本文關(guān)鍵詞： 類風(fēng)濕性關(guān)節(jié)炎 多元統(tǒng)計(jì)分析 證候 實(shí)驗(yàn)室指標(biāo)　出處：《大連醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究通過調(diào)查和收集類風(fēng)濕關(guān)節(jié)炎(RA)患者的臨床癥狀、體征及相關(guān)實(shí)驗(yàn)室指標(biāo),應(yīng)用統(tǒng)計(jì)分析,探討RA的主要證型,擬確立RA各主要證型所包含的主次癥,并探討相關(guān)實(shí)驗(yàn)室指標(biāo)與各證型的關(guān)系,以期為中醫(yī)藥治療RA提供更多辨證依據(jù)。方法:通過查閱文獻(xiàn)及專家組討論,制定RA相關(guān)的證候調(diào)查表,選取2012年5月-2014年5月北京軍區(qū)總醫(yī)院的RA患者,共計(jì)606例。收集患者的年齡、性別、癥狀和體征等資料,并抽血化驗(yàn)每位患者的血沉(ESR)、血小板(PLT)、C反應(yīng)蛋白(CRP)、類風(fēng)濕因子(RF)、抗環(huán)瓜氨酸肽抗體(anti-CCP)。對所有調(diào)查資料進(jìn)行數(shù)據(jù)整理,應(yīng)用SPSS16.0、SAS9.1.3統(tǒng)計(jì)軟件對證候信息進(jìn)行多元統(tǒng)計(jì)分析確立RA的主要證型,建立RA證候診斷體系;最后分析所觀察的實(shí)驗(yàn)室指標(biāo)與各證型的關(guān)系。結(jié)果:1)收集的606份病例中,男135例,女471例,男女比例約為1:3.5;年齡最小21歲,最大70歲,平均年齡為44.13±13.74歲,發(fā)病年齡45-59歲組有311人發(fā)病,占總?cè)藬?shù)的51.32%,比例最高;病程最短為6個月,最長為492個月,平均病程為113.2±63.44月。關(guān)節(jié)畸形的患者有188人(31.02%),女性163人,男性25人。2)經(jīng)聚類分析及專家組結(jié)合臨床分析得到RA 6種主要證型,分別為氣血兩虛證、寒濕痹阻證、濕熱痹阻證、肝腎虧虛證、瘀血阻絡(luò)證、痰濁阻絡(luò)證。經(jīng)Logistic回歸分析及因子分析后得到各證型證候因素及主次癥。3)此研究樣本中有312例ESR陽性,328例PLT計(jì)數(shù)升高,392例RF陽性,331例CRP陽性,335例anti-CCP陽性。采用卡方檢驗(yàn)分別對5項(xiàng)實(shí)驗(yàn)室指標(biāo)在各證型的分布進(jìn)行分析,其中PLT升高在各證型間的分布有統(tǒng)計(jì)學(xué)差異,χ2=11.329,P=0.0450.05,按照陽性頻率順序由高到低依次為瘀血阻絡(luò)證濕熱痹阻證氣血兩虛證痰濁阻絡(luò)證肝腎虧虛證寒濕痹阻證。其他實(shí)驗(yàn)室指標(biāo)在證型中的分布沒有統(tǒng)計(jì)學(xué)差異。結(jié)論:通過多元統(tǒng)計(jì)分析得到RA的6個基本證型:氣血兩虛證、寒濕痹阻證、濕熱痹阻證、肝腎虧虛證、瘀血阻絡(luò)證、痰濁阻絡(luò)證。不同證型的患者PLT陽性率有差異且瘀血阻絡(luò)證最高,其他4項(xiàng)指標(biāo)無統(tǒng)計(jì)學(xué)差異。
[Abstract]:Objective: to investigate and collect the clinical symptoms, signs and related laboratory indexes of patients with rheumatoid arthritis (RA), and to explore the main syndromes of RA by statistical analysis, and to establish the primary and secondary syndromes included in the main syndromes of RA. In order to provide more evidence of syndrome differentiation for the treatment of RA by traditional Chinese medicine (TCM), the relationship between the related laboratory indexes and the types of syndromes was discussed. Methods: by consulting the literature and discussing the expert group, we formulated the questionnaire of syndromes related to RA. A total of 606 RA patients from May 2012 to May 2014 in Beijing military region General Hospital were selected. The age, sex, symptoms and signs of the patients were collected. Blood samples were taken from each patient for ESR, PLT C reactive protein, rheumatoid factor, anti-CCPP and anti-CCP.All the data were collected. The statistical software SPSS 16.0 / SAS9.1.3 was used to establish the main syndromes of RA, to establish the diagnosis system of RA, and to analyze the relationship between the laboratory indexes observed and the syndromes. Results: among 606 cases collected, 135 cases were males. There were 471 females, the ratio of male to female was about 1: 3.5; the youngest 21 years old, the oldest 70 years old, the average age was 44.13 鹵13.74 years old. The onset age group 45-59 years old had 311 cases, accounting for 51.32% of the total, the shortest course of disease was 6 months and the longest was 492 months. The average course of disease was 113.2 鹵63.44 months. 188 patients with joint deformity were divided into three groups: female 163, male 25. 2) by cluster analysis and expert group analysis, six main syndromes of RA were obtained, namely qi and blood deficiency syndrome, cold and dampness obstruction syndrome, damp-heat obstruction syndrome, respectively. Liver and kidney deficiency syndrome, blood stasis blocking collaterals syndrome, By Logistic regression analysis and factor analysis, the factors of syndromes and main and secondary syndromes of each syndrome type were obtained. (3) in this study, 312 cases of ESR positive and 328 cases of increased PLT count were found in 392 cases of RF positive cases with CRP positive and 335 cases of CRP positive cases with anti-CCP positive. The distribution of five laboratory indexes in each syndrome type was analyzed by square test. There was statistical difference in the distribution of PLT among the different syndrome types, 蠂 ~ 2 ~ 2 ~ 2 ~ (11) 329 ~ (1) P ~ (1) 0. 05. According to the order of positive frequency, the order of positive frequency was blood stasis, blood stasis, obstruction of collaterals, dampness, arthralgia, stagnation of qi and blood, stagnation of phlegm and stagnation of collaterals, liver and kidney deficiency, cold and dampness. There was no statistical difference in the distribution of ventricular indexes in the syndromes. Conclusion: six basic syndromes of RA were obtained by multivariate statistical analysis: Qi and blood deficiency syndrome, The positive rate of PLT in patients with different types of syndrome was different and the syndrome of stagnation of collaterals with blood stasis was the highest, but there was no statistical difference among the other four indexes.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 ;多元統(tǒng)計(jì)分析與結(jié)果解釋錯誤辨析試題答案[J];外科理論與實(shí)踐;2006年04期

2 史秉璋;多元統(tǒng)計(jì)分析借助電子計(jì)算機(jī)用于醫(yī)學(xué)研究[J];上海第二醫(yī)學(xué)院學(xué)報(bào);1981年01期

3 屈蔭生;高玉琪;楊秀英;王家馳;;皮質(zhì)醇增多癥與單純性肥胖癥的鑒別——多元統(tǒng)計(jì)分析的應(yīng)用[J];天津醫(yī)藥;1983年03期

4 白，

本文編號：1500839