摘要
目的:中医以辨证论治为主,多层次、多环节、多靶点作用于机体,阻止类风湿关节炎病变发展,在防治方面具有很大优势。但目前中医在类风湿关节炎证候学的研究上尚存在较多分歧,证候分类种类繁多,难以统一,就其现状加以综述。资料来源:本资料通过查阅清华同方数据库经计算机检索方法收集(其中小部分经新疆医科大学图书馆馆藏资料手工检索),查阅来自1991-10/2005-07期间相关资料及专著。检索词“类风湿关节炎、中医、证候”,限定文章语言种类为中文。资料选择:对资料进行初审,选取包括上述主题词的文献,然后筛除单纯中医证型研究及单纯西医临床研究文献,对剩余的文献开始查找全文。资料提炼:收集到178篇原始文献,有47篇与关类风湿关节炎中医证候学研究进展相关。再次排除10篇单纯中医证型研究及19篇单纯西医临床试验研究,共有18篇文献符合标准,进入综述。资料综合:①近年中医类风湿关节炎病因病机及分期:其代表性的学说继承《内经》旨意,以虚实立论,强调肝肾气血亏虚在发病中的决定作用,制定了祛风胜湿,温经散寒,清热通痹,益气养血,调和营卫等治疗大法。其病机主要为正虚邪犯。分期主要为活动期、缓解期,再具体分析。②类风湿关节炎中西医结合论证:研究表明,类风湿关节炎寒湿阻络证人血清可溶性白细胞介素Ⅱ受体显著升高。可溶性肿瘤坏死因子受体明显降低,而湿热阻络证可溶性肿瘤坏死因子受体显著升高,人血清可溶性白细胞介素Ⅱ受体显著降低,对应中医辨证分型中,肝肾两虚证患者血清可溶性白细胞介素Ⅱ受体的水平高于(寒湿阻络证、湿热阻络证、气阴两虚证患者。又有研究发现,在活动期类风湿关节炎患者初诊时,辨证分型为:湿热阻络型、寒热错杂型、寒湿阻络型、痰瘀阻络型、肝肾阴虚(兼挟外感)型,其中湿热阻络型、寒热错杂型最为常见。③现代医学发现:一系列自身抗体如抗环瓜氨酸肽抗体、抗核周因子、抗角蛋白抗体、抗Sa抗体、抗聚角蛋白微丝蛋白抗体等可在类风湿关节炎的早期出现,对诊断类风湿关节炎具有较高的特异性,可成为中医证型病证结合研究的新着眼点。结论:中医证候规范化研究已成为当前中医界研究的重大课题之一,对中医证候进行规范化、定量化、标准化研究,建立统一的证候诊断标准已成为中医学术发展的一个必然趋势。应以中医学理论为指导,运用中医理论与现代科学技术相结合、宏观辨证与微观指标相结合方法,分析本病病因病机、证候演变的规律,揭示类风湿关节炎的证候本质。
OBJECTIVE： Traditional Chinese theory is mainly determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs, which is characteristic of multi-strata, multi-link and multi-target. As to the development .of rheumatoid arthritis （RA）, it has great advantages in prevention and treatment. However, many dissensions exist in researches on syndrome of RA, and the syndrome types are great, which are hard to unify. The aim of this article is to review its status quo.
DATA SOURCES： Tsinghua Tongfang database was searched with computer for relevant Chinese data and monographs between October 1991 and July 2005 with the key words of ＂rheumatoid arthritis, traditional Chinese medicine, syndrome＂. Meanwhile, relevant data were searched .manually in the library of Xinjiang Medical University.
STUDY SELECTION： Data were checked in the first trial, and relevant literatures were selected, while researches of simple traditional Chinese syndrome types and literatures about simple western clinical researches were excluded. Rest ariicles were looked for the full text.
DATA EXTRACTION： A total of 178 primary literatures were collected, including 47 researches about traditional Chinese syndrome of RA.. Another 10 researches about simple traditional Chinese syndrome and 19 studies related to simple western clinical experiment were excluded. A total of 18 articles were in accordance with the inclusion criteria and were reviewed.
DATA SYNTHESIS： ①The etiological factors, pathogenesis and staging of RA： The representative theory inherited the decrees of Endo-meridians, based on the argumentation of asthenia and sthenia, the decisive action of deficiency of both qi and blood in liver and kidney on onset was emphasized on, and＇methods of expelling wind and eliminating dampness, wanning meridian and pathogenic cold, clearing heat and losing bowels, supplemnting qi and tonifying blood as well as keeping y/ng and weiqi in balance etc. were instituted. Its pathogenesis were mainly deficiency of genuine qi and excess of pathogenic factor, and the stages included active stage, catabasis, which were analyzed in detail.②Integrated demonstration of Chinese and western medicine on RA： researches showed that the level of soluble interleukin Ⅱreceptor in serum of patients with RA of cold-damp in collaterals was remarkably increased. Level of soluble tumor necrosis factor receptor （STNFR） was significantly decreased, while STNFR of cold-damp in collaterals was obviously increased, and level of human serum interleukin Ⅱ receptor was greatly decreased. In corresponding traditional Chinese differentiation of symptoms and signs for classification of syndrome, the level of serum interleukin Ⅱ receptor in patients of deficiency of qi in both liver and kidney was obviously higher than patients of cold-damp in collaterals, humid heat in collaterals and deficiency of both qi and yin. It was also found by researches that in first diagnosed RA patients at active phase, there were types of humid heat in collaterals, cold-heat complex, cold-damp in collaterals, stagnation of phlegm-damp and hepatic and renal yin deficiency, in which types of humid heat in collaterals and cold-heat complex were the most common. ③Moderu medicine represented that a series of autoantibody such as anti-CCP antibody, antiperinuclear factor, anti-keratin antibody, anti-Sa antibody and anti-cytokeratin filament aggregatingprotein antibody etc. were found＇in early period of RA, which has a high specificity in diagnosis of RA, and might be a new view of integrated researches of traditional Chinese syndromes.
CONCLUSION： Standardized research on traditional Chinese syndromes has been one of the important topic in recent researches of traditional Chinese region. To standardize, quantify and normalize the researches of Chinese syndromes as well as establish a unified standard for syndromes is an inexorable trend in the development of traditional Chinese learning. Based on traditional Chinese theory, we should integrate traditional Chinese theory and modern science and technology as well as macro-differentiation and micro-differentiation, analyze the etiological factor, pathogenesis and changing rules of syndromes, so as to reveal the essence of RA syndromes.
出处
《中国临床康复》
CSCD
北大核心
2006年第27期119-121,共3页
Chinese Journal of Clinical Rehabilitation
