ObjectiveIdiopathic inflammatory myopathies(ⅡM)is a group of autoimmune diseases with unclear etiology.It is clinically divided into polymyositis(PM),dermatomyositis(DM),inclusion body myositis(IBM)three categories,as well as nonspecific myositis,immunemediated necrotizing myopathy(IMNM)2 subtypes.At present,the guideline standards or clinical research of traditional Chinese medicine(TCM)on IIM are mostly limited to PM or DM.There is a lack of comprehensive TCM syndrome researches for IIM and agreed classification criteria.In this study,a statistical analysis of idiopathic inflammatory myopathies was conducted to study the regularities of TCM syndromes and classification criteria for IIM.It is an exploration and practical experience for the further statistical analysis of TCM syndromes on IIM.MethodsThis study was a prospective study and a cross-sectional survey was conducted.From November 2017 to March 2018,the hospitalized patients who were diagnosed with IIM in the Department of Rheumatology and Immunology of China-Japan Friendship Hospital and screened with exclusion criteria were selected.Referring to the "Toxicosis" part of the"Clinical criteria for the diagnosis and efficacy of TCM internal medicine syndromes","Guidelines for the clinical research of new Chinese medicines",the previous IIM guidelines for diagnosis and treatment,Chinese medicine research literature and books,the TCM Syndrome Information Collection for IIM was designed to record TCM syndrome-related information of these selected patients.The clinical information collected was managed with Excel 2007 software,rechecked after the input work was completed.Then the data was imported into SPSS 24.0,and the frequency and percentage of each index were statistically analyzed.Cluster analysis and principal component analysis were used for symptom classification and selection of primary and secondary syndromes.Chi-square test and other methods were used to analyze relationship between clinical information and TCM syndromes.Results(1)General situation:A total of 49 patients were included in the study,including 11 males and 38 females,with a male to female ratio of 1:3.5.The oldest patient was 77 years old and the youngest was 13 years old.There were a total of 46 adult patients,accounting for 93.9%of the total.Adult patients were at the peak of 40-59 years old,accounting for 55.2%of the total number of adult patients,and the average age was about 51.4 years.The minor patients were all aged between 10-15 years old and the average age was 14 years old.Western medical diagnosis includes 34 cases of DM patients(69.4%of total adult patients),8 cases of PM patients(16.3%),7 cases of IMNM patients(14.3%),3 cases of JDM patients(6%of total patients).The patients with the disease duration less than 6 months were the most common,accounting for 40.8%;the patients with disease duration between 6 months to 1 year and 1 year to 3 years were accounting for 20.4%and 24.5%;the patients with disease duration more than 3 years were the least,accounting for 14.2%.Western medicine diagnostic typing in patients of different sexes and different age groups showed no significant difference,similar to the overall distribution.(2)Typical symptoms of IIM:Muscle pain occurs most frequently in muscle symptoms(42.9%),followed by muscle tenderness and muscle soreness,and no muscle atrophy was observed.The change in limb power was most often seen in limb weakness,with a frequency of 59.2%and the lowest frequency of limb numbness,6.1%.In terms of skin lesions,the frequency of bright red rash and dark red rash was the highest,which was 22.4%and 20.4%respectively;followed by tan skin rash and purple skin rash,which accounted for 8.2%and 4.1%,respectively;no purple rash was observed.(3)Mental and sleep symptoms:More than half of the patients(55.1%)had symptoms of forgetfulness,and 30%had symptoms of fatigue and irritability.(4)TCM syndrome information:There are seven items in the top and more than half of the frequency:string-like pulse in 33 cases(67.3%);rough skin in 30 cases(61.2%);limb weakness in 29 cases(59.2%);easily awakening in 29 cases(59.2%);in 28 cases were white fur,accounting for 57.1%;27 cases were forgetfulness,accounting for 55.1%;27 cases were thick fur,accounting for 55.1%.In the tongue manifestation,the most common abnormal tongue color was tongue red(49.0%),and the least was pale tongue(6.1%).In terms of abnormal tongues,the most common are teeth-marked tongue(20.4%).In the performance of tongue fur,white fur(57.1%)was higher than that of yellow fur(42.9%).In the performances of pulse condition,the most common occurrence of string-like pulse is the frequency of 67.3%,and sometimes string-like pulse is accompanied by fine pulse or sunken pulse.(5)TCM syndrome type classification results:After systematic cluster analysis(Ward method)and principal component analysis,combined with the clinical experience of Professor Wang Weigang,the TCM syndrome classification of TCM is as follows:① syndrome of dual deficiency of qi and yin:The main sign has asthma,shortness of breath,night sweats,fatigue,dreaminess,frequent urination,pale red tongue,peeling fur;secondary sign has hoarseness,cough,dry mouth desiring to drink,heart palpitations.② syndrome of blood stasis-turbidity obstructing the collaterals:The main sign has subcutaneous induration,muscle tenderness,absence of sweating,headache,irritability,depression,difficulty falling asleep,dry mouth not want to drink,torpid intake,abdominal pain,urine yellow,sloppy stool,dim tongue,teeth-marked tongue,slimy fur,dry fur;secondary sign has dark red rash,muscle aches,muscle pain,fever,consciously fever,dry stool,dizziness,spontaneous diarrhea,lack of fur,thin fur,sunken pulse.③ syndrome of spleen deficiency with dampness and phlegm:The main sign has limb weakness,bright red rash,pigmentation,rough skin,forgetfulness,easily awakening,thick fur,slippery pulse;secondary syign has fear of cold,red tongue,white fur,string-like pulse.There is a group of symptoms hinting dampness-heat syndrome,including limb weight,spontaneous sweating,abdominal distention,yellow fur,and fine pulse.(6)Distribution of syndromes and correlation of clinical information:Among the three syndromes,the highest proportion of syndrome of spleen deficiency with dampness and phlegm accounted for 61.2%,followed by syndrome of blood stasis-turbidity obstructing the collaterals,accounting for 26.5%;syndrome of dual deficiency of qi and yin was the least,accounting for 12.2%.There was no significant difference in the distribution of TCM syndromes among patients of different genders or different age groups,which was similar to the overall distribution.The distribution of TCM syndromes in patients diagnosed by Western medicine is roughly the same.Only thte proportion of syndrome of dual deficiency of qi and yin in PM patients is slightly higher,accounting for about 20%.With the prolonged duration of the disease,the proportion of syndrome of spleen deficiency with dampness and phlegm gradually decreased,while the proportion of the other two syndromes gradually increased.In the patients with disease duration more than 3 years,syndrome of blood stasis-turbidity obstructing the collaterals accounted for 40%of the cases,the proportion of syndrome of dual deficiency of qi and yin rose to 30%which is in line with syndrome of spleen deficiency with dampness and phlegm.Conclusions(1)The theory of gender difference of Qi-Blood and Yin-yang as well as the theory of"seven-seven eight-eight" in "Huangdi Neijing" about the law of human growth can be used as an explanation angle to explain the gender differences in IIM patients and the peak age of adult patients.(2)There were 7 symptoms with the highest frequency,whose mechanism of disease was consistent with the pathogenesis of spleen deficiency,dual deficiency of qi and blood and dampness encumbrance.It hints that syndrome of spleen deficiency with dampness and phlegm was closest to IIM basic pathogenesis.(3)From the perspective of TCM pathogenesis,symptoms of forgetfulness,fatigue,irritability,depression,and poor sleep are closely related to the one or more pathogenesis of three syndromes in IIM,suggesting that these symptoms can be used as TCM Syndrome Reference Symptoms of IIM.(4)Syndrome of spleen deficiency with dampness and phlegm is closest to the basic pathogenesis of the disease,which runs through the whole period of IIM,especially in the early stage.As the disease progresses,due to the prolonged illness,phlegm-dampness turns into blood stasis,or fever and glucocorticoid lead to yin-blood depletion,syndrome of blood stasis-turbidity obstructing the collaterals and syndrome of dual deficiency of qi and yin become the main component of the syndromes in later period.(5)The result of syndrome classification obtained by systematic cluster analysis is similar to the classification standards of TCM industry standards.But due to low number of cases,the clinical significance remains to be further research expanding the sample size in the future.In the meantime,explorations of the correlation between TCM syndromes and iconography,pathology,and immunohistochemical results are necessary in the future. |