Clinical Study On Syndrome Differentiation And Treatment Of Primary Sjögren's Syndrome Based On Latent Class Analysis Of The Method Of Removing Heat And Retaining Flui

Objective: Primary Sj?gren’s syndrome(p SS)is highly heterogeneous.By clustering the four major symptoms of dryness,pain,fatigue and anxiety and depression,reflecting the differences in clinical characteristics,immunological indexes and treatment response of each symptom group,we explore whether Chinese medicine treatment has therapeutic differences for different disease subgroups of theprimary Sj?gren’s sy ndrome.Methods: A Based on potential category analysis,344 patients with primary Sj?gren’s syndrome from October 01,2018,to October 30,2022,who were seen in our department were clustered and one-way analysis of variance(ANOVA)was used to analyze clinical symptoms,signs,and laboratory findings between different symptom groups.The consistency test Kappa test was used to determine whether there was a correlation between Western medicine based on symptom stratification and the primary evidence type in Chinese medicine.After 12 weeks of treatment with Chinese medicine based on the method of withdrawing heat and preserving fluid,the χ2 test was used to investigate the differences between the response rates of the symptom groups,and multivariate stepwise logistic regression analysis was used to explore the risk factors for poor response rates.Results: 1.Based on the four main symptoms of primary Sj?gren’s syndrome dryness,fatigue,pain and anxiety-depression symptoms based on potential category analysis 344 patients could be divided into 1)high symptom burden in all categories,i.e.high symptom burden group(56 individuals);2)pain dominant symptom group with high pain,low-moderate dryness and low fatigue(57 individuals);3)high dryness,low pain and low-moderate fatigue " dryness-dominant symptom group(149);and 4)low-symptom burden group with low scores for all symptoms(82).Compared to the other three groups,the dry burden group was the oldest(55 [49-64])and the high symptom burden group had a longer disease duration(13.5 [5.25-46.5])and a higher index ESSPRI value(5.7 [5.3-6]).In terms of signs and laboratory tests,the high symptom burden group and the dry predominant burden group had a higher proportion of rampant dental and parotid enlargement presentations.The low symptom burden group had a higher proportion of purpura(17.1%)manifestations.The high symptom burden group had a higher rate of rheumatoid factor positivity(76.8%);while the dryness-predominant burden group tended to have a higher rate of cold globulin positivity(49.0%).In addition,compared with the other three groups,the high symptom burden group was more likely to have renal damage(11.1%),peripheral nerve damage(10.7%)and a higher risk of concurrent solid tumours(10.7%);the pain predominant burden group was more likely to have pulmonary damage(17.5%)and central nervous system damage;the dry predominant burden group was more likely to have leukopenia(34.9%),while the low symptom burden group was more likely to have combined immune thrombocytopenia(20.7%)as well as autoimmune thyroiditis(18.3%).2.Based on the clustering of the symptoms of primary Sj?gren’s syndrome and the correlation on the TCM evidence types,there were correlations between Yin deficiency and heat toxicity evidence and high symptom burden group,dry heat and blood stasis evidence and pain-based burden group,Yin deficiency and dry heat evidence and dryness-based burden group,and Qi and Yin two deficiency evidence and low symptom burden group,but the correlation was not high.3.In primary Sj?gren’s syndrome,there were differences in response rates among the groups based on the evidence-based treatment with the method of withdrawing heat and preserving fluid,with the method of withdrawing heat and preserving fluid showing good results in the high symptom burden group and the dryness-oriented burden group,followed by the pain-oriented burden group,and relatively poor efficacy in the low symptom burden group.Low ESSPRI score and combined purpura and thrombocytopenia were independent risk factors for poor response rate of treatment in the low symptom burden group.Conclusion: Based on symptoms,patients with primary Sj?gren’s syndrome can be divided into four clinical subgroups,each with different clinical features and laboratory findings.The stratification based on symptoms correlated with the main evidence types in TCM,but the correlation was poor.The method of identifying and treating the symptoms by withdrawing heat and storing fluid was effective in reducing the disease activity(ESSPRI score)of primary Sj?gren’s syndrome,especially in the high symptom burden group and the dryness-oriented symptom group;low ESSPRI score,combined purpura and thrombocytopenia were the key factors for the low response rate of Chinese medicine treatment in the low symptom burden group.