【目的】 探讨痛风性关节炎骨侵蚀的中医证型分布特点及相关因素分析。【方法】 选择2021年11月至2023年11月在佛 山市中医院风湿免疫科住院治疗且行骨肌彩超检查的痛风性关节炎患者共318例，根据骨肌彩超是否出现骨侵蚀，将患者分 为痛风性关节炎伴骨侵蚀组（骨侵蚀组）142例和痛风性关节炎不伴骨侵蚀组（非骨侵蚀组）176例。收集痛风性关节炎患者住 院期间的临床资料，包括性别、年龄、身高、体质量、体质量指数（BMI）、收缩压、舒张压、痛风病程、 骨肌彩超结果、 血常规[白细胞计数（WBC）、血小板计数（PLT）、血红蛋白（Hb）、红细胞计数（RBC）]、血尿酸（UA）、肌酐（Cr）、红细胞沉降 率（ESR）、C反应蛋白（CRP）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）等。比较骨侵蚀组与非骨侵蚀组患者的一般资 料、实验室指标、中医证型分布差异，初步探讨痛风性关节炎骨侵蚀的影响因素。【结果】（1）一般资料方面，骨侵蚀组患者 的痛风病程明显长于非骨侵蚀组，BMI略低于非骨侵蚀组，差异均有统计学意义（P＜0.05或 P＜0.01）；而 2组患者的年龄、 身高、体质量、收缩压和舒张压比较，差异均无统计学意义（P＞0.05）。（2）实验室指标方面，骨侵蚀组患者的Cr、UA、ESR 及 TC 水平均明显高于非骨侵蚀组，差异均有统计学意义（P＜0.05 或 P＜0.01）；而 2 组患者的 CRP、WBC、RBC、PLT 及 LDL-C 水平比较，差异均无统计学意义（P＞0.05）。（3）中医证型分布方面，骨侵蚀组患者以瘀热阻滞证所占比例最多 （33.10%），其他从高到低依次为痰浊阻滞证（29.58%）、湿热蕴结证（22.54%）及肝肾阴虚证（14.79%）；非骨侵蚀组患者以湿 热蕴结证所占比例最多（38.07%），其他从高到低依次为肝肾阴虚证（32.95%）、痰浊阻滞证（14.77%）及瘀热阻滞证（14.20%）。 2组患者的中医证型分布比较，差异有统计学意义（P＜0.01）。（4）影响因素方面，Logistic 回归分析结果提示：ESR、UA、TC 水平越高，痛风病程越长，中医证型为瘀热阻滞证和痰浊阻滞证是痛风性关节炎骨侵蚀的危险因素（P＜0.05 或 P＜0.01）。 【结论】 痛风性关节炎伴骨侵蚀患者的UA、ESR、Cr及TC水平均较痛风性关节炎不伴骨侵蚀患者高；与痛风性关节炎不伴 骨侵蚀患者相比，痛风性关节炎伴骨侵蚀患者的病程普遍偏长，中医证型主要以瘀热阻滞证与痰浊阻滞证为主；痛风性关 节炎骨侵蚀的发生与UA、ESR、TC水平及痰浊阻滞证、瘀热阻滞证密切相关。

Objective To investigate the characteristic distribution of traditional Chinese medicine（TCM） syndrome types in gouty arthritis patients complicated with bone erosion， and to analyze the associated factors. Methods A total of 318 gouty arthritis patients hospitalized in the Rheumatology and Immunology Department of Foshan Hospital of Traditional Chinese Medicine between November 2021 and November 2023 were included. The patients were allocated to a bone erosion group（142 cases） and a non-bone erosion group（176 cases） according to the findings of musculoskeletal ultrasound. The clinical data of gender， age， body height， body mass，body mass index（BMI），systolic blood pressure（SBP），diastolic blood pressure（DBP），course of gout，findings of musculoskeletal ultrasound， complete blood count [white blood cell count（WBC）， platelet count （PLT），hemoglobin（Hb），and red blood cell count（RBC）]，blood uric acid（UA），creatinine（Cr），erythrocyte sedimentation rate（ESR）， C-reactive protein（CRP）， total cholesterol（TC）， and low-density lipoprotein cholesterol（LDL-C） of the patients during hospitalization were collected. Differences in general information， laboratory parameters，and distribution of TCM syndrome types were compared between the two groups，and then the potential influencing factors of bone erosion in gouty arthritis patients were explored. Results （1） Analysis of general information showed that the bone erosion group had longer course of gout and slightly lower BMI than that the non-bone erosion group， and the differences were statistically significant（P＜0.05 or P＜0.01）. However， there were no statistically significant differences in age， body height， body mass， SBP and DBP among the patients of the two groups（P > 0.05）（. 2） Analysis of laboratory indicators showed that the levels of Cr，UA，ESR and TC in the bone erosion group were significantly higher than those in the non-bone erosion group， and the differences were statistically significant（P＜0.05 or P＜0.01）. However，no statistically significant differences in the levels of CRP，WBC，RBC，PLT and LDL-C were presented between the two groups（P＞0.05）.（3）Analysis of the distribution of TCM syndromes showed that in the bone erosion group，stagnant-heat obstruction syndrome accounted for the largest proportion（33.10%）， followed by phlegm-turbidity obstruction syndrome（29.58%）， damp-heat accumulation syndrome（22.54%），and liver-kidney yin deficiency syndrome（14.79%）；in the nonbone erosion group，damp-heat accumulation syndrome accounted for the largest proportion（38.07%），followed by liver-kidney yin deficiency syndrome（32.95%），phlegm-turbidity obstruction（14.77%），and stagnant-heat obstruction（14.20%）. There was statistically significant difference in the distribution of TCM syndromes between the two groups（P＜0.01）.（4） The results of logistic regression analysis suggested that the higher the levels of ESR， UA，and TC，the longer the course of gout. And the TCM syndromes of stagnant-heat obstruction and phlegmheat obstruction were the risk factors for bone erosion in gouty arthritis（P＜0.05 or P＜0.01）. Conclusion Gouty arthritis patients with bone erosion exhibit higher UA，ESR，Cr，and TC levels，longer course of disease，and higher incidence of stagnant-heat obstruction syndrome and phlegm-turbidity obstruction syndrome. Bone erosion in gouty arthritis is closely associated with elevated UA，ESR，TC，and some specific TCM syndrome patterns.

R259.897

广东省中医药局科研项目（编号：20210210）；佛山市自筹经费类科技创新项目（编号：2220001004676）