李院魏+娄玉钤

【摘 要】目的：探討有阴雨天加重与无阴雨天加重的类风湿关节炎中医证候的异同及对临床辨证论治的意义。方法：将河南风湿病医院类风湿关节炎数据库（HFRA数据库）中收录的409例患者按有无阴雨天加重分为阴雨天加重组和无阴雨天加重组。并采用SPSS 19.0软件统计分析2组在关节表现及关节外表现方面的区别与联系。结果：阴雨天加重者占患者数的3/5（240/409），病程较无阴雨天加重组长。阴雨天加重组受凉诱发、劳累加重、生气加重、夜间加重、遇冷痛增遇热痛减、游走痛、热痛、刺痛、全身怕风怕冷、健忘、全身乏力、神倦懒动、易怒、心烦、视物模糊、畏寒肢冷、口苦、渴喜热饮、低热、少气懒言、头晕、心慌、咽干、纳少、易感冒、眼干、口干、口唇淡白等气虚、阴虚、阳虚及风邪、湿邪、热邪等现象均较明显，同时瘀血气滞也较明显；而无阴雨天加重组固定痛、颧红等较明显。聚类分析：结合临床，阴雨天加重组以聚7类较合适；无阴雨天加重组原始变量之间相关性弱，不适合因子分析的统计学方法，无法进行聚类分析。结论：阴雨天加重组病情更重，虚邪瘀病机更复杂；无阴雨天加重组病情相对较轻，可将其视为一个相对独立的中医证候。

【关键词】 关节炎，类风湿；阴雨天加重；无阴雨天加重；中医证候；虚邪瘀；HFRA数据库；临床研究

On the Similarities and Differences of TCM Syndromes of Rheumatoid Arthritis Aggravated in Rainy Days and in Days without Rain

LI Yuan-wei，LOU Yu-qian

【ABSTRACT】Objective：To investigate the similarities and differences of TCM syndromes of rheumatoid arthritis aggravated in rainy days and in days without rain，and its clinical significance of syndrome differentiation and treatment.Methods：Four hundred and nine cases with rheumatoid arthritis recorded in the HFRA database（database of Henan Rheumatism Hospital）were divided into a rain-caused aggravation group and a non-rain-caused aggravation group.The software SPSS 19.0 was used to analyze the differences and relations of joint manifestation and extra-articular manifestation of the two groups.Results：Patients in the rain-caused aggravation group accounted for 3/5（240/409）and their course of disease was longer than that of the other group.The aggravation of the rain-caused aggravation group was induced by cold and the condition was aggravated by overwork，anger and night，which manifested as pain aggravated while its cold and relieved while its hot，wandering pain，burning pain，stabbing pain，aversion to wind and cold of the whole body，forgetfulness，fa-tigue，lassitude，lazy，irritability，restlessness，

blurred vision，aversion to cold with cold limbs，bitter taste，thirst for hot drinks，low temperature，weak breathing with no desire to speak，dizziness，palpitation，dry throat，poor appetite，tending to catch cold，dry eyes，dry mouth，pale lips.Above manifestations were caused by qi deficiency，yin deficiency，yang deficiency，pathogenic wind，pathogenic dampness，pathogenic heat，or blood stasis and qi stagnation.Fixed pain and hectic cheek were more obvious in the non-rain-caused aggravation group.Cluster analysis showed that the rain-caused aggravation group was proper for cluster 7，while the non-rain-caused aggravation group was not suitable for statistical methods of factor analysis because there was less correlation between the original variables，so there was no cluster analysis.Conclusion：Patients condition in the rain-caused aggravation group is more severe and pathogenesis such as deficiency，pathogenic factor and stagnation is more complex.Patients condition in the non-rain-caused aggravation group is comparatively mild，which can be regarded as a relatively independent TCM syndrome.

【Keywords】 arthritis，rheumatoid；aggravated in rainy days；aggravated in days without rain；TCM syndrome；deficiency，pathogenic factor and stagnation；HFRA database；clinical research

笔者前期的研究结果提示：类风湿关节炎（rheumatoid arthritis，RA）有阴雨天加重者病情更突出地反映了本病的本质——免疫功能异常、慢性滑膜炎[1]。中医治疗RA取得疗效的关键是辨证论治，那么，有阴雨天加重与无阴雨天加重的这两类RA的中医证候有无区别或有何异同？……