Study On The Relationship Between The Distribution And Disease Activity Of Osteophytes In Spine Of Patients With Ankylosing Spondylitis And TCM

Objective By exploring the relationship between the distribution of spinal osteophytes and physical and chemical indicators in patients with ankylosing spondylitis and traditional Chinese medicine,it provides new ideas and methods for the prevention and treatment of pathological new bone formation in AS by traditional Chinese medicine and integrated traditional Chinese and western medicine.Methods A total of 204 patients with ankylosing spondylitis aged 16 ～ 40 years who visited the Department of Rheumatology of Inner Mongolia Autonomous Region Hospital of Traditional Chinese Medicine,the Department of Rheumatology and Physical Examination Center of Inner Mongolia Armed Police Corps Hospital,the Department of Rheumatology and Immunology of the First Affiliated Hospital of Inner Mongolia Medical University,and the Department of Rheumatology and Immunology of Inner Mongolia Autonomous Region People’s Hospital from December 2020 to December 2021 were included,and the basic data of the patients were collected to improve The MRI results of sacroiliac joint were observed,and the distribution of ligamentous osteophytes in anteroposterior and lateral X-ray films of cervical,thoracic and lumbar spine was counted.The patients were divided into two groups according to the presence or absence of osteophyte formation: osteophyte group without osteophyte.The levels of CRP and ESR in peripheral blood of patients in each group(including dampness-heat syndrome,cold-dampness syndrome,blood stasis syndrome,kidney-yang deficiency syndrome,liver-kidney deficiency syndrome)were determined,BASDAI assessment,BASFI assessment,MRI grading of sacroiliitis were performed,the data were collected for statistical analysis,and finally the study results were analyzed and discuss.Results 1.General information: In this topic,204 AS cases were finally collected,and male patients accounted for about 74.5%.Ligamentous osteophytes were seen in about 60.3% of patients,and cervical,thoracic,and lumbar spine involvement was 38.2%,15.4%,and 54.5%,respectively,in patients with osteophytes.There was no significant difference in gender distribution and age distribution between the two groups(P > 0.05);the average course of disease in the group with bone dewlap was significantly longer than that in the group without bone dewlap(P < 0.05);there was no significant difference in BASDAI score,ESR and CRP between the two groups(P > 0.05),and the BASFI score in the group with bone dewlap was significantly higher than that in the group without bone dewlap(P < 0.05).All patients were mainly grade III according to the MRI grading criteria for sacroiliitis,accounting for about 50.5%,and there was a significant difference in the MRI grading of the sacroiliac joint between the two groups(P < 0.05).2.Syndrome type of TCM: Among 204 patients with AS,liver and kidney deficiency syndrome was the most common,accounting for 28.9%,kidney yang deficiency syndrome accounted for 19.6%,cold-dampness syndrome accounted for23.0%,dampness-heat syndrome accounted for 11.3%,and blood stasis syndrome accounted for 17.2%.There were 33.3% patients without osteophytes with cold-dampness syndrome,followed by 25.9% patients with blood stasis syndrome,11.1% patients with liver-kidney deficiency,14.8% patients with kidney-yang deficiency and 14.8% patients with dampness-heat syndrome.The patients with osteophyte syndrome of liver and kidney deficiency were the most common,accounting for about 40.7%,followed by kidney yang deficiency syndrome,accounting for 22.8%,cold dampness,dampness and heat,blood stasis accounted for16.3%,8.9%,11.4%,respectively.The difference in the distribution between the two groups had statistical significance(P < 0.05).3.Syndrome types,laboratory indexes and disease activity: Among all patients,there were significant differences in CRP,ESR,BASDAI and BASFI among patients(P < 0.05).The average inflammatory level and BASDAI score of patients with excess syndrome(cold-dampness obstruction,dampness-heat obstruction,blood stasis obstruction)were higher than those of patients with deficiency syndrome(liver-kidney deficiency,kidney-yang deficiency);the BASFI score of patients with deficiency syndrome(liver-kidney deficiency,kidney-yang deficiency)was higher than that of patients with excess syndrome(cold-dampness obstruction,dampness-heat obstruction,blood stasis obstruction)(P < 0.05).4.Distribution of TCM and osteophytes: There were osteophytes,and the patients with cervical spine involvement had the most kidney yang deficiency syndrome,accounting for about 36.2%;the patients with lumbar spine involvement had the most liver and kidney deficiency syndrome,accounting for about 59.7%;and there were only 19 patients with thoracic spine involvement,which was not discussed in this study.There was significant difference in the distribution between the affected sites(P < 0.05).Conclusion 1.AS empirical patients have a short course of disease,severe conflict between the right and the evil,and prominent inflammatory symptoms;osteophyte formation is to be performed,and most patients have a disease dominated by deficiency syndrome for a long time,with insignificant inflammatory symptoms,but significantly limited spinal function.Combined with MRI findings,AS inflammation level may be a relatively independent process with imaging progression of sacroiliac joint,so in many AS patients with controlled inflammation level after treatment in clinical practice,there is still ankylosis deformity of spine at a later stage.2.Considering the characteristics of ankylosing spondylitis,tonifying the liver and kidney while expelling pathogenic factors may become a new idea for TCM to prevent pathological new bone formation in AS in the early stage of the disease;while for patients who have experienced pathological new bone formation in the late stage of the disease,more attention should be paid to nourishing the liver and kidney or warming the kidney and strengthening the governor for different patients,in order to control the continuous progression of ossification.3.According to the different distribution sites of osteophytes,AS patients with lumbar spine involvement were mainly characterized by liver and kidney deficiency syndrome,while patients with cervical spine involvement were mainly characterized by kidney yang deficiency syndrome.It is suggested that in clinical treatment,for patients with pathological new bone formation in the lumbar or cervical spine,the treatment should be focused.For patients with liver and kidney deficiency or kidney yang deficiency at the early stage of the disease,the imaging changes of the lumbar spine or cervical spine should be vigilant.