【目的】 分析类风湿关节炎患者的中医证型分布及其与血清同型半胱氨酸（Hcy）、C反应蛋白（CRP）的相关性。【方法】 选 取2021年12月至2023年12月山东大学齐鲁医院德州医院收治的186例类风湿关节炎患者作为研究组，根据中医辨证分型标 准将患者分为寒湿痹阻证、气血两虚证、痰瘀痹阻证、肝肾不足证4种中医证型；另外，纳入同期在山东大学齐鲁医院德州 医院体检的100例健康志愿者作为健康对照组。分析类风湿关节炎患者的中医证型分布，比较研究组与对照组及不同中医证 型患者血清Hcy、CRP水平，并采用Pearson分析类风湿关节炎患者血清Hcy、CRP水平与不同中医证型病情严重程度的相关 性。【结果】（1）中医证型分布方面，研究组的 186 例类风湿关节炎患者中，寒湿痹阻证 41 例（22.04%），痰瘀痹阻证 40 例 （21.51%），气血两虚证 50例（26.88%），肝肾不足证 55例（29.57%）。（2）血清 Hcy、CRP水平方面，研究组的血清 Hcy和 CRP 水平分别为（7.61 ± 2.07）μmol/L和（27.93 ± 5.92）mg/L，均高于健康对照组的（5.33 ± 0.91）μmol/L和（1.85 ± 0.67）mg/L，差异均 有统计学意义（P < 0.01）；不同中医证型患者血清Hcy、CRP水平比较，差异均有统计学意义（F = 7.637，P < 0.01；F = 5.639， P < 0.01）。其中，以寒湿痹阻证患者的血清Hcy、CRP水平最高，其他依次为痰瘀痹阻证、气血两虚证和肝肾不足证患者， 组间两两比较，差异均有统计学意义（P < 0.05）。（3）相关性方面，经Pearson相关性分析，28个关节疾病活动度（DAS28）评分 与血清Hcy、CRP水平均呈正相关关系（r = 0.396，P < 0.01；r = 0.407，P < 0.01）；血清Hcy、CRP水平与类风湿关节炎不同 中医证型病情严重程度均呈正相关关系（P < 0.05或P < 0.01）。【结论】 类风湿关节炎患者血清Hcy、CRP表达异常升高；血清 Hcy、CRP表达水平与不同中医证型密切相关，其中以寒湿痹阻证的表达水平最高。

Objective To investigate the distribution of traditional Chinese medicine（TCM）syndrome types in patients with rheumatoid arthritis（RA）and to explore their correlation with serum homocysteine（Hcy）and C-reactive protein（CRP）levels. Methods From December 2021 to December 2023，a total of 186 RA patients admitted to Dezhou Hospital of Qilu Hospital of Shandong University were selected as the study group，and the patients were classified into four TCM syndrome types according to the criteria of TCM syndrome differentiation，namely colddamp blockage syndrome，qi and blood deficiency syndrome，phlegm-stasis blockage syndrome，deficiency of liver and kidney syndrome. Moreover，100 healthy volunteers who had physical examination at the same hospital during the same period were included as the healthy control group. The distribution of TCM syndrome types in RA patients was investigated，the serum Hcy and CRP levels in the two groups and in RA patients with various TCM syndrome types were observed，and then Pearson 􀆳s correlation was used for explorating the correlation of serum Hcy and CRP levels with severity of illness of RA patients with different TCM syndrome types. Results（1） Among the 186 RA patients in the study group，there were 41 cases（22.04%）of cold-damp blockage syndrome，40 cases（21.51%）of phlegm-stasis blockage syndrome，50 cases（26.88%）of qi and blood deficiency syndrome，and 55 cases（29.57%）of deficiency of liver and kidney syndrome.（2）The serum Hcy and CRP levels in the study group were（7.61 ± 2.07）μmol/L and（27.93 ± 5.92）mg/L，respectively，which were higher than those of the healthy control group （[ 5.33 ± 0.91）μmol/L and（1.85 ± 0.67）mg/L，respectively]，and the differences were statistically significant（P < 0.01）. Statistically significant differences of serum Hcy and CRP levels were shown among the patients with various TCM syndrome types（F = 7.637，P < 0.01；F = 5.639，P < 0.01）. The serum levels of Hcy and CRP in patients with cold-damp blockage syndrome were the highest，and the levels in patients with phlegm-stasis blockage syndrome， qi and blood deficiency syndrome， and deficiency of liver and kidney syndrome were in decreasing sequence. The pairwise comparison between groups showed that the differences were statistically significant（P < 0.05）.（3）Pearson􀆳s correlation analysis showed that Disease Activity Score in 28 joints （DAS28）scores were positively correlated with serum Hcy and CRP levels（r = 0.396，P < 0.01；r = 0.407，P < 0.01），and the serum Hcy and CRP levels were positively correlated with the severity of illness in RA patients with different TCM syndrome types（P < 0.05 or P < 0.01）. Conclusion The expression of serum Hcy and CRP in patients with RA is abnormally increased，and the expression levels of serum Hcy and CRP are correlated with TCM syndrome types. RA patients with cold-damp blockage syndrome have the highest expression levels of serum Hcy and CRP.

R259.322

国家自然科学基金项目（编号：81601368）；山东省中医药科技计划项目（编号：2020M176）