1153例寒湿痹阻证类风湿关节炎患者真实世界用药规律研究OA

Objective To analyze the medication patterns of traditional Chinese medicine(TCM)in treating rheumatoid arthritis(RA)of cold-dampness obstruction syndrome(Hanshi Bizu Zheng)based on data mining,providing clinical reference.Methods A retrospective analysis was conducted on clinical data of RA patients from the"Ask Rheumatism Patient Platform"between January 2019 and December 2022.Statistical methods,including frequency analysis,association rule analysis,and hierarchical clustering analysis,were applied to the TCM prescriptions.Results The study included 1,153 clinical records.Among them,437 cases(37.90%)showed significant improvement in the Clinical Disease Activity Index(CDAI).Commonly used formulas included Guizhi Shaoyao Zhimu Tang and Wutou Tang.High-frequency herbs included Baishao(Paeoniae Radix Alba),Gancao(Glycyrrhizae Radix Et Rhizoma),and Mahuang(Ephedrae Herba),totaling 27 herbs.Common herb combinations in the treatment included Baishao-Gancao and Baishao-Guizhi.Through hierarchical clustering analysis,four distinct herb clusters were identified.Among these,Cluster Ⅱ—comprising herbs such as Baishao,Gancao,Guizhi(Cinnamomi Ramulus),Zhimu(Anemarrhenae Rhizoma),and Fangfeng(Saposhnikoviae Radix)—may serve as the core prescription for managing RA characterized by cold-dampness obstruction syndrome.In the long-disease-duration group,herbs for activating blood,dispelling wind,tonifying the liver and kidney were predominant,while in the short-disease-duration group,herbs for dispersing pathogens,relieving the exterior,strengthening the spleen,and resolving dampness were more common.The improvement rate for the main symptom(aversion to wind and cold)was 32.87%,while improvement rates for accompanying symptoms(fatigue,insomnia,poor appetite)were 28.45%,30.27%,and 27.32%,respectively.After excluding herbs recommended in the Guidelines for Combined Disease and Syndrome Diagnosis and Treatment of Rheumatoid Arthritis,it was found that Jianghuang(Curcumae Longae Rhizoma)and Xuduan(Dipsaci Radix)improved fatigue;Qianghuo(Notopterygii Rhizoma Et Radix)and Shudihuang(Rehmanniae Radix Praeparata)improved insomnia;and Gusuibu(Drynariae Rhizoma)and Shudihuang improved poor appetite.Conclusion In real-world clinical practice,TCM demonstrates certain efficacy and identifiable medication patterns in treating RA of cold-dampness obstruction syndrome.Cluster Ⅱ may represent the core prescription for reducing CDAI in patients.Some herbs not only alleviate main symptoms but also significantly improve common accompanying symptoms.