Study On TCM Syndrome Types And Medication Rules Of Primary Sjögren's Syndrome Combined With Hashimoto's Thyroiditi

Objective:Based on the thought of syndrome differentiation and treatment and holistic view in traditional Chinese medicine,this study collected the case data of patients with primary SjOgren syndrome,obtained the general information,clinical symptoms,laboratory tests,Chinese medicine evidence patterns and Chinese medicine prescriptions of the patients.In order to obtain the characteristics of TCM evidence patterns and clinical features of patients with primary Sj?gren syndrome combined with Hashimoto’s thyroiditis and the prescription pattern of TCM for the treatment of this disease,and to provide some ideas and basis for the clinical prevention and treatment of primary SjOgren syndrome combined with Hashimoto’s thyroiditis in TCM.METHODS:A cross-sectional study was conducted to collect patients with primary Sj?gren syndrome hospitalized in the Department of Rheumatology,Guang’anmen Hospital,Chinese Academy of Traditional Chinese Medicine from January 2018 to December 2022,and divided into two groups according to whether they had Hashimoto’s thyroiditis combined with primary Sj?gren syndrome,to collect general conditions,symptoms,signs and laboratory information,and to investigate the TCM symptoms of primary Sj?gren syndrome combined with Hashimoto’s thyroiditis.The data of the Chinese medicine prescriptions of patients with primary Sj?gren syndrome combined with Hashimoto’s thyroiditis were collected,and the core prescriptions were obtained by data mining using SPSS Modeler software and clustering analysis of high frequency drugs was performed by SPSS Statistic 20.0.Results:1.In this study,161 medical records were collected,77 cases in the combined Hashimoto’s thyroiditis group and 84 cases in the non-combined Hashimoto’s thyroiditis group.There was no statistical difference in the sex ratio,age at onset and duration of illness between the two groups(P>0.05).In both groups,dry mouth,dry eyes and weakness were the most common symptoms.In the group with Hashimoto’s thyroiditis,the proportion of symptoms of neck discomfort and acid reflux and heartburn was higher than that of the group without Hashimoto’s thyroiditis(p<0.05),while the proportion of symptoms of SjOgren mouth was lower than that of the group without Hashimoto’s thyroiditis.In terms of laboratory tests,there were statistical differences in ESR TSH,C3,IgM and CRP between the two groups(p<0.05).In terms of TCM syndrome,the proportion of Qi and Blood stasis syndrome in the combined Hashimoto’s thyroiditis group was higher than that in the non-combined group,and the proportion of Qi and Yin deficiency syndrome was lower than that in the non-combined group,with a statistical difference between the two groups(p<0.05).A total of 127 prescriptions with 224 herbs were included in the section of medication pattern.30 herbs were used 20 times or more,among which Mai Dong had the highest frequency(56 times).The most frequent herbs were,in order,Mai Dong,Radix Angelicae Sinensis,Atractylodes Macrocephala,Radix Bupleurum Chinense,Dendrobium and so on.In terms of herbs properties,cold,warm and flat medicines were the top three used,accounting for 42.41%,26.79%and 22.77%of the total frequency respectively;bitter,sweet and pungent medicines were more frequently used,accounting for 31.81%,30.93%and 23.72%respectively;medicines attributed to the liver meridian were the most frequent,accounting for 20.72%,followed by those attributed to the lung and spleen meridians,accounting for The highest proportion of drugs was for tonic deficiencies(20.09%),followed by those for clearing heat(17.86%),activating blood circulation and resolving blood stasis(9.82%)and regulating qi(7.14%).6.The association rule analysis of herbs was performed on 224 Chinese herbal medicines,setting the support level at 20 and the confidence level at 65.The pairs of herbs with higher confidence levels were obtained as Radix Puerariae-Radix Paeoniae,Radix Puerariae-Yam,Radix Rehmanniae-Angelicae,Radix Paeoniae-Angelicae and Radix BupleurumAngelicae,while the Category 3 with higher confidence levels were Atractylodes-Angelicae-Poria and Radix Paeoniae-Radix Paeoniae-Yam.Cluster analysis of the core drugs yielded 3 combinations of more than two herbs,and based on frequency of use,the core prescriptions were identified as Dendrobium,honeysuckle,Radix Astragali,Radix Angelicae Sinensis,ophiopogon japonicus,Radix Paeoniae Alba,Atractylodes Macrocephala,Radix Bupleurum,Poria and Yam.Conclusion1.In patients with primary SjOgren syndrome,those with combined Hashimoto’s thyroiditis have different characteristics in terms of symptoms and signs and laboratory tests than those without combined Hashimoto’s thyroiditis.2.Patients with primary Sj?gren syndrome combined with Hashimoto’s thyroiditis have more evidence of Qi and blood stagnation and obstruction.The etiology of the disease may be related to the deficiency of the disease mechanism and the prolonged course of the disease.3.The treatment of primary Sj?gren syndrome combined with Hashimoto’s thyroiditis with traditional Chinese medicine is based on the methods of tonifying deficiency,clearing heat,invigorating blood and regulating qi,reflecting that the disease mechanism is mainly based on deficiency of the root and the symptoms of the disease,and the treatment should focus on both helping the righteous and eliminating the evil.