| BackgroundThere are advantages in the treatment of ankylosing spondylitis with TCM,and good curative effect can be achieved through TCM syndrome differentiation and treatment.Syndrome differentiation is the key.However,there are many types of syndrome differentiation of ankylosing spondylitis.At present,there are many types of syndrome differentiation in ankylosing spondylitis,which is not conducive to clinical study.the etiology and pathogenesis of ankylosing spondylitis can be sulnarized as deficiency of kidney and Dumai,Coldness and hottness take the opportunity to invade,causing meridian obstruction.Take deficiency of kidney and Dumai as the base,cold and heat evil as the standard.Patients with ankylosing spondylitis are mostly young men with fewer underlying diseases and fewer external factors.Therefore,the etiology and pathogenesis are relatively simple.According to the years of experience of professor Ji Wei,the theory of dialectical classification system based on "cold and heat as the outline" is proposed to summarize all syndrome types of AS,which may simplify the TCM syndrome types and can facilitate clinical mastery and promotion.ObjectiveThe characteristics of TCM syndromes of AS were analyzed by collecting statistical data and clinical data of AS patients with the help of statistical methods,and used a dialectical classifieation system based on the "cold and heat as the outline".Exploring the feasibility of sumnarizing AS's TCM syndrome types through " main syndrome+one or more secondary syndrome " and discussing the relationship between TCM syndrome types and related objective indicators.It was hoped to provide theoretical basis for optimizing TCM syndrome types and clinical differentiation of TCM clinical syndromes.MethodsThe aim of the experiment was to collect 121 cases of patients with ankylosing spondylitis(AS)from the outpatient department and inpatient department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from 2018 to 2020.All AS patients were classified by TCM syndrome type.It also collected clinical TCM symptom information and related clinical laboratory examination data to analyzed the correlation with the TCM syndrome types.The main contents included:1.Using the self-made AS TCM syndrome questionnaire(based on:analysis of a large number of relevant literatures and many years of clinical experience of Professor Ji Wei)to make TCM syndrome judgments.The main syndromes were:kidney deficiency and governor meridian cold syndrome,kidney deficiency and governor meridian heat syndrome.They also had three secondary syndromes:cold-damp syndrome,heat-damp syndrome,and phlegm stasis sydrome.2.Collect the basic data and clinical test data of each patient.The basic data included the patient's gender,age and course of disease.Clinical test data included inflammatory indicators,bone metabolism indicators,disease activity indicators.All these data were used to explore the correlation between relevant data and TCM syndrome types.3.Used SPSS25.0 statistical software to perform statistical analysis on each group of data,in which all measurement data were expressed by mean±standard deviation.Count data was tested by chi-square test.Independent samples were tested using t-test for normal distribution,and rank sum test was used for normal distribution.P<0.05 was considered statistically significant for the difference tested,and P<0.01 was considered statistically significant for the difference tested.Results1.General information121 cases were studied in this project.The ratio of male to female was 7:3.The average age was 39.47±13.61 years.The age of onset was 32.42 years and the disease course was 7.05±6.58 years.Young people accounted for the majority,reaching 52.07%.2.Clinical manifestationsThe main clinical manifestations divided into joint manifestations and extra-articular manifestations.Those involved in joints were mainly divided into axial and peripheral spondyloarthritis.Among them,patients with axial spondyloarthritis accounted for 71.07%,and patients with peripheral spondyloarthritis accounted for 19.01%.There were five cases without joint manifestations,four of which were mainly binocular red and one were mainly diarrhea.The axis spondyloarthritis mainly involved the spine joints(including the spine,sacroiliac joint,and thoracocostal joint).Peripheral spondyloarthritis mainly involved peripheral joints(including hip,knee,shoulder,heel,ankle,elbow,etc.).Common extra-articular manifestations included deformity of stool,rash,tenderness of waist and knees,fatigue,dizziness and tinnitus.3,Distribution of Syndrome TypesThe feasibility of typing syndromes in patients with ankylosing spondylitis was 96.69%using the main syndromes of kidney deficiency and govermor meridian cold syndrome and kidney deficiency and governor meridian heat syndrome.Among them,the subject find that the axis spondyloarthrltis was mainly kidney deficiency and governor meridian cold syndrome,and the peripheral spondyloarthritis was mainly kidney deficiency and governor meridian heat syndrome,and the difference was statistically significant(P<0.01).There were 54 cases of AS with secondary syndrome,accounting for 44.63%.Patients with kidney deficiency and governor meridian cold syndrome often combined with cold-damp syndrome or phlegm stasis sydrome,kidney deficiency and govermor meridian heat syndrome with heat-damp syndrome or phlegjn stasis sydrome.From high to low,the proportion of all secondary syndrome was phlegm stasis sydrome(38.89%),heat-damp syndrome(29.63%),cold-damp syndrome(22.22%),cold-damp+phlegm stasis syndrome(5.56%),heat-damp+phlegm stasis syndrome(3.70%).Among the disease course of patients with secondary syndrome,the disease course of patients with phlegm and stasis syndrome was longer,and the disease course of patients with damp-heat syndrome was shorter,the difference was statistically significant(P<0.01).4.Correlation of Lab parametersIn the primary syndrome,there was a significant difference in the ESR,CRP between kidney deficiency and governor meridian cold syndrome and kidney deficiency and governor meridian heat syndrome.The ESR and CRP of the kidney deficiency and governor meridian heat syndrome was higher than that in the kidney deficiency and governor meridian cold syndrome.The difference was statistically significant(P<0.01).Among patients with secondary syndromes,there are significant differences in ESR and CRP of cold-damp syndrome,heat-damp syndrome and phlegm stasis sydrome.The heat-damp syndrome was higher than phlegm stasis sydrome and cold-damp syndrome,and the difference was statistically significant(P<0.01).There were significant differences between the primary and secondary syndromes in the ESR and CRP.The ESR and CRP of patients with concurrent syndromes were higher than the primary syndromes,the differences were statistically significant(P<0.01).5.Correlation of clinical activity parametersThere was a statistically significant difference between the primary and secondary syndrome patients with BASDAI and BASFI with the primary syndrome compared with the primary syndrome(P<0.05).Among the syndromes,there were significant differences in cold-damp syndrome,heat-damp syndrome and phlegm stasis syndrome in BASFI and ASDAS(P<0.01).The phlegm stasis syndrome's BASFI was higher than the cold-damp syndrome and heat-damp syndrome.Heat-damp syndrome had higher ASDAS than cold-damp syndrome and phlegm stasis syndrome.6.Correlation of bone metabolism indicatorsThe amount of 25-hydroxyvitamin D of secondary syndrome was less than that of the primary syndromes in all patients,the difference was statistically significant(P<0.05).And bone mineral density(BMD)was significantly lower,the difference is statistically significant(P<0.01).In terms of sacroiliac joint MRI grading,the sacroiliac joint grade of patients with secondary syndrome was slightly higher than that of the primary syndrome,and the difference is statistically significant(P<0.05).Among all the secondary syndromes,the sacroiliac joint grade of phlegm stasis syndrome was significantly higher than that of heat-damp syndrome and cold-damp syndrome,and the difference was statistically significant(P<0.01).Decreased levels of 25-hydroxyvitamin D,HLA-B27(+),and longer disease duration could reduce bone mineral density in patients with AS.ConclusionThere were various classification methods of TCM Syndromes of ankylosing spondylitis(AS),but they all basically associated with the deficiency of the kidney and Du MAi.This project showed:1.Using "cold and heat as the outline","primary syndrome+one or more secondary syndrome" could basically summarize the main syndrome types of AS patients.The axis spondyloarthritis were mostly kidney deficiency and governor meridian cold syndrome,and the peripheral spondyloarthritis were mostly kidney deficiency and governor meridian heat syndrome.2.Each type of syndrome was closely related to relevant physical and chemical indicators.In particular,in terms of inflammation indicators,the activity of kidney deficiency and govermor meridian heat syndrome was higher than that of kidney deficiency and governor meridian cold syndrome.Patients with secondary syndrome were more active than those with primary syndrome,and patients with heat syndrome were more active than those with cold syndrome.Bone metabolism in AS patients may be related to TCM syndromes,Bone loss was more pronounced in patients with secondary syndrome. |
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