摘要
目的：探讨昆明市膝骨关节炎的中医证候类型分布规律.方法：由经过统一培训的中医风湿病专业医师,采用统一制定的流行病学调查表对2009年6月至2013年1月在云南中医学院第一附属医院风湿科门诊、住院部及名医馆就诊者进行问卷调查,了解患者的一般情况、病史、伴随症状、体征（含舌脉）及膝关节X线表现.调查结束后,将有效的调查表资料建立数据库,对患者的中医证候类型与性别、年龄、病程、关节功能分级及X线分级的关系进行列联分析.结果：①总体情况.共发放调查表3200份,回收2720份,其中2608份符合要求.男680例,女1928例.年龄38～82岁,中位数59.5岁;病程2～300个月,中位数57.5个月.2608例患者中,肝肾亏虚证1020例、寒湿痹阻证652例、气血两虚证596例、痰瘀互结证200例、湿热阻络证140例;关节功能分级,Ⅰ级156例、Ⅱ级1 636例、Ⅲ级772例、Ⅳ级44例;X线分级,0级24例、Ⅰ级608例、Ⅱ级1 384例、Ⅲ级532例、Ⅳ级60例.②中医证候类型与性别的关系.湿热阻络证患者中男性较多,肝肾亏虚证、气血两虚证和痰瘀痹阻证患者中女性居多,寒湿痹阻证患者男女比例相当.昆明市膝骨关节炎中医证候类型与性别有关联（x^2 =282.082,P=0.000,C=0.312）.③中医证候类型与年龄的关系.肝肾亏虚证、痰瘀互结证患者中,以60岁以上患者为主;湿热阻络证以50岁以下患者为主;寒湿痹阻证、气血两虚证患者年龄分布相对均匀.昆明市膝骨关节炎中医证候类型与年龄有关联（x^2=514.032,P=0.000,C=0.406）.④中医证候类型与病程的关系.肝肾亏虚证患者的病程多在12～ 120个月,气血两虚证、湿热阻络证患者的病程多在12～60个月,痰瘀互结证患者的病程多在120个月以上,寒湿痹阻证患者的病程多在12个月以内.昆明市膝骨关节炎中医证候类型与病程有关联（x^2=1.405,P=0.000,C=0.592）.⑤中医证候类型与关节功能分级的关系.肝肾亏虚证、寒湿痹阻证和气血两虚证患者关节功能分级多为Ⅱ级和（或）Ⅲ级,而痰瘀互结证、湿热阻络证患者关节功能分级多为Ⅲ级.昆明市膝骨关节炎中医证候类型与关节功能分级有关联（x^2=1.085,P=0.000,C=0.542）.⑥中医证候类型与X线分级的关系.肝肾亏虚证患者X线分级多属Ⅱ级和Ⅲ级,气血两虚证、寒湿痹阻证和湿热阻络证患者X线分级多属Ⅰ级和Ⅱ级,痰瘀互结证患者X线分级多属Ⅲ级.昆明市膝骨关节炎中医证候类型与X线分级有关联（x^2=1.528,P=0.000,C=0.608）.结论：昆明市膝骨关节炎的中医证候类型以肝肾亏虚证、寒湿痹阻证和气血两虚证为主,证候类型与患者的性别、年龄、病程、关节功能分级和X线分级均存在一定的关联.
Objective：To investigate the type of SYMPTOM COMPLEX（TCM） on patients with knee osteoarthritis（KOA）in Kunming city.Methods：The patients treated in rheumatology department of the First Affiliated Hospital of Yunnan College of TCM from June 2009 to January 2013 were asked to complete the questionnaire for their informations,including general state of health,medical history,symptoms,signs and knee joint X-ray manifestations.The database was established upon the effective questionnaires information after the investigation,and then the contingency analysis was conducted to study the correlations between SYMPTOM COMPLEX （TCM）types and gender,age,disease course,joint functional classification and X-ray classification of the patients with KOA.Results：Totally 3 200 questionnaires were distributed to the patients with KOA,and 2 720 were returned and 2 608 met the requirements.The patients consisted of 680 males and 1928 females,which ranged in age from 38 to 82 years（Median =59.5 yrs）and disease course from 2 to 300 months （Median =57.5 months）.According to SYMPTOM COMPLEX（TCM）classification,1020 patients were categorized as LIVER-KIDNEY DEFICIENCY,652 COLD -DAMPNESS STAGNATION,596 QI-BLOOD DEFICIENCY,200 INTERMINGLED PHLEGM-BLOOD STASIS and 140 DAMPNESS -HEAT BLOCK COLLATERALS.According to joint functional classification made by American College of Rheumatology,156 patients were categorized as grade Ⅰ,1 636 grade Ⅱ,772 grade Ⅲ and 44 gradeⅣ.According to the Kellgren-Lawrence X-ray classification,24 patients were catcgorized as grade 0,608 grade Ⅰ,1 384 grade Ⅱ,532 gradeⅢand 60 gradeⅣ.More males were found in patients with DAMP-NESS-HEAT BLOCKING COLLATERALS,and more females were found in patients with LIVER-KIDNEY DEFICIENCY,QI-BLOOD DEFICIENCY and INTERMINGLED PHLEGM-BLOOD STASIS,and balanced sex ratio were found in patients with COLD-DAMPNESS STAGNATION.There was correlation between SYMPTOM COMPLEX（TCM）type and gender in patients with KOA in Kunming city （x2 =282.082,P =0.000,C =0.312）.The patients over 60 years old were more susceptible to LIVER-KIDNEY DEFICIENCY and INTER-MINGLED PHLEGM-BLOOD STASIS,and the patients under 50 years old were more susceptible to DAMPNESS-HEAT BLOCKING COLLATERALS.The age distribution of the patients with COLD-DAMPNESS STAGNATION and QI-BLOOD DEFICIENCY was relatively uniform.There was correlation between SYMPTOM COMPLEX （TCM） type and age in patients with KOA in Kunming city （x^2 =514.032,P =0.000,C =0.406）.The course of the disease were 2-120 months for patients with LIVER-KIDNEY DEFICIENCY,12-60 months for patients with QI-BLOOD DEFICIENCY and DAMPNESS-HEAT BLOCKING COLLATERALS,more than 120 months for patients with INTERMINGLED PHLEGM-BLOOD STASIS and less than 12 months for patients with COLD-DAMPNESS STAGNATION.There was correlation between SYMPTOM COMPLEX（TCM） type and disease course in patients with KOA in Kunming city（x2 =1.405,P =0.000,C =0.592）.The joint functional grades of patients with LIVER-KIDNEY DEFICIENCY,COLD-DAMPNESS STAGNATION and QI-BLOOD DEFICIENCY were generally categorized as grade Ⅱ and （or） grade Ⅲ,while those of patients with INTERMINGLED PHLEGM-BLOOD STASIS and DAMPNESS-HEAT BLOCKING COLLATERALS were generally categorized as grade Ⅲ.There was correlation between SYMPTOM COMPLEX（TCM） type and joint functional classification in patients with KOA in Kunming city （x^2 =1.085,P =0.000,C =0.542）.The X-ray grades of patients with LIVER-KIDNEY DEFICIENCY were generally categorized as grade Ⅱ and grade Ⅲ,patients with QI-BLOOD DEFICIENCY,COLD-DAMPNESS STAGNATION and DAMPNESS-HEAT BLOCKING COLLATERALS were generally categorized as grade Ⅰ and grade Ⅱ,and patients with INTERMINGLED PHLEGM-BLOOD STASIS were generally categorized as gradeⅢ.There was correlation between SYMPTOM COMPLEX（TCM） type and X-ray classification in patients with KOA in Kunming city（x^2 =1.528,P =0.00,C =0.608）.Conclusion：The SYMPTOM COMPLEX （TCM） type of KOA in Kunming city were mainly LIVER-KIDNEY DEFICIENCY,COLD-DAMPNESS STAGNATION and QI-BLOOD DEFICIENCY.There is correlation between SYMPTOM COMPLEX（TCM）and the gender,age,disease course,joint functional classification and X-ray classification in patients with KOA.
出处
《中医正骨》
2014年第6期24-27,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
国家自然科学基金项目(81360542)
云南省自然科学基金项目(2010ZC191)
关键词
骨关节炎
膝
证候
辨证论治
流行病学研究
昆明市
Osteoarthritis, knee
Symptom complex
Syndrome differ treatment
Epidemiologic studies
Kunming city
