Analysis Of Clinical Features Of Primary Sjogren's Syndrome Of Yin Deficiency Type And Damp-heat Type

Objective: To analyze the differences in gender,age,history of smoking and drinking,family history,emotional factors,system involvement,tumor history,laboratory tests,scores of the TCM symptom classification and quantification table and ESSDAI disease activity between patients with yin-deficiency type and damp-heat type primary Sjogren's syndrome(p SS).It provides a certain reference for the clinical characteristics of traditional Chinese medicine for yin-deficiency type and damp-heat type p SS.Method: This study used questionnaires to collect medical history data for p SS patients that met the 2002 European and American collusion classification criteria for Sjogren's syndrome.According to the diagnostic criteria of yin-deficiency type and damp-heat type prepared by the "Chinese medicine clinical diagnosis and treatment terminology part" in the 1997 national standard,the three doctors conducted a strict dialectical analysis on the patient's four diagnosis and data of tongue picture.Patients with p SS who met the criteria were included,and non-compliant p SS were excluded,then they were divided into two groups of damp-heat type and yin-deficiency type.Collecting gender,age,history of smoking and drinking,family history,emotional factors,systemic involvement,tumor history,laboratory examination,scores of the TCM symptom classification and quantification table,ESSDAI disease activity and other data of patients with p SS were used to compare two group of patients with syndromes.Results: 1.A total of 368 patients with p SS were enrolled,and 277 patients met the inclusion criteria,including 167 with yin-deficiency type and 110 with damp-heat type.2.As for the age distribution,the yin-deficiency type was 56.93±13.04 years old,and the average age of damp-heat type was 51.24±13.70 years old.The average age of damp-heat type patients was lower than that of yin-deficiency type.The age difference was measured by independent sample t test,and the difference was statistically significant(P<0.05).3.In the gender distribution of the two groups,there were 268 females and 9 males with a ratio of 1:29.78.The difference was not statistically significant(P>0.05).There were 163 females in the yin-deficiency type,accounting for 97.60%,and 4 males,accounting for 3.25%.There were 105 females of damp-heat type p SS patients,accounting for 95.45%,and 5 males,accounting for 4.55%.The difference was not statistically significant(P>0.05).There were no significant differences in smoking history,drinking history,family history,and emotional factors between the two groups(P>0.05).4.A total of 225 patients in the two groups had systemic involvement,accounting for 81.23%of all patients,of which 134 cases were yin-deficiency type and 91 cases were damp-heat type.In all systems involved,skin and mucous membranes accounted for 25.60%,skeletal muscle accounted for 24.90%,blood system accounted for 24.20%,respiratory system accounted for11.20%,digestive system accounted for 14.10%,nervous system accounted for 4.70%,urinary system accounted for 2.20%.Notably,the number of patients who suffered skin mucosa lesion is the largest.5.6 patients developed urinary system involvement,and all showed renal tubular acidosis.There was 1 case of yin-deficiency type,accounting for 0.60%,5 cases of damp-heat type,accounting for 4.50%.The chi-square test was used and the difference was statistically significant(P<0.05).There were 13 patients with nervous system involvement,4 cases with yin deficiency type,accounting for 2.40%,9 cases with damp heat type,accounting for 8.20%.The chi-square test was used,and the difference was statistically significant(P<0.05).There were 39 patients with digestive system,17 patients with yin-deficiency type,accounting for10.20%,22 cases with damp-heat type,accounting for 20.00%.The chi-square test was used,and the difference was statistically significant(P < 0.05).There were 67 patients with blood system involvement,44 cases with yin-deficiency type,accounting for 26.30%,and 23 caseswith damp heat type,accounting for 20.90%.There was no significant difference between the two groups(P>0.05).There were 71 patients with skin mucosa,41 cases with yin-deficiency type,accounting for 24.55%,30 cases in dam-heat type,accounting for 27.27%.There was no significant difference between the two groups(P> 0.05).There were 69 patients with skeletal muscle involvement,39 cases with yin deficiency type,accounting for 23.40%,and 30 cases with damp heat type,accounting for 27.30%.There was no significant difference between the two groups(P>0.05).There were 31 patients with respiratory system,18 cases with yin-deficiency type,accounting for 10.80%,and 13 cases with damp heat type,accounting for11.80%.There was no significant difference between the two groups(P>0.05).6.There were 8 patients with a history of tumors in the two groups of syndromes,accounting for 2.89% of all patients.Among them,5 cases were yin-deficiency type,accounting for2.99%,including 1 case of thyroid cancer(female),2 cases of lymphoma(female),1 case of ductal carcinoma of the breast,and 1 case of malignant melanoma of the right foot(male).3cases were damp-heat type,accounting for 2.73%,including thyroid cancer,breast cancer,endometrial cancer,and 3 cases were female.There was no significant difference in tumor history between the two groups(P>0.05).7.In the laboratory examination and analysis,the hemoglobin of 12 patients with yin-deficiency type was decreased,accounting for 7.20%,and that of 2 cases patients with damp-heat type was reduced,accounting for 1.80%.The difference was statistically significant(P<0.05).17 cases of yin-deficiency type had a urine of p H>6,accounting for30.90%,and 30 cases of damp-heat type had a urine of p H>6,accounting for 76.90%.The difference was statistically significant.(P<0.05).As for ANA,SSA,SSB,RF,ALT,CK,ESR,CRP,Ig G,Ig M,Ig A,C3,C4,WBC,PLT,Scr,IL-1?,IL-2R,IL-6,IL-8,IL-10,TNF-?,lip gland biopsy index,there was no significant difference between the groups(P>0.05).8.Statistical analysis was performed on the scores of the TCM symptom classification and quantification table of the two groups of patients.The scores of the yin-deficiency type patients were 16.18±5.02,and the scores of the damp-heat type patients were 14.34±5.59.The average scores of the yin-deficiency type were higher than that of the damp-heat type.The above was tested by independent sample t test,and the difference was statistically significant(P<0.05).There was no significant difference in the ESSDAI disease activity score between the two groups(P>0.05).Conclusion: 1.The average age of patients with damp-heat type p SS is lower than that of patients with yin-deficiency type p SS.2.The proportion of patients with damp-heat type involving the urinary system,nervous system and digestive system is more than that of yin deficiency type.The proportion of patients with yin-deficiency type involving the blood system is more than that of damp-heat type.It has certain reference significance in the clinical characteristics of patients with two types of classification.3.The number of patients with elevated urinary p H in the damp-heat group was more than that in the yin-deficiency group,which may be related to hot and humid injection and urinary system,renal tubular acidosis.Patients with yin-deficiency type have more Hb reduction than damp-heat type,and deficiency of yin-fluid and blood may be its main pathogenesis.4.The average score of TCM syndromes in patients with yin-deficiency type is greater than that of damp-heat type,suggesting that patients with yin-deficiency type are more likely to have more significant clinical symptoms.5.The incidence of yin-deficiency type and damp-heat type p SS was 2.89%.The yin-deficiency type included lymphoma,thyroid cancer,breast ductal carcinoma,right foot malignant melanoma;and damp-heat type included thyroid cancer,breast cancer and endometrial cancer.According to global cancer statistics in 2018,the incidence of cancer in China is 0.029%.The incidence of tumors in p SS in this study was higher than that in China in 2018,suggesting that tumors may be associated with p SS and should be noted in clinicalwork.