| ObjectiveTo research the correlation between syndrome differentiation of rheumatoid arthritis(RA)and the performance of musculoskeletal ultrasound(MSUS),applying medical imaging toprovide the basis ofsyndrome differentiation and to explain the condition and prognosis,further guidance on treatment.MethodsIn this study,422 cases of RA patients who conform the standard in rheumatology outpatient and inpatient departments of the first affiliated hospital of Guangzhou University of TCM from April 2015 to June 2017 were included.The 422 research objects were divided into 4 syndrome syndromes,then recoded laboratory indicators such as rheumatoid factor(RF),anti-cyclic citrullinated peptide(anti-CCP)antibody,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),evaluated patients activity by disease activity scores 28(DAS28).Qualified doctors examined the patients’ small joints of hands including wrist,proximal interphalangeal joints,metacarpophalangeal joints and reported the grade of synovial hyperplasia,the level of color Doppler flow signal,whether there is bone erosion,whether there is joint cavity effusion,whether there is tendinitis/tenosynovitis.SPSS 22.0 statistical software was used to analyze whether there was a statistical difference between the various syndromes and the above indicators.Results1.The 422 patients who participated in the study were divided into four groups after the syndrome differentiation,including 161 in wind-cold-dampness blockage syndrome,98 in dampness-heat blockage syndrome,54 in phlegm-stasis blockage syndrome,109 in liver and kidney deficiency syndrome.2.There was no statistically significant difference in age,gender in the four groups(P<0.05),indicating that the patients in each group were basically balanced in age and gender,and were comparable.3.Through statistics,disease course between the four groups of patients with significant difference(P<0.05),of which course level of patients of phlegm-stasis blockage syndrome was obviously higher than that of the rest three syndromes,and higher than the average level of the total sample.4.DAS28-ESR was used as the evaluation indicator of patient’s disease activity,and the difference of DAS28-ESR in the four groups was not statistically significant(P>0.05).5.Among the relevant laboratory indicators,the level of RF,ESR and anti-CCP antibody was not statistically significant among the four groups(P>0.05).However,there were significant statistical differences respectively between liver and kidney deficiency syndrome and wind-cold-dampness blockage syndrome,dampness-heat blockage syndrome(P<0.0083),and the CRP level of patients in liver and kidney deficiency syndrome was lower than that in wind-cold-dampness blockage syndrome and dampness-heat blockage syndrome.6.In MSUS,there was no significant difference in synovial hyperplasia between the four groups(P>0.05).In the level of color Doppler flow signal,there were statistically significant differences between liver and kidney deficiency syndrome and wind-cold-dampness blockage syndrome,dampness-heat blockage syndrome(P<0.0083),while liver and kidney deficiency syndrome patients had lower color Doppler flow signal levels.On the bone erosion,there were significant differences between liver and kidney deficiency syndrome and wind-cold-dampness blockage syndrome,dampness-heat blockage syndrome,phlegm-stasis blockage syndrome and with statistical significance(P<0.0083),and the probability of bone erosion in liver and kidney deficiency syndrome was higher.Presence of tendinitis/tenosynovitis,between dampness-heat blockage syndrome and the rest three syndromes were statistically significant differences(P<0.0083),patients of dampness-heat blockage syndrome appeared tendinitis/tenosynovitis probability is the highest.7.Compared with the MSUS performance of excessive syndrome and deficiency syndrome,there was no statistically significant difference between the two groups in the degree of synovial hyperplasia and the presence of joint cavity effusion(P>0.05).Excessive syndrome and deficiency syndrome in the level of color Doppler flow signal,with or without bone erosion,the presence of tendinitis/tenosynovitis with significant difference(P<0.05).The level of color Doppler flow signal in excessive syndrome was stronger than that in deficiency syndrome,and the probability of bone erosion in deficiency syndrome was higher,and the probability of tendinitis/tenosynovitis in excessive syndrome was higher.8.The degree of synovial hyperplasia and the level of color Doppler flow signal under MSUS was positively correlated with ESR,CRP and DAS28-ESR respectively(P<0.05).ConclusionIn the RA syndrome differentiation,MSUS can be used as a modern,microscopic and local method to assist syndrome differentiation,which is worth promoting in TCM clinical practice.The patients in phlegm-stasis blockage syndrome had the longest course of disease,and the patients with long course of disease could refer to phlegm-stasis blockage syndrome,and pay attention to the application of the method of removing phlegm and blood-stasis in the treatment.The CRP level in liver and kidney deficiency syndromewas lower than that in wind-cold-dampness blockage syndrome and dampness-heat blockage syndrome,suggesting that RA patients with elevated CRP were more likely to be identified as excessive syndrome,like wind-cold-dampness blockage syndrome and dampness-heat blockage syndrome,and patients with low CRP were more likely to identify liver and kidney deficiency syndrome.In the level of color Doppler flow signal of MSUS,patients in liver and kidney deficiency syndrome was lower than those of wind-cold-dampness blockage syndrome,dampness-heat blockage syndrome,prompting strong color Doppler flow signal RA patients may be inclined to differentiate into excessive syndrome,such as wind-cold-dampness blockage syndrome and dampness-heat blockage syndrome,color Doppler flow signal is weak or no obvious color Doppler flow signal can be tended to differentiate into liver and kidney deficiency syndrome.The positive rate of bone erosion in liver and kidney deficiency syndrome was significantly higher than that of the other three syndromes,suggesting that the RA patients in liver and kidney deficiency syndrome were more prone to bone erosion,and bone erosion could also be a reference factor for liver and kidney deficiency syndrome.Positive of tendinitis/tenosynovitis in dampness-heat blockage syndrome was obviously higher than that of other three syndromes,revealing that patients in dampness-heat blockage syndrome are prone to tendinitis/tenosynovitis,and patients with tendinitis/tenosynovitis may be considered as dampness-heat blockage syndrome.However,there were no significant differences with RF,anti-CCP antibody,ESR,DAS28,the grade of synovial hyperplasia and joint cavity effusion in four syndromes.There is not enough evidence to prove these factors can be used as auxiliary project of differentiation.The degree of synovial hyperplasia and the level of color Doppler flow signal in MSUS can be used to evaluate the activity of RA.The higher the degree and the level,the more active RA is. |
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