| 摘要: | 類風濕性關節炎是以慢性多發性關節病變為主的全身自體免疫疾病，其發病機轉尚不清楚，在中醫是屬「痹證」之範疇。 本病臨床見證常屬虛實相兼，寒熱錯雜，痰瘀互結，表現非常複雜，而其主要證型之分類，各家見解也不盡相同，不易進行客觀而標準化的辨證診斷。本研究以RA患者為對象，進行中醫診察，並以語意差別量表方式，製作寒熱虛實之辨證量表，並以多元尺度法分析所得資料，結果顯示: RA患者整體與關節局部的寒熱虛實經常錯雜互見，如果合併辨證，則不易看出明確的分佈趨勢。若將此兩方面分別觀察，則可發現患者整體的寒熱辨證有與關節局部的虛實表現均有清楚的分佈趨勢。 本項研究所設計之量表結合多元尺度分析法，可對上述二種辨證進行量化，並能作為療效評估之參考。另以RA患者，進行「望聞問切，四診合參」之傳統中醫辨證，並綜合分析，依據中醫學理的疾病辨證編碼系統進行編碼，嘗試建立其中醫臨床流行病學資料庫，然後用集群分析法進行統計分析。結果可見「濕熱」、「氣陰兩虛夾濕熱」、「陰虛有熱」及「虛證」等四種主要證型，病機以濕熱及虛證最為重要。; Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology with chronic inflammation in multiple joints. According to traditional Chinese medicine (TCM), it is in the category of “Bi” syndromes. Its pattern is usually a combination of vacuity and repletion, cold and heat, or phlegm and blood stasis. The classification of the clinical patterns of RA is varied, thus, it is difficult to make an objective and standardized treatment protocol. We recruited 60 RA patients to undergo pattern identification according to TCM. We designed parameters for cold and heat, and vacuity and repletion using a questionnaire, and analyzed the data using a multi-dimension scale (MDS). The results revealed that it was difficult to show a trend of distribution of heat, cold, vacuity and repletion for the whole body and local joints. Thus, we separated the whole body and local joints into two parts. The results marked trends in the cold-heat pattern of the whole body and the vacuity-repletion pattern of local joints. The newly developed criteria combined with using a multi-dimension scale may enable practitioners to quantify pattern identification mentioned above and may be useful in evaluating the therapeutic effects of RA using TCM. Seventy nine RA patients fulfill the criteria were recruited via rheumatology out- patient clinic and were examined by experienced physician, a TCM pattern- identification coding system was applied to generated codes for different etiology, location, mechanism and consequence of RA, the data set was managed by cluster analysis. Our study population shows four predominant subgroups, i.e., vacuity, dampness-heat, yin-vacuity with heat and Qi-yin vacuity with dampness-heat. This study provides objective parameters for rheumatoid arthritis in Traditional Chinese Medicine. |
