湿热证黄腻苔与类风湿关节炎的相关性探析
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摘要
舌诊是望诊的重要部分,通过观察患者舌质、舌苔的形状和质地以诊察疾病的方法。舌苔由脾胃之气上熏于舌背而成,根据邪气的寒热虚实不同,舌苔的病理性表现亦有所差异。黄腻苔是湿热证的特征性表现之一,司外揣内,而预判体内的疾病变化。类风湿关节炎的发病,是机体免疫失衡的结果,其影响因素众多。文章以湿热证黄腻苔为立论点,从其成因、现代研究,中医病机及其与炎症细胞因子、菌群变化、疾病活动度等方面探讨二者相关性,以探寻是否有可量化的指标,从而辅助疾病的诊断,并为后续的基础及临床研究提供些许思路。
The diagnosis of tongue is an important part of the clinic.The patient′s tongue shape and texture can be used to examine the disease.The tongue coating is made from the spleen and stomach.It is based on the cold and heat of the evil,and the pathological performance of the tongue is also different.Yellow greasy tongue coating is one of the characteristic manifestations of dampness and heat syndrome.The onset of rheumatoid arthritis is the result of the body′s immune imbalance,and it has many influencing factors.In this paper,the damp-heat syndrome yellow greasy tongue coating as a point of argument,from its causes,modern research,pathogenesis of traditional Chinese medicine and inflammatory cytokines,changes in bacterial flora,disease activity and other aspects,it explores whether there is quantifiable indicators to assist in the diagnosis of disease and provide some ideas for follow-up basic and clinical research.
The diagnosis of tongue is an important part of the clinic.The patient′s tongue shape and texture can be used to examine the disease.The tongue coating is made from the spleen and stomach.It is based on the cold and heat of the evil,and the pathological performance of the tongue is also different.Yellow greasy tongue coating is one of the characteristic manifestations of dampness and heat syndrome.The onset of rheumatoid arthritis is the result of the body′s immune imbalance,and it has many influencing factors.In this paper,the damp-heat syndrome yellow greasy tongue coating as a point of argument,from its causes,modern research,pathogenesis of traditional Chinese medicine and inflammatory cytokines,changes in bacterial flora,disease activity and other aspects,it explores whether there is quantifiable indicators to assist in the diagnosis of disease and provide some ideas for follow-up basic and clinical research.
引文
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[4] 李响,张军峰,杨亚平.舌苔形成的微生态学机制探讨[J].辽宁中医杂志,2014,41(6):1102-1106.
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[12] 姜泉,蒋红,曹炜,等.475 例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[13] 王志中,方勇飞,罗彦,等.322 例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究[J].中国中西医结合杂志,2011,31(4):466-470.
[14] 刘德芳,晏姣,郭明阳,等.类风湿关节炎湿热痹阻型患者血清和滑膜液IL-17与ESR、CRP的相关性研究[J].中国中西医结合杂志,2014,34(3):272-275.
[15] Miossec P,Korn T,Kuchroo VK.Interleukin-17 and type 17 helper T cells[J].Mechanisms Dis,2009,361(9):888-898.
[16] 阎翔,郭明阳.温病湿热证湿重于热动物模型舌的病理观察[J].安徽中医学院学报,2005(1):19-21.
[17] 吕军影,黄李平,阙铁生,等.湿热证患者舌苔微生态的研究[J].辽宁中医杂志,2008(4):487-488.
[18] 朱莲娜,黄李平,吕军影,等.微生态学方法在湿热证舌苔微生物群研究中的应用[J].广西医学,2009,31(4):480-482.
[19] Lange L,Thiele GM,McCracken C,et al.Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis[J].Pediatr Rheumatol Online J,2016,14(1):8.
[20] Potikuri D,Dannana KC,Kanchinadam S,et al.Periodontal disease is significantly higher in non-smoking treatment-naive rheumatoid arthritis patients:results from a case-control study[J].Annals of the Rheumatic Diseases,2012,71(9):1541-1544.
[21] 庞立园,丁锐,张瑾,等.菌群变化对类风湿关节炎的影响[J].中国微生态学杂志,2016,28(12):1477-1479.
[22] Zhang X,Zhang D,Jia H,et al.The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment[J].Nature Medicine,2015,21(8):895-905.
[23] 陈延强,谢丽萍.类风湿关节炎湿热痹阻证的舌象与活动性指标关系的研究[J].辽宁中医杂志,2013,40(6):1068-1070.
[24] 李航,段惠军.Nrf2/ARE信号通路及其调控的抗氧化蛋白[J].中国药理学通报,2011,27(3):300-303.
[25] 郭锦晨,刘健,忻凌,等.湿热痹阻型类风湿关节炎患者超氧化物歧化酶的变化及关联规则挖掘研究[J].中国临床保健杂志,2017,20(2):185-188.
[26] 张皖东,曹云祥,盛长健,等.类风湿关节炎辨证分型与外周血T细胞亚群的关系[J].中医药临床杂志,2011,23(6):514-516.
[27] 张志明,刘叶,金冬梅.温病湿热证与免疫功能关系的研究进展[J].中华中医药学刊,2014,32(1):99-101.
[28] 刘叶.清热化湿透表法干预小鼠流感病毒性湿热证免疫损伤的机理研究[D].广州:广州中医药大学,2008.
[2] 辛瑛,郭霞珍,张莉莎.舌诊[M].天津:天津科技翻译出版公司,2001:59.
[3] 朱文峰.中医诊断学[M].北京:中国中医药出版社,2002:79.
[4] 李响,张军峰,杨亚平.舌苔形成的微生态学机制探讨[J].辽宁中医杂志,2014,41(6):1102-1106.
[5] 张昕洋,郭子宁.舌苔与病、证探讨[J].北京中医药大学学报,2015,38(6):373-376.
[6] 张平,水文霞,杜月光.黄腻苔舌脱落上皮细胞的形态计量分析[J].中国体视学与图像分析,2001,6(1):13-15.
[7] 阙铁生,卓冬婷,吕军影,等.脾胃湿热证黄腻苔与舌上皮细胞凋亡和细菌总数的关系探讨[J].时珍国医国药,2011,22(3):692-693.
[8] 吴凡,董昌武,周雪梅.呼吸及消化系统疾病黄腻苔微生态学与舌苔脱落细胞凋亡指数的比较[J].长春中医药大学学报,2014,30(5):874-875,905.
[9] 鲁明源,迟华基.现代生活方式与人类体质演化[J].山东中医药大学学报,2002,26(1):48-52.
[10] 路志正.北方亦多湿续论[J].中华中医药杂志,2006(9):515-518.
[11] 姜泉.痹病必挟瘀[J].北京中医,1994(5):12.
[12] 姜泉,蒋红,曹炜,等.475 例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[13] 王志中,方勇飞,罗彦,等.322 例湿热痹阻型及寒湿痹阻型类风湿关节炎中医证型的客观化研究[J].中国中西医结合杂志,2011,31(4):466-470.
[14] 刘德芳,晏姣,郭明阳,等.类风湿关节炎湿热痹阻型患者血清和滑膜液IL-17与ESR、CRP的相关性研究[J].中国中西医结合杂志,2014,34(3):272-275.
[15] Miossec P,Korn T,Kuchroo VK.Interleukin-17 and type 17 helper T cells[J].Mechanisms Dis,2009,361(9):888-898.
[16] 阎翔,郭明阳.温病湿热证湿重于热动物模型舌的病理观察[J].安徽中医学院学报,2005(1):19-21.
[17] 吕军影,黄李平,阙铁生,等.湿热证患者舌苔微生态的研究[J].辽宁中医杂志,2008(4):487-488.
[18] 朱莲娜,黄李平,吕军影,等.微生态学方法在湿热证舌苔微生物群研究中的应用[J].广西医学,2009,31(4):480-482.
[19] Lange L,Thiele GM,McCracken C,et al.Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis[J].Pediatr Rheumatol Online J,2016,14(1):8.
[20] Potikuri D,Dannana KC,Kanchinadam S,et al.Periodontal disease is significantly higher in non-smoking treatment-naive rheumatoid arthritis patients:results from a case-control study[J].Annals of the Rheumatic Diseases,2012,71(9):1541-1544.
[21] 庞立园,丁锐,张瑾,等.菌群变化对类风湿关节炎的影响[J].中国微生态学杂志,2016,28(12):1477-1479.
[22] Zhang X,Zhang D,Jia H,et al.The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment[J].Nature Medicine,2015,21(8):895-905.
[23] 陈延强,谢丽萍.类风湿关节炎湿热痹阻证的舌象与活动性指标关系的研究[J].辽宁中医杂志,2013,40(6):1068-1070.
[24] 李航,段惠军.Nrf2/ARE信号通路及其调控的抗氧化蛋白[J].中国药理学通报,2011,27(3):300-303.
[25] 郭锦晨,刘健,忻凌,等.湿热痹阻型类风湿关节炎患者超氧化物歧化酶的变化及关联规则挖掘研究[J].中国临床保健杂志,2017,20(2):185-188.
[26] 张皖东,曹云祥,盛长健,等.类风湿关节炎辨证分型与外周血T细胞亚群的关系[J].中医药临床杂志,2011,23(6):514-516.
[27] 张志明,刘叶,金冬梅.温病湿热证与免疫功能关系的研究进展[J].中华中医药学刊,2014,32(1):99-101.
[28] 刘叶.清热化湿透表法干预小鼠流感病毒性湿热证免疫损伤的机理研究[D].广州:广州中医药大学,2008.