| Objective:To analyse the correlation between platelet (PLT) counts and various syndromes on156cases of active rheumatoid arthritis (RA) patients, as well as correlation analysis between PLT and inflammatory markers, evaluation indexes, symptoms or signs in each syndrome of activity. So as to guide clinical diagnosis, treatment based on syndrome differentiation, and as the basis to use Chinese herbology.Methods:The study’s cases entry from Guang’anmen Hospital of China Academy of Chinese medical is the patients with rheumatoid arthritis during the period of2011-2013in department of rheumatism. It contains156cases of active rheumatoid arthritis (RA) patients. Select these cases in activity to analyse the propotion of each syndrome, and the differentiation in inflammatory markers, evaluation indexes and symptoms or signs in each symdrome. Further more, analyse the distribution of elevated platelet group and the normal group in the various syndromes, and the correlation between platelet counts and various syndromes. And then,to observe the correlation or differentiation between PLT and other indexes in active RA of each syndrome, such as CRP, ESR, DAS28, joint functional classification, joint X-rays, symptoms or signs and so on.Results:(1) In this study there are156cases included meet the conditions inactive RA cases. Among these cases, male39and female117, the ratio is1:3, mean age is59.2±13.752years old, mean course of the disease is117.94±120.794months. The proportion of the various syndromes of active RA in this study is: there are93cases of wind-damp-heat syndrome,29cases of phlegm-blood stasis syndrome,34cases of deficiency syndrome. The percentage is respectively59.6%,18.6%,21.8%. These show that the proportion of sex in active RA is consistent with the RA epidemiology proportion, and the age trends to the elderly, disease easily activities when A longer duration. The number of cases of various syndromes distribute as follows:wind-damp-heat type> deficiency type> phlegm-blood stasis type.(2) Compare the basic information between the three syndromes in active RA, it shows that sex, age and the course of the disease, there is no statistic significance among the three syndromes(P>0.05). And the evaluation indexes, including RF, DAS28, joint function, joint X-rays, the number of joints swelling and joints tenderness also are no significant difference between these three syndromes (P>0.05). So there is comparability between the various syndromes.(3) Compare the inflammatory markers in the three syndromes, it shows:CRP was no difference (P>0.05) between wind dampness fever syndrome and phlegm-blood stasis type, but there are significant differences between the deficiency type and wind-damp-heat type or phlegm-blood stasis type (P<0.05), and the CRP in wind-damp-heat type is higher than CRP in deficiency type, also CPR in phlegm-blood stasis type is higher than deficiency type. ESR just has significant difference between wind-damp-heat type and deficiency type (P<0.05), the other two have no significant difference (P>0.05), and the ESR in wind-damp-heat type is higher than in deficiency type. It follows that in active RA, the inflammatory markers like CRP, ESR have significant differences between the three syndromes.(4) The distribution of PLT in various syndromes:there are significant diffrience between the elevated PLT group and nomal group in each syndrome (P <0.05). The number of the elevated PLT group (PLT>300×109/L) cases is more than the normal group (PLT is100-300×109/L) in wind-damp-heat type and phlegm-blood stasis type, but in deficiency type, the number of cases with elevated PLT group is less than the normal group. Further more, the percentage of the elevated PLT group number is64.5%in the total number of cases in wind-damp-heat type, the number of patients at increased PLT group accounted for82.8%of the total number in phlegm-blood stasis type. Relatively, the PLT increased proportion in phlegm-blood stasis is more than the wind-damp-heat type, and in deficiency type, PLT is substantially no increase. The comparison of PLT increasing proportion in various syndromes:phlegm-blood stasis type>wind-damp-heat type>deficiency type.(5) The difference and correlation of the PLT between the three syndromes in active RA:PLT is associated with each of the three syndromes (P<0.01), and PLT is highly correlated with the various syndrome, and further found that PLT is positively related to the wind-damp-heat type, as the same as the phlegm-blood stasis type, by contrast, PLT and deficiency type with a negative correlation. By pairwise comparison, PLT has no difference in wind-damp-heat type and phlegm-blood stasis type (P>0.05). And compared with the deficiency type and wind-damp-heat type, there has significant difference (P<0.05), and the PLT of the latter type is higher than the deficiency type. Compared with the deficiency type and phlegm and blood type, there has significant difference (P<0.05), and the PLT of the phlegm and blood type is higher than the deficiency type.(6) In active RA, comparison of PLT with the indexes shows:PLT and CRP, ESR has positive correlation (P<0.05), but PLT and RF, DAS28has no significant correlation (P>0.05). And further more, the relevance of PLT and RF, DAS28in each syndrome also has no correlation (P>0.05); on the other hand, in wind-damp-heat syndrome, comparison of PLT and CRP, ESR has a significant correlation (P<0.01), but in this study, PLT and CRP, ESR in phlegm-blood stasis type and deficiency type has no statistically significant correlation (P>0.05). PLT associated with inflammatory markers, but not with evaluation indicators. Combined with the analysis of the inflammatory markers in active RA before, thus the manifestation of PLT with various syndromes in active RA are basically the same, so PLT is indeed associated with inflammation, and can be used as an index for inflammation in active RA.(7) Comparison between PLT and the examinations of the joints in various syndromes:in active RA, classification of joint function concentrates on level2or3, and joints X-rays are also concentrates on stages2or3. PLT has no significant difference in Joints functional classification (P>0.05). PLT has statistical difference in the X-ray of hands (P<0.05), comparison between groups: no difference between stage1and2; there has difference between stage1and3, and PLT in stage3is higher than it in stage1; there is a difference between stage1and4, and PLT in stage4is higher than it in stage1; the difference between stage2and3, stage2and4or stage3and4are all not significant. PLT in knee X-rays stages, there was significant difference (P<0.05). Comparison between groups:there is no difference between stage1with the other three stages; the difference between stage2and3is statistical significant, and PLT in stage3is higher than it in stage2; and the rest is no difference between groups. In a related comparison, only in wind-damp-heat type, PLT and joints X-rays has correlation (P<0.05), in the other two syndromes, no correlation (P>0.05). And about joints function and PLT, there still has no correlation in every syndromes in active RA of this study (P>0.05).(8) The comparison of the various symptoms or signs in various syndromes shows: the difference of dry mouth, fatigue, warm joints, morning stiffness among syndrome types respectively were statistically significant (P<0.01). The remaining symptoms have no difference in various syndromes.(9) The correlation between PLT and symptoms in active RA shows:there have significant correlations between PLT and fever, dry mouth, warm joints, morning stiffness (P<0.01), and PLT also relatied to joints limitation of motion (P <0.05). PLT and fatigue has a negative correlation (P<0.05).Conclusion:(1) PLT and various syndromes of RA activity have correlations, and PLT has positively correlated with the wind-damp-heat syndrome type and phlegm-blood stasis syndrome type, a negative correlation with the deficiency type. So PLT can be used as reference for syndrome differentiation.(2) Comparison PLT elevated ratio in various syndromes shows:phlegm-blood stasis type>wind-damp-heat type>deficiency type.(3) In active RA, to compare PLT and CRP, ESR, joint X-ray in each syndrome shows:in the wind-damp-heat syndrome, they have significant correlations. And the wind-damp-heat syndrome is the most one in active RA. So, PLT can be used as an inflammatory activity reference indicator of active RA.(4) Compare PLT with the signs and symptoms in the syndrome, fever, dry mouth, warm joints, morning stiffness, joints limitation of motion has correlation with PLT. |
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