolism indicators and AS severity. [Results] Different positions of the cluster dendrogram yielded different syndrome classifications. Taking 5 as the cut-off point，four syndrome types were identified：blood stasis obstructing collaterals，liver and kidney deficiency，cold-dampness obstruction，and damp-heat obstructing collaterals. Among the 160 AS patients，there were 45 cases（28.12%） of blood stasis obstructing collaterals，21 cases（13.12%） of liver and kidney deficiency，22 cases（13.75%） of cold-dampness obstruction，and 72 cases（45.00%） of damp-heat obstructing collaterals. Significant differences were observed in the levels of type Ⅰ collagen carboxyl-terminal peptide（ICTP），type Ⅰ procollagen carboxyl-terminal peptide（PICP），and osteocalcin（BGP） among the four syndrome types（P<0.05）. The blood stasis obstructing collaterals syndrome did not show a bias toward any particular grade of AS severity；liver and kidney deficiency syndrome was biased toward mild severity；damp-heat obstructing collaterals syndrome was biased toward moderate severity；and cold-dampness obstruction syndrome was biased toward severe severity. Multiple regression analysis showed that ICTP，PICP，and BGP levels in AS patients were positively correlated with AS severity（P<0.05）. Regression analysis of the correlation between TCM syndromes and bone metabolism indicated that blood stasis obstructing collaterals and liver and kidney deficiency syndromes were positively correlated with ICTP and PICP but negatively correlated with BGP；cold-dampness obstruction and damp-heat obstructing collaterals syndromes were positively correlated with ICTP，PICP，and BGP（P<0.05）. [Conclusion] Cluster analysis shows that the TCM syndromes of AS are mainly classified into blood stasis obstructing collaterals，liver and kidney deficiency，cold-dampness obstruction，and damp-heat obstructing collaterals，which are closely related to the severity of AS.