香港地区不孕症中医体质与证型分布及其他影响因素研究

发布时间：2018-07-10 08:57

本文选题：不孕症 + 中医证型　；参考：《广州中医药大学》2017年博士论文

【摘要】：目的通过对香港地区女性不孕症中医证型及体质进行调查研究,通过统计分析,了解不孕症患者中医证型及体质类型分布,找出本地区不孕症患者的常见中医证型与体质并探讨两者间的相关性;了解本地区不孕症的病因及其他影响因素,从中探讨这些影响因素与不孕症常见中医证型的关系,为本地区不孕症的治疗提供参考依据。方法采用方便样本调查方法,以2016年1至12月期间于香港工会联合会工人医疗所其下十间中医诊所及千金医馆就诊的病人及其认识的亲戚朋友中现正诊断为不孕症的患者作为调查研究对象,根据不孕症的诊断标准、纳入标准、排除标准选择符合标准的286例。通过问卷方式,并依据《中医体质分类与判定标准》、《中医妇科常见病诊疗指南》判定中医体质和证型,将所有数据录入计算机建立数据库,然后采用SPSS17.0统计软件进行统计分析。结果本次调查共发出问卷301份,收回291份,有效问卷286份,其中6份因病人未做相关检查做病因统计时排除。1.280例已做相关检查不孕症患者中,原发性不孕者占60.84%,继发性不孕者占39.16%。病因方面,有排卵相关性疾病的患者较多共103例,占36.79%;有输卵管阻塞性疾病的患者共82例,占29.28%;合并有输卵管阻塞性疾病和排卵相关性疾病的不孕症患者共14例,占5.00%;有其他病因的患者共81例,占28.93%。2.不孕症患者证型以肾阳虚证(19.93%)和肾气虚证(19.93%)较多,其他依次为肝气郁结证(18.53%)、肾阴虚证(13.99%)、痰湿内阻证(13.29%)、瘀滞胞宫证(11.54%)、湿热蕴结证(2.8%)。3.不孕症患者不同证型年龄不同,湿热蕴结证患者的年龄相对较小(32.00岁),肾阳虚证患者的年龄相对较大(36.40岁),不同体质年龄比较差异有统计学意义(P0.05)。年龄少于35岁不孕症患者以肝气郁结证比例最多,占25.00%;年龄35至40岁患者以肾阴虚证比例最多,占20.13%;年龄40岁或以上患者以肾气虚证和肾阳虚证比例最多,各占32.43%。不同证型年龄比较差异有统计学意义(P0.01)。4.不孕症患者不同证型患病年限不同,湿热蕴结证的病程相对较短(3年),肾阳虚证的病程相对较长(6年),不同证型病程比较差异有统计学意义(P0.01)。病程少于4年不孕症患者以肾气虚证和肝气郁结证比例最多,分别占23.47%和19.39%;病程4至7年患者以肝气郁结证比例最多,占22.61%,其次是肾阳虚证和肾气虚证,分别占17.39%和16.52%;病程7至10年和10年以上患者以肾阳虚证比例最多,分别占33.33%和36.84%。不孕症患者中医证型与病程段比较,差异有统计学意义(P0.05)。5.排卵相关性疾病方面,肾阳虚证患者较多(22.33%),湿热蕴结证相对较少,但不同证型间比较差异无统计学意义(P0.05);输卵管阻塞方面,瘀滞胞宫证患者较多(20.73%),其次为肾阳虚证(17.07%),湿热蕴结证相对较少,不同证型间比较差异有统计学意义(PO.01);排卵相关性疾病合并输卵管阻塞方面,肾阳虚证和瘀滞胞宫证患者较多(各占28.57%);其他病因方面,肾气虚症患者最多(30.86%),湿热蕴结证相对较少,不同证型间比较差异有统计学意义(P0.01)。输卵管阻塞、排卵相关性疾病与中医证型比较,差异无统计学意义(P0.05)。6.不孕症患者中医证型与饮酒频率(P0.01)、睡眠品质(P0.01)入睡时间(P0.01)、压力(P0.01)构成间不同;不孕症患者中医证型与原继发(P0.05)、教育程度(P0.05)、职业(P0.05)间差异无统计学意义。7.不孕症患者中医体质频次由高到低依次为阳虚质(19.93%)、气虚质(17.83%)、气郁质(13.99%)、阴虚质(11.89%)、血瘀质(10.14%)、平和质(8.74%)、痰湿质(8.04%)、湿热质(4.90%)、特禀质(4.55%)。8.不孕症患者不同体质年龄不同,湿热质的年龄相对较小(32岁),阴虚质的年龄相对较大(37岁),不同体质年龄比较差异有统计学意义(P0.05);年龄少于35岁不孕症患者以气虚质和阳虚质比例最多,分布占21.00%和18.00%;年龄35至40岁患者以阳虚质和阴虚质比例最多,分布占20.13%和17.45%;年龄40岁以上患者以阳虚质和气虚质比例最多,分别占24.32%和21.62%。不孕症患者中医体质与年龄段比较,差异无统计学意义(P0.05)。9.不孕症患者不同体质患病年期不同,湿热质的病程相对较短(3年),血瘀质的病程相对较长(7年),不同体质病程比较差异有统计学意义(P0.01);差异有统计学意义;病程1至4年不孕症患者以气虚质和阳虚质比例最多,各占17.35%:病程4至7年患者以气虚质和阳虚质比例最多,各占20.87%;病程7至10年不孕症患者以阳虚质和气郁质比例最多,分别占24.07%和20.37;病程10或以上患者以痰湿质比例最多,占31.58%;不孕症患者中医体质与病程段比较,差异有统计学意义(P0.05)。10.排卵相关性疾病方面,阳虚质患者较多(20.51%),其次为气虚质(17.95%);特禀质患者相对较少,但不同体质间比较差异无统计学意义(P0.05);输卵管阻塞方面,阳虚质患者较多(18.75%),其次为血瘀质和气郁质(各占15.63%),特禀质相对较少,不同体质间比较差异无统计学意义(P0.05);排卵相关疾病合并输卵管阻塞方面,血瘀质患者相对较多(28.57%),其次为阳虚质(21.43%),不同体质间比较差异无统计学意义(P0.05);其他病因方面,气虚质患者较多(19.75%)其次是阳虚质(18.52%)和阴虚质(17.28%),不同体质间比较差异无统计学意义(P0.05);输卵管阻塞、排卵相关性疾病与患者中医体质比较,差异无统计学意义(P0.05)。11.不孕症患者中医体质与证型比较(1)平和质患者中医证型频次由高到低依次为肾气虚证(28.00%)、肝气郁结证(24.00%)、肾阳虚证(20.00%)、肾阴虚证(12.00%)、痰湿内阻证(12.00%)、瘀滞胞宫证(4.00%),无湿热蕴结证患者;(2)气虚质患者中医证型频次由高到低依次为肾气虚证(39.22%)、肾阳虚证(27.45%)、痰湿内阻证(11.76%)、肝气郁结证(9.80%)、肾阴虚证(7.84%)、瘀滞胞宫证(3.92%),无湿热蕴结证患者;各中医证型分布差异有统计学意义(P0.01);(3)阳虚质患者中医证型频次由高到低依次为肾阳虚证(45.61%)、肾气虚证(28.07%)、痰湿内阻证(17.54%)、瘀滞胞宫证(5.26%)、肝气郁结证(3.51%),无肾阴虚证和湿热蕴结证患者;(4)阴虚质患者中医证型频次由高到低依次为肾阴虚证(61.76%)、瘀滞胞宫证(11.76%)、肾气虚证(8.82%)、肝气郁结证(8.82%)、痰湿内阻证(5.88%)、肾阳虚证(2.94%),无湿热蕴结证患者;(5)痰湿质患者中医证型频次由高到低依次为痰湿内阻证(36.78%)、肾阳虚证(21.74%)、肝气郁结证(17.39%)、肾气虚证(13.04%)、瘀滞胞宫证(8.70%)、湿热蕴结证(4.35%),无肾阴虚证患者;(6)湿热质患者中医证型频次由高到低依次为湿热蕴结证(50.00%)、痰湿内阻证(21.43%)、肝气郁结证(14.29%)、肾阴虚证(7.14%)、瘀滞胞宫证(7.14%),无肾气虚证和肾阳虚证患者;(7)血瘀质患者中医证型频次由高到低依次为瘀滞胞宫证(34.48%)、肝气郁结证(24.14%)、肾阳虚证(13.79%)、肾阴虚证(13.79%)、肾气虚证(10.34%)、痰湿内阻证(3.45%),无湿热蕴结证患者;(8)气郁质患者中医证型频次由高到低依次为肝气郁结证(55.00%)、瘀滞胞宫证22.50%)、肾阴虚证(15.00%)、痰湿内阻证(5.00%)、肾气虚证(2.50%),无肾阳虚证和湿热蕴结证患者;各中医证型分布差异有统计学意义(P0.01);(9)特禀质患者中医证型频次由高到低依次为肾气虚证(30.77%)、痰湿内阻证(23.08%)、肾阳虚证(15.38%)、肝气郁结证(15.38%)、肾阴虚证(7.69%)、瘀滞胞宫证(7.69%),无湿热蕴结证患者。(10)不孕症患者中医体质与证型比较,排除例数较少的湿热蕴结证,差异有统计学意义(P0.01)。12.不孕症患者常见中医体质与证型的相关性比较:阳虚质与肾阳虚证呈正相关关系;气虚质与肾气虚证呈正相关关系;气虚质与肝气郁结证和瘀滞胞宫证呈正相关关系。13.不孕症患者常见中医证型与其他影响因素的相关性比较:肾气虚证与压力呈负相关关系;肾阳虚证与压力呈负相关关系,与病程呈正相关关系;肝气郁结证与压力呈正相关关系。14.不孕症常见病因与其他影响因素的相关性排卵相关性不孕的发生与继发呈负相关关系;输卵管阻塞性不孕与继发呈正相关关系。结论1.香港地区女性不孕症患者的主要中医证型为肾阳虚证和肾气虚证,其次是肝气郁结证。2.香港地区女性不孕症患者的主要中医体质为阳虚质、气虚质及气郁质。3.不孕症患者阳虚质与肾阳虚证呈正相关关系;气虚质与肾气虚证呈正相关关系;气虚质与肝气郁结证和瘀滞胞宫证呈正相关关系。4.不孕症患者肾气虚证与压力呈负相关关系;肾阳虚证与压力呈负相关关系,与病程呈正相关关系;肝气郁结证与压力呈正相关关系。5.不孕症常见病因与其他影响因素的相关性排卵相关性不孕的发生与继发呈负相关关系;输卵管阻塞性不孕与继发呈正相关关系。
[Abstract]:Objective to investigate the TCM syndrome type and constitution of female infertility in Hongkong area, through statistical analysis, to find out the type of TCM syndrome and the distribution of physique type, find out the common TCM syndrome type and constitution of the infertile patients in this area and discuss the correlation between them, and understand the cause and other influence factors of the local infertility. The relationship between these factors and the common TCM syndrome types of infertility was discussed in order to provide reference for the treatment of infertility in the region. Methods using a convenient sample survey method, the patients and relatives of the ten Chinese medicine clinics and Qianjin medical centers of the Hongkong union union workers' Medical Institute from 1 to December 2016 A friend is now diagnosed with infertility as the subject of investigation. According to the criteria for diagnosis of infertility, the criteria are included, and 286 cases are selected to meet the standard. The computer set up a database and then used the SPSS17.0 statistical software to make statistical analysis. Results 301 questionnaires were sent out, 291 were recovered and 286 were valid. Among them, 6 cases were excluded from the diagnosis of the disease because of the patients did not do the related examination. Among the patients, the primary infertility accounted for 60.84% and secondary infertility. There were 103 cases of ovulatory related diseases in 103 cases, accounting for 36.79%, and 82 cases of oviduct obstructive disease, accounting for 29.28%, 14 cases with oviduct obstructive disease and 5% of oviposit related diseases, 81 cases of his causes, accounting for the syndrome type of 28.93%.2. infertile patients. With kidney yang deficiency syndrome (19.93%) and kidney qi deficiency syndrome (19.93%), the others were liver qi stagnation syndrome (18.53%), kidney yin deficiency syndrome (13.99%), phlegm damp internal resistance syndrome (13.29%), stasis hysteria syndrome (11.54%), damp heat syndrome (2.8%).3. infertility patients with different years of age, the age of damp heat syndrome patients were relatively small (32 years old), kidney yang deficiency syndrome patients Age is relatively large (36.40 years old), there is a significant difference in the age of different physiques (P0.05). The proportion of liver qi stagnation syndrome is the most in age less than 35 years of age, accounting for 25%, and the proportion of kidney yin deficiency syndrome is the most, accounting for 20.13%, age 35 to 40 years old, age 40 years old or upper patients with kidney qi deficiency syndrome and kidney yang deficiency syndrome the most, each accounting for 32.43%. The difference of age of different syndrome types was statistically significant (P0.01).4. infertility patients with different syndrome years were different, the course of damp heat syndrome was relatively short (3 years), the course of kidney yang deficiency syndrome was relatively long (6 years), the difference of different syndrome types was statistically significant (P0.01). The course of disease was less than 4 years of infertility patients with kidney qi deficiency syndrome and liver Qi The proportion of stagnation syndrome was the most, accounting for 23.47% and 19.39%, respectively. The rate of liver qi stagnation syndrome was the most in the course of 4 to 7 years, 22.61%, and the second was kidney yang deficiency syndrome and kidney qi deficiency syndrome, accounting for 17.39% and 16.52% respectively. The patients with kidney yang deficiency syndrome for 7 to 10 years and more than 10 years, accounted for 33.33% and 36.84%. infertile patients with TCM syndrome and course section respectively. The difference was statistically significant (P0.05).5. ovulation related diseases, the kidney yang deficiency syndrome was more (22.33%), and the damp heat syndrome was relatively less, but there was no significant difference between different syndrome types (P0.05); the oviduct obstruction, the stagnation of the uterine syndrome were more (20.73%), the second was kidney yang deficiency syndrome (17.07%), and the damp heat syndrome was relatively more than that of the syndrome. There were statistically significant differences between different types of syndrome (PO.01); the patients with oviposit related diseases combined with tubal obstruction, kidney yang deficiency syndrome and stagnation of hysteria syndrome were more (each accounted for 28.57%); the other etiology, the most (30.86%) patients with kidney qi deficiency syndrome, relatively less damp heat syndrome, the difference between different types of syndromes was statistically significant (P0.01). No significant difference (P0.05) of TCM syndrome type and drinking frequency (P0.01), sleep quality (P0.01), sleep time (P0.01), and pressure (P0.01) in the patients with.6. infertility. The difference between TCM syndrome type and Yuan Jifa (P0.05), education (P0.05) and occupational (P0.05) difference between patients with infertility was not statistically significant. The frequency of traditional Chinese medicine in.7. infertility was from high to low in the order of Yang deficiency (19.93%), Qi deficiency (17.83%), Qi Stagnation (13.99%), yin deficiency (11.89%), blood stasis (10.14%), flat and qualitative (8.74%), phlegm wet mass (8.04%), damp heat (4.90%), and idiosyncrasy (4.55%).8. infertile patients with different ages of different physique and relative age of damp heat The younger (32 years old), the age of the yin deficiency was relatively large (37 years old), the difference of the age of different constitution was statistically significant (P0.05); the proportion of qi deficiency and yang deficiency was the most in the patients with age less than 35 years, and the distribution accounted for 21% and 18%; the age 35 to 40 years of age was the largest proportion of Yang deficiency and yin deficiency, the distribution accounted for 20.13% and 17.45%; the age 40 years old. The most of the patients were Yang deficiency and Qi deficiency, 24.32% and 21.62%. infertile patients, the difference was not statistically significant (P0.05) in.9. infertility patients with different physical conditions, the course of damp heat was relatively short (3 years), the course of blood stasis was relatively long (7 years), and the course of different physical conditions was compared. The difference was statistically significant (P0.01), and the difference was statistically significant; the proportion of qi deficiency and yang deficiency was the most in the 1 to 4 years of the course of disease, and the proportion was 17.35%, and the proportion of qi deficiency and yang deficiency was the most in the course of 4 to 7 years, and the proportion of the patients was 20.87%, and the proportion of Yang deficiency and qi depression was the most, 24.07% and 20.37, respectively, for the course of the course of 7 to 10 years. 10 or more patients with phlegm and moisture content were the most, accounting for 31.58%. The difference of TCM Constitution and course section of infertility patients was statistically significant (P0.05).10. ovulation related diseases, the patients with Yang deficiency were more (20.51%), the second was Qi deficiency (17.95%), and the patients with special temperament were relatively less, but there was no statistical difference between the non hermaphroditic patients. P0.05 (18.75%), followed by blood stasis and Qi Stagnation (15.63%), with relatively less special quality and no statistical difference between different physiques (P0.05), oviposit related diseases combined with tubal obstruction, blood stasis patients were relatively more (28.57%), followed by Yang deficiency (21.43%), different There was no statistical difference between the physique (P0.05), and the other causes of qi deficiency (19.75%) were Yang deficiency (18.52%) and yin deficiency (17.28%), and there was no statistical difference between different physiques (P0.05); oviduct obstruction, ovulatory related diseases and patients' physique were not statistically significant (P0.05).11. The comparison of TCM Constitution and syndrome type of pregnant patients (1) the frequency of TCM syndrome type of flat and quality patients from high to low were kidney qi deficiency syndrome (28%), liver qi stagnation syndrome (24%), kidney yang deficiency syndrome (20%), kidney yin deficiency syndrome (12%), phlegm damp internal resistance syndrome (12%), stagnation of uterus syndrome (4%), no damp heat syndrome patients; (2) the frequency of TCM syndrome type in Qi deficiency patients was high The lower order was kidney qi deficiency syndrome (39.22%), kidney yang deficiency syndrome (27.45%), phlegm damp internal resistance syndrome (11.76%), liver qi stagnation syndrome (9.80%), kidney yin deficiency syndrome (7.84%), stasis hysteria syndrome (3.92%), no damp heat syndrome (3.92%), the distribution difference of TCM syndrome types was statistically significant (P0.01); (3) the frequency of TCM syndrome type from high to low was the kidney yang deficiency syndrome (45.6). (3) the syndrome type of Yang deficiency syndrome was in the order of kidney yang deficiency syndrome (45.6) 1%) kidney qi deficiency syndrome (28.07%), phlegm damp internal resistance syndrome (17.54%), stasis hysteria syndrome (5.26%), liver qi stagnation syndrome (3.51%), no kidney yin deficiency syndrome and damp heat syndrome patients; (4) the frequency of TCM syndrome type from high to low was kidney yin deficiency syndrome (61.76%), stasis hysteria syndrome (11.76%), kidney qi deficiency syndrome (8.82%), liver qi stagnation syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm damp internal resistance syndrome (5.8) syndrome (8.82%), phlegm dampness syndrome (5.8) syndrome (phlegm damp internal resistance syndrome) 8%) kidney yang deficiency syndrome (2.94%), no damp heat syndrome patients; (5) the frequency of TCM syndrome type of phlegm wet quality from high to low in order of phlegm damp internal resistance syndrome (36.78%), kidney yang deficiency syndrome (21.74%), liver qi stagnation syndrome (17.39%), kidney qi deficiency syndrome (13.04%), stasis hysteria syndrome (8.70%), damp heat syndrome (4.35%), no kidney yin deficiency syndrome patients; (6) syndrome type frequency of damp heat patients (6) syndrome type frequency of TCM The order from high to low was damp heat syndrome (50%), phlegm damp internal resistance syndrome (21.43%), liver qi stagnation syndrome (14.29%), kidney yin deficiency syndrome (7.14%), stagnation of blood stasis syndrome (7.14%), no kidney qi deficiency syndrome and kidney yang deficiency syndrome patients; (7) the frequency of TCM syndrome type of blood stasis syndrome was from high to low in order of blood stasis and hysteria syndrome (34.48%), liver qi stagnation syndrome (24.14%) and kidney yang deficiency syndrome (13.79). %), kidney yin deficiency syndrome (13.79%), kidney qi deficiency syndrome (10.34%), phlegm damp internal resistance syndrome (3.45%), no damp heat syndrome patients; (8) the frequency of TCM syndrome type of qi stagnation from high to low was liver qi stagnation syndrome (55%), stasis of uterus syndrome 22.50%), kidney yin deficiency syndrome (15%), phlegm damp internal resistance syndrome (5%), kidney qi deficiency syndrome (2.50%), no deficiency of kidney yang deficiency syndrome and damp heat implication syndrome The differences in the distribution of TCM syndrome types were statistically significant (P0.01); (9) the frequency of TCM syndrome types from high to low was the kidney qi deficiency syndrome (30.77%), phlegm damp internal resistance syndrome (23.08%), kidney yang deficiency syndrome (15.38%), liver qi stagnation syndrome (15.38%), kidney yin deficiency syndrome (7.69%), stagnation of the uterus syndrome (7.69%), no damp heat syndrome patients. (10) infertile patients traditional Chinese medicine (10) Comparison of physique and syndrome type, eliminating damp heat syndrome with fewer cases, the difference is statistically significant (P0.01) the correlation of common TCM Constitution and syndrome type of.12. infertility patients: Yang deficiency and kidney yang deficiency syndrome is positively related; Qi deficiency is positively related to kidney qi deficiency syndrome; Qi deficiency is positively related to liver qi stagnation syndrome and stagnation of stagnation of the uterus. The correlation of common TCM syndrome type and other influential factors in.13. infertility patients: negative correlation between kidney deficiency syndrome and pressure, negative correlation between deficiency of kidney yang and pressure, positive correlation with course of disease, and positive correlation between liver qi stagnation syndrome and pressure, the correlation between common etiological factors and other influencing factors of.14. infertility The main TCM syndrome types of female infertility in Hongkong area are kidney yang deficiency syndrome and kidney qi deficiency syndrome, and the second is liver qi stagnation syndrome in.2. Hongkong area of women with infertility, the main TCM constitution is Yang deficiency and Qi deficiency, the main TCM Constitution of female infertility in the Hongkong area is Yang Deficiency and Qi deficiency. There was a positive correlation between Yang deficiency quality and kidney yang deficiency syndrome in the patients with Qi and qi depression.3. infertility; Qi deficiency and kidney qi deficiency syndrome were positively related, Qi deficiency syndrome and liver qi stagnation syndrome and stasis hysteria syndrome were positively related to.4. infertility patients with negative correlation between kidney qi deficiency syndrome and pressure; kidney yang deficiency syndrome and pressure were negatively related, and the course Cheng Zhengxiang The relationship between the syndrome of liver qi stagnation and pressure is positively related to the relationship between the common causes of.5. infertility and other influencing factors. The relationship between the occurrence of ovulation related infertility and the secondary is negative correlation, and the tubal obstruction infertility is positively correlated with secondary infertility.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R271.14

【相似文献】