李院魏 娄玉钤

【摘 要】目的：探讨类风湿关节炎患者病情有或无“活动后减轻”其中医证候的异同。方法：将河南风湿病医院类风湿关节炎患者基线资料数据库（HFRA数据库）中收录的409例患者按病情有无活动后减轻分为活动后减轻组和无活动后减轻组。并采用SPSS 19.0软件分析2组在关节表现及关节外表现方面的区别与联系。结果：在一般资料中，无活动后减轻组家族史更明显，在病程、晨僵持续时间中，无活动后减轻组病程较长，活动后减轻组晨僵更明显。活动后减轻组气、血、阳虚等症较为明显，同时兼见气滞、血瘀；而无活动后减轻组风、寒、湿、热等实症为主，同时兼见气虚症。结论：活动后减轻组以虚症为主，无活动后减轻组以实症为主。

【关键词】 关节炎，类风湿；病情；活动后减轻；无活动后减轻；中医证候；HFRA数据库

【ABSTRACT】Objective：To explore the similarities and differences of TCM Syndromes of patients with rheumatoid arthritis with or without "relieving after activity".Methods：Four hundred and nine patients with rheumatoid arthritis in Henan Rheumatology Arthritis database（HFRA database）were divided into two groups according to whether they were relieved with or without activity：Group 1（with activity）and Group 2（without activity）.Software SPSS 19.0 was used to analyze the differences and relations between the two groups in joint performance and extra-articular performance.Results：In general，Group 2 had a more obvious family history and a longer course of disease，while the duration of morning stiffness of Group 1 was more obvious.Deficiency of qi，blood and yang in Group 1 was more obvious，as well as qi stagnation and blood stasis.While Group 2 had sthenia syndromes such as wind，cold，dampness and heat，as well as qi deficiency.Conclusion：Group 1 mainly demonstrates as deficiency syndromes，while Group 2 mainly has sthenia syndromes with relatively.

【Keywords】 arthritis，rheumatoid；illness；relieved with activity；relieved without activity；TCM syndrome；

HFRA database

類风湿关节炎（rheumatoid arthritis，RA）的病情或临床表现是复杂的，而且有不少因素可以影响病情的轻重，患者自身对整体病情的轻重也会做出较准确的判断，所以在西医疗效判断标准中的ACR20等就有“患者对病情的全面评价”一项。笔者在临床中注意到，在适当活动后有些RA患者自觉病情减轻，有些不自觉病情减轻，这些不同的反应在中医辨证时有何意义？笔者为此进行了深入研究。

1 病例来源

本研究的病例来源于河南风湿病医院RA数据库（HFRA数据库）[1]，该数据库收录了自2013年4月至2016年7月在本院就诊的符合纳入标准的409例RA患者的一般资料、关节表现及关节外表现等信息。……