Analysis Of TCM Syndromes In Primary Sjögren's Syndrome Combined With Abnormal Thyroid Functio

Purpose:Retrospective analysis of the characteristics of TCM syndromes of primary Sj（?）gren syndrome（p SS）with thyroid dysfunction（TD）.To compare the differences in general conditions,TCM syndrome types,clinical symptoms,and related laboratory indicators between patients with p SS combined with TD and patients without p SS combined with TD,explore the correlation between general conditions,TCM syndrome types,clinical symptoms,and related laboratory indicators and p SS combined with TD,as well as its significance in diagnosis and treatment,analyze the risk factors of p SS combined with TD,and provide clinical data support for the early diagnosis and intervention of p SS combined with TD.Material and Method:This study case is based on the clinical data of 63patients with primary Sjogren’s syndrome complicated with thyroid dysfunction（p SS-TD）who met the inclusion criteria and were hospitalized in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from July 1,2016 to June 30,2022,forming an affected group,referred to as the p SS-TD group,The clinical data of 121 patients with primary Sjogren’s syndrome without thyroid dysfunction（p SS-NTD）were included in the non-involved group,referred to as the p SS-NTD group.A total of 184 patients were included in the clinical data.This study adopts a retrospective research method,combines the actual situation of the department of rheumatism in our hospital,and refers to the diagnostic criteria for syndrome of Sjogren’s syndrome in the Guiding Principles for Clinical Research of New Chinese Medicines（Volume II）^[19]and the Practical Rheumatology of Traditional Chinese Medicine^[20].There are five TCM syndrome types of Sjogren’s syndrome,namely,dryness invading the lung syndrome,yin deficiency and heat toxicity syndrome,qi and yin deficiency syndrome,yin deficiency and blood stasis syndrome,and liver and kidney yin deficiency syndrome.The clinical data of 184 patients were entered into a Microsoft Excel database and statistically analyzed using SPSS 26.0software.Results:1.The average age of onset in the p SS-TD group（55.33±10.00）was higher than that in the p SS-NTD group（51.53±11.88）,and the difference was statistically significant（P=0.031<0.05）;The average course of disease in the p SS-TD group（64.17±61.34）was lower than that in the p SS-NTD group（89.88±69.13）,and the difference was statistically significant（P=0.014<0.05）.1.1 Among them,there is a statistically significant difference in the onset age between the p SS-TD group and the p SS-NTD group with deficiency of both qi and yin（P<0.05）.The average age of onset in the p SS-TD group with deficiency of both qi and yin（58.36±8.50）was higher than that in the p SS-NTD group（52.14±11.39）.1.2 Among them,the difference in disease course between the p SS-TD group and the p SS-NTD group with deficiency of both qi and yin was statistically significant（P<0.01）.The average course of disease in the p SS-TD group with deficiency of both qi and yin（50.80±41.96）was lower than that in the p SS-NTD group（86.25±65.42）;2.184 patients with p SS,including 5 cases of dryness invading the lung syndrome,17cases of yin deficiency and heat toxicity syndrome,90 cases of qi and yin deficiency syndrome,39 cases of yin deficiency and blood stasis syndrome,and 33 cases of liver and kidney yin deficiency syndrome.2.1 Among them,the distribution of traditional Chinese medicine syndrome types in the p SS-TD group is as follows:25 cases（39.7%）of Qi and Yin deficiency syndrome=25 cases（39.7%）of Yin deficiency and blood stasis syndrome>6 cases（9.5%）of Yin deficiency and heat toxin syndrome>5 cases（7.9%）of liver and kidney yin deficiency syndrome>2 cases（3.2%）of dry evil invading lung syndrome;The distribution of traditional Chinese medicine syndrome types in the p SS-NTD group is as follows:65 cases（53.7%）of qi and yin deficiency syndrome>28 cases（23.1%）of liver and kidney yin deficiency syndrome>14 cases（11.6%）of yin deficiency and blood stasis syndrome>11 cases（9.1%）of yin deficiency and heat toxicity syndrome>3 cases（2.5%）of dryness invading the lung syndrome.2.2 The merger rate of TD in patients with p SS of various traditional Chinese medicine syndrome types has significant statistical significance（P=0.000<0.01）.The incidence of TD in PSS patients is as follows:dryness invading the lung syndrome（40.0%）,yin deficiency and heat toxicity syndrome（35.3%）,qi and yin deficiency syndrome（27.8%）,yin deficiency and blood stasis syndrome（64.1%）,and liver and kidney yin deficiency syndrome（12.5%）;Compared between the two groups of different traditional Chinese medicine syndrome types,the incidence of TD in Yin deficiency and blood stasis syndrome is higher than that in other syndrome types,and the difference is statistically significant（P<0.05）.3.The frequency of clinical symptoms in 184 patients with p SS was as follows:dry mouth（181 cases,98.4%）>dry eye（168 cases,91.3%）>joint pain（78.8%）>fatigue（50.5%）>insomnia（44.6%）>rampant teeth（13.0%）.3.1 The frequency of clinical symptoms in 184 patients with p SS was as follows:dry mouth（181 cases,98.4%）>dry eye（168 cases,91.3%）>joint pain（78.8%）>fatigue（50.5%）>insomnia（44.6%）>rampant teeth（13.0%）;The frequency of clinical symptoms in the p SS-NTD group was as follows:dry mouth（119 cases,98.3%）>dry eye（110 cases,90.9%）>joint pain（96 cases,79.3%）>fatigue（48 cases,39.7%）>insomnia（41 cases,33.9%）>rampant teeth（12 cases,9.9%）;The frequency of clinical symptoms in the p SS-TD group was:dry mouth（62 cases,98.4%）>dry eye（58 cases,92.1%）>joint pain（49 cases,77.8%）>fatigue（45 cases,71.4%）>insomnia（41 cases,65.1%）>rampant teeth（12 cases,19.0%）.3.2 There was a statistically significant difference in fatigue and insomnia between the p SS-TD group and the p SS-NTD group（P<0.05）.Fatigue accounted for 48 cases（39.7%）in the p SS-NTD group and 45 cases（71.4%）in the p SS-TD group;Insomnia accounted for 41 cases（33.9%）in the p SS-NTD group and 41 cases（65.1%）in the p SS-TD group.3.3 The difference between the p SS-TD group and the p SS-NTD group in terms of fatigue,insomnia,and rampant teeth is statistically significant（P<0.05）.There were19 cases（76.0%）of fatigue in the p SS-TD group with deficiency of both qi and yin,and 22 cases（33.8%）in the p SS-NTD group with fatigue;There were 18 cases（72.0%）of insomnia in the p SS-TD group with deficiency of both qi and yin,and 17cases（26.2%）in the p SS-NTD group with insomnia;There were 7 cases（28.0%）of rampant teeth in the p SS-TD group with deficiency of both qi and yin,and 5 cases（7.7%）in the p SS-NTD group with rampant teeth.3.5 The difference in insomnia between the p SS-TD group and the p SS-NTD group with liver and kidney yin deficiency type was statistically significant（P<0.01）.There were 5 cases（100.0%）of insomnia in the liver kidney yin deficiency type p SS-TD group,and 13 cases（46.4%）in the p SS-NTD group.4.1 The difference in ESR,Ig M,and WBC reduction between the p SS-TD group and the p SS-NTD group was statistically significant（P<0.01）.The average ESR of the p SS-TD group（41.71±30.23）was higher than that of the p SS-NTD group（29.64±24.31）;The average Ig M value of the p SS-TD group（1.16±0.73）was higher than that of the p SS-NTD group（0.81±0.62）;40 cases（63.5%）showed a decrease in WBC in the p SS-TD group,while 46 cases（38.0%）showed a decrease in WBC in the p SS-NTD group.4.2 The difference in CRP between the p SS-TD group and the p SS-NTD group was statistically significant（P<0.05）.The average CRP of the p SS-TD group（16.65±36.40）was higher than that of the p SS-NTD group（8.52±16.70）.4.3 The difference in Ig M and WBC reduction between the p SS-TD group and the p SS-NTD group with deficiency of both qi and yin was statistically significant（P<0.01）.The average Ig M of the p SS-TD group with deficiency of both qi and yin（1.20±0.73）was higher than that of the p SS-NTD group（0.73±0.64）;24 cases（96.0%）showed a decrease in WBC in the p SS-TD group with deficiency of both qi and yin,while 27 cases（41.5%）showed a decrease in WBC in the p SS-NTD group.4.4 The difference in ESR between the p SS-TD group and the p SS-NTD group with deficiency of both qi and yin was statistically significant（P<0.05）.The average ESR（60.50±26.62）of the p SS-TD group with deficiency of both qi and yin was higher than the average onset age（26.00±26.56）of the p SS-NTD group.Conclusion:1.Yin deficiency and blood stasis type p SS is more likely to merge with TD.2.Patients with PTSS combined with TD have a higher probability of developing fatigue,insomnia,and decreased WBC compared to those without the combination.3.The inflammatory response of p SS combined with TD worsens with an increase in Ig M.4.The probability of developing fatigue,insomnia,rampant teeth,increased ESR,increased Ig M,and decreased WBC in patients with deficiency of both qi and yin combined with TD is higher than in those without the combination.5.Patients with yin deficiency and blood stasis type of p SS combined with TD have a higher probability of developing fatigue compared to those without the combination.