早期膝骨关节炎患者不同中医证型与高频超声下改变的关系

作者	单位
孙洁,孙春林,蒋雪梅,张峰,翟红丽,李建宁,姜萍	1.山东中医药大学附属医院风湿科（济南 250014）；2.德州学院医药与护理学院（山东 253023）；3.山东省威海市中心医院中医科（山东 264400）；4.山东中医药大学附属医院超声科（济南 250014）

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中文摘要:

目的探讨早期膝骨关节炎（KOA）患者不同中医证型与高频超声下改变的关系。方法依照中医辨证分型标准将81例早期KOA患者分为肝肾亏虚证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证4型，应用超声检测双膝关节滑膜厚度、滑膜血流信号、关节积液、软骨改变、骨侵蚀程度及是否存在腘窝囊肿、半月板退行性变，并进行指标评分，分析早期KOA患者不同中医证型与高频超声下改变阳性率关系及与高频超声指标评分关系。结果（1）湿热痹阻证患者的滑膜增生阳性率高于肝肾亏虚证（χ2=10.13，P<0.05）；肝肾亏虚证患者的软骨改变阳性率高于寒湿痹阻证、湿热痹阻证（χ2=25.22，P<0.01；χ2=12.83，P<0.01）；不同中医证型间关节积液、骨侵蚀、滑膜血流信号、腘窝囊肿、半月板退行性变的阳性率比较，差异无统计学意义（P>0.05）。（2）湿热痹阻证患者的滑膜增生超声评分高于肝肾亏虚证、寒湿痹阻证、痰瘀痹阻证（P<0.01）；寒湿痹阻证患者的关节积液超声评分高于肝肾亏虚证、痰瘀痹阻证（P<0.01）；肝肾亏虚证患者的软骨改变超声评分高于寒湿痹阻证、湿热痹阻证（P<0.01）；不同证型间的骨侵蚀超声评分差异无统计学意义（P>0.05）。结论早期KOA患者的高频超声下改变与中医证型有一定的关系，高频超声可为早期KOA中医辨证分型提供一定的客观化依据。

英文摘要:

Objective To study the correlations between different Chinese medicine （CM） syndrome types and changes of early knee osteoarthritis （KOA） under high frequency ultrasound. Methods According to the CM syndrome typing standard， 81 early KOA patients were assigned to 4 groups： Gan-Shen deficiency syndrome， cold-dampness obstruction syndrome， damp-heat obstruction syndrome， and phlegm-stasis obstruction syndrome. By using ultrasonic technique， a comparative observation of synovium thickness，synovium blood flow，effusion of joint，destructions of arthrodial cartilage and subchondral bone，popliteal cyst， meniscus degeneration were performed in all patients to analyze correlation between different CM syndrome types and the positive rate of changes under high frequency ultrasound and the score of high frequency ultrasound indices in early KOA patients. Results （1） The positive rate of synovial hyperplasia of damp-heat obstruction type was higher than that of Gan-Shen deficiency type （χ2=10.13，P<0.05）. The positive rate of cartilage changes of Gan-Shen deficiency type was higher than that of cold-dampness obstruction type and damp-heat obstruction type （χ2=25.22， P<0.01； χ2=12.83， P<0.01）. There were no statistical differences in the positive rates of joint effusion， bone erosion， synovial blood flow signal， popliteal cyst， or meniscus degeneration between different syndromes （P>0.05）.（2）The ultrasound score of synovial hyperplasia in damp-heat obstruction type was higher than that of Gan-Shen deficiency type，cold-dampness obstruction type， and phlegm and blood stasis type （P<0.01）. The ultrasound score of joint effusion in cold-dampness obstruction type was higher than that of Gan-Shen deficiency type and phlegm and blood stasis obstruction type （P<0.01）. The ultrasound score of cartilage changes in Gan-Shen deficiency type was higher than that in cold-dampness obstruction type and damp-heat obstruction type （P<0.01）. There were no significant differences in the ultrasound scores of bone erosion among different syndrome types （P>0.05）. Conclusions There was certain correlation between the changes under high-frequency ultrasound in early KOA patients and CM syndrome types. High-frequency ultrasound provided certain objective bases for CM syndrome typing of early KOA patients.

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