Preliminary Study On The Distribution Of TCM Syndromes And Related Factors Of Rheumatoid Arthritis-interstitial Lung Disease

Objective : Using epidemiological survey and statistical methods,Investigate the gender,age,course of disease,smoking history,clinical manifestations,laboratory and auxiliary examinations of patients with rheumatoid arthritis-interstitial lung disease(RA-ILD).Preliminary discussion on the distribution characteristics of TCM syndromes and related factors of RA-ILD in order to fully apply the advantages of TCM syndrome differentiation and treatment to the standardized diagnosis and treatment of RA-ILD,and provide references for the treatment and prevention of this disease.Methods : According to the research purpose of the project and clinical research content,a clinical information questionnaire was compiled.From January 2018 to December 2020,360 case data that met the RA-ILD clinical diagnostic criteria and case selection criteria were collected at the Yunnan Provincial Hospital of Traditional Chinese Medicine(Guanghua District and Dianchi District),including gender,age,course of disease,and smoking History,laboratory examinations and auxiliary examinations,etc.At the same time,360 RA patients were collected as controls.Using SPSS 25.0 software,statistical methods such as frequency analysis,cluster analysis,chi-square test,non-parametric rank sum test and other statistical methods were used to analyze the distribution characteristics of TCM syndromes and related factors in RA-ILD patients.Results:1.The cluster analysis results show that the clustering of TCM syndromes of 360RA-ILD subjects is the most reasonable in 4 categories.In order of frequency,there were151 cases with wind-cold-dampness arthralgia syndrome(41.9%)94 cases with phlegm stasis obstruction syndrome(26.1%),58 cases with deficiency of both qi and blood(16.1%),and 57 cases with deficiency of liver and kidney(15.8%).2.The general data of the RA-ILD group and the RA group were compared.The results showed that there were statistical differences in age,disease course,and smoking history between the two groups(P<0.05),and the difference in gender distribution was not statistically significant(P> 0.05).The RA-ILD group was compared with the RA group’s laboratory tests,and the results showed: ESR,CRP,CCP antibody titer,RF-Ig G titer,RFIg M titer and anti-U1-RNP antibody,anti-SSA antibody,anti-Ro-52 antibody positive rate was statistically different between the two groups(P<0.05),D-dimer,complement C3,complement C4,ANA preliminary screening,anti-SSB antibody,anti-Sm antibody,antiPM-Scl antibody,anti-Jo-1 antibody,anti-centromere antibody,anti-histone antibody,anti-ribosomal P protein antibody,anti-M2 antibody,AKA,P-ANCA,RF-Ig A titers were not statistically different between the two groups(P>0.05),but the average value of D-dimer in the two groups was higher than the normal level.360 cases of RA-ILD all showed different levels of pulmonary interstitial lesions,of which 136 cases(37.8%)were in the early stage of imaging,197 cases(54.7%)were in the fibrotic stage,and 27 cases(7.5%)were in the honeycomb stage.3.Through the analysis of RA-ILD TCM syndrome types and related factors,it is found that in the gender distribution and smoking history,there are more male patients with phlegm-stasis syndrome and more smokers.There are statistical differences compared with Qi-blood deficiency syndrome and wind-cold-dampness syndrome.There was no statistical difference among other syndrome types(P>0.05).In terms of the distribution of the disease course,the course of phlegm-stasis-bi-block syndrome is slightly shorter,which is statistically different from Qi-blood deficiency and liver-kidney deficiency(P<0.05),and there is no statistical difference among the other types of syndromes(P>0.05)).In terms of CRP,the syndrome phlegm-stasis-bi-block is relatively high,which is statistically different from the syndrome of wind-cold-dampness and arthralgia(P<0.05),and there is no statistical difference among the other types of syndromes(P>0.05)).On age distribution,ESR,D-dimer,complement C3,complement C4 and CCP,RF-Ig A,RF-Ig G,RF-Ig M titer,anti-U1-RNP antibody,anti-SSA antibody,anti-Ro-52 antibody,there was no statistical difference among the four syndrome types(P>0.05).In HRCT imaging staging,there are more patients with wind-cold-dampness arthralgia syndrome in the early stage,which is statistically different from phlegm stasis obstruction syndrome,qi-blood deficiency syndrome,liver and kidney deficiency syndromes(P<0.05),among other syndrome types There is no statistical difference(P>0.05).Conclusion:1.The common TCM syndrome types of RA-ILD are as follows: wind-cold-dampness syndrome,phlegm and blood stasis syndrome,qi and blood deficiency syndrome,liver and kidney deficiency syndrome.2.Older age,long course of disease,history of smoking,high ESR,CRP,CCP antibody titers,RF-Ig G titers,and RF-Ig M titers may be associated with secondary ILD.The positive rate of anti-U1-RNP antibody,anti-SSA antibody,and anti-Ro-52 antibody may also be related to the occurrence of ILD.Both RA patients and RA-ILD patients showed different degrees of hypercoagulability.3.Patients with an elder disease course are more common with Qi-blood deficiency syndrome and liver and kidney deficiency syndrome;Men and smoking are more likely to develop phlegm-stasis arthralgia syndrome,and the CRP value of patients with phlegmstasis arthralgia syndrome is relatively high;In the early stages of HRCT,it is mainly redundant,and wind-cold-damp syndrome is more common.The fibrosis stage and the honeycomb lung stage are mostly mixed syndromes of deficiency and redundant,eficiency syndromes,and most of them are syndromes of phlegm and blood stasis obstruction,deficiency of qi and blood,and deficiency of liver and kidney.It can provide objective basis for syndrome differentiation.