胚胎停育发病相关因素及中医证候、体质类型的调查研究

发布时间：2018-08-26 08:18

【摘要】：目的:通过收集胚胎停育患者资料,探讨引起胚胎停育的相关高危因素;统计分析该病的中医证候特点及体质类型,为胚胎停育的中医药防治提供参考依据,据此通过对孕前体质进行辨识,调节易感体质,以减少胚胎停育的发生发展,体现中医"治未病"的理念和优势,为中医药认识和防治胚胎停育提供了新的思路和方法。方法：以就诊于北京中医药大学东方医院妇科门诊及病房的有过胚胎停育病史的患者为研究对象,设计胚胎停育一般情况调查表、中医体质自测表,通过收集患者一般情况、辅助检查结果、中医四诊资料、体质类型,运用Excel软件及SPSS 19.0统计学软件对数据进行分析,探讨与胚胎停育发病相关的不良因素,探究中医证型特点及体质类型。结果:1.胚胎停育以31-35岁发病率最高,比例为43%,平均年龄31.49土0.372岁。2.胚胎停育患者文化程度以大学及以上者最多见,高中以其以下的人群所占比例较小,并且随着文化程度的增高,发病率随之增高。高发人群多集中在职业紧张程度大、脑力劳动为主的职业中,包括:医药类、教育文化类、金融贸易、文员相关、设计相关、国营公务等。3.胚胎停育发生的次数最少为1次,最多为4次,范围为1-4次;发病时孕周以6-8周多见。4.本次调查中,诸多与胚胎停育发生有关的危险因素中,熬夜、接触噪音、被动吸烟占据前三位。5.本次调查的患者每日接触电脑及手机的时间,最短为2小时,最长为16小时。其中以每日接触电脑及手机的时间在11h-14h之间最多见。6.本次调查中,有36%的胚胎停育患者的饮食偏好辛辣。7.胚胎停育患者月经情况以经色紫黯、有血块、量少为主要表现;带下情况以带下量少,质粘稠,色黄白为主要表现;全身状况以以腰膝酸软最多见,其次为经前乳房胀痛、神疲乏力、畏寒肢冷。提示该病虚实夹杂,虚证以肾虚、脾虚、气血虚弱为主、实证以气滞、血瘀、痰湿为主。8.本次调查,实验室检查异常项目中,以孕激素偏低最为常见,比例约为21.1%,其次为亚临床甲减,比例为15.2%;患者的血型以B型最多,共54人,比例为31.6%;其次为A型、0型,比例均为23.4%;AB型的比例最少,为21.6%;有148位患者的爱人进行过精液检查,在这148位中,异常项主要包括精子活力低,比例为10.5%;另一项为精子形态异常:畸形率高,比例为3.5%。9.常见中医证型分布:肾虚肝郁型(34.5%),肾虚血瘀(17.5%)、肾虚痰湿(15.8%)、脾肾两虚(13.5%)、肾阳虚(10.5%)、气血虚弱(8.2%)10.体质分布特点:阳虚质所占比例最高,为26.3%,其次为气郁质,比例为22.2%,再者为平和质(18.1%),接下来依次为湿热质(8.2%)、痰湿质(4.1%)、特禀质和阴虚质(均为3.5%)、血瘀质(2.9%)结论:1.胚胎停育患者的年龄多集中在31岁以上。2.胚胎停育以文化程度高、职业紧张程度大的脑力劳动工作者较为多见,高发职业有:医药类、教育文化类、金融贸易、文员相关、设计相关、国营公务。3.胚胎停育发生时的孕周以6-8周之间常见。4.辨证分型中,肾虚肝郁型最多,依次为肾虚血瘀、肾虚痰湿、脾肾两虚、肾阳虚、气血虚弱。5.体质类型以阳虚质、气郁质最多见。6.相关检查项目中,以TORCH的未检查率最高,其次支原体、衣原体的检测,提示患者对这三项检测的重要性认识不足。7.相关疾病中,以孕激素偏低、亚临床甲减、子宫肌瘤占调查结果的前三位。
[Abstract]:Objective: To investigate the high risk factors of embryonic cessation by collecting the data of patients with embryonic cessation, analyze the characteristics of TCM syndromes and constitution types of embryonic cessation, and provide reference for the prevention and treatment of embryonic cessation. The concept and advantages of "treating pre-disease" in traditional Chinese medicine (TCM) provide a new idea and method for TCM to recognize and prevent embryo cessation.Methods: Taking the patients who had been diagnosed with embryo cessation in the gynecological clinic and ward of Oriental Hospital of Beijing University of Traditional Chinese Medicine as the research object, the general situation questionnaire of embryo cessation was designed, and the self-test table of TCM constitution was adopted. After collecting the general situation of patients, the results of auxiliary examination, the four diagnostic materials of traditional Chinese medicine, the type of constitution, using Excel software and SPSS 19.0 statistical software to analyze the data, to explore the adverse factors associated with embryo cessation, to explore the characteristics of TCM syndrome types and constitutional types. The average age was 31.49 Tu 0.372.2. Most of the patients with embryo cessation were college or above. The proportion of the people below high school was small, and the incidence increased with the increase of education level. 3. Embryo cessation occurs at least once, at most four times, ranging from 1 to 4 times; the gestational age at onset is more than 6-8 weeks. 4. In this survey, many risk factors related to embryo cessation, such as staying up late, exposure to noise, passive smoking occupied the top three.5. This survey In this survey, 36% of the embryonic cessation patients had a spicy diet preference. 7. The menstrual state of the embryonic cessation patients was characterized by purple menstruation, blood clots and low dosage. The main manifestations of the disease are less bandage, viscous texture and yellowish-white color; the most common general condition is soreness and weakness of the waist and knee, followed by pain and distention of the breast before menstruation, fatigue of the mind, fear of cold and limbs. Among them, low progesterone was the most common, accounting for 21.1%, followed by subclinical hypothyroidism, accounting for 15.2%; 54 patients with B blood type, accounting for 31.6%; followed by A, 0, accounting for 23.4%; AB, accounting for the least proportion, accounting for 21.6%; 148 patients with a loved one had semen examination, of which the abnormal items mainly included sperm. The abnormal sperm morphology rate was 3.5%. 9. Distribution of common TCM syndrome types: kidney deficiency and liver depression (34.5%), kidney deficiency and blood stasis (17.5%), kidney deficiency and phlegm dampness (15.8%), spleen and kidney deficiency (13.5%), kidney yang deficiency (10.5%) and Qi and blood deficiency (8.2%) was the highest, followed by Yang deficiency and blood deficiency (26.3%). Qi depression (22.2%) was found in 22.2% of the patients, and then was calm (18.1%), followed by dampness-heat (8.2%), phlegm-dampness (4.1%), special temperament and yin deficiency (3.5%) and blood stasis (2.9%). Conclusion: 1. Most of the patients with embryo cessation were over 31 years old. 2. Brain workers with high educational level and high occupational stress were more likely to have embryo cessation. See, the high-incidence occupations are: medicine, education and culture, finance and trade, clerk-related, design-related, state-owned public affairs.3. Embryo cessation occurs in the gestational week between 6-8 weeks common.4. Syndrome differentiation, kidney deficiency and liver depression type is the most, followed by kidney deficiency and blood stasis, kidney deficiency and phlegm-dampness, spleen and kidney deficiency, kidney-yang deficiency, Qi and blood deficiency.5. Among the related examinations, TORCH had the highest rate of non-examination, followed by the detection of Mycoplasma and chlamydia, suggesting that the importance of these three examinations was not well understood. 7. Among the related diseases, low progesterone, subclinical hypothyroidism and hysteromyoma accounted for the first three.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

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