台湾地区ICPP女童证候分布及阴虚火旺型中医疗效观察

发布时间：2018-06-14 17:19

本文选题：台湾地区 + 特发性中枢性性早熟　；参考：《广州中医药大学》2015年博士论文

【摘要】：目的：研究台湾北部女童特发性中枢性性早熟(ICPP)的中医证型分布特点,分析诱发该病的危险因素及两者之间的相关性,收集阴虚火旺型ICPP女童病例,探讨滋阴降火类中药对此证型的疗效,为台湾中医治疗性早熟建立一遵循规范。方法：本研究采用横断面调查病例方法结合现代数理统计方法,通过文献考证、专家咨询、早期预调查等,设计病历调查表,采集台湾北部女童ICPP患者一般资料及中医四诊信息。将量化后的症状、舌、脉作为证候变量输入计算机,建立SPSS数据库。一般资料采用描述性统计分析,对整理后的证候变量进行系统聚类法变量聚类分析,依据专业知识结合《证素辨证学》诊断标准确定聚类类别的证型,然后得出各证型的分布情况。同时以问卷调查的形式研究性早熟发病相关因素中的危险因素,根据调查结果使用SPSS19.0统计软件进行统计分析。最后,根据临床的问卷研究调查、专家提问及聚类型统计分析的结果,确定受试患儿中阴虚火旺型的例数,采用自身前后对照的方法来研究滋阴降火类中药治疗这一个证型的临床效果。结果：1.对92例患者症状体征及舌脉统计频数、积分,SPSS19.0统计软件进行聚类分析,依据专业知识结合《证素辨证学》诊断标准确定聚类类别的证型,得出三个主要证型：阴虚火旺型：占52%,主证：乳房异常发育、月经来潮、舌质红、苔少、脉细数;兼证：五心烦热、口干咽燥、潮热盗汗、夜寐不安、大便秘结、消瘦。肝郁化火型：占25%,主证：乳房胀满或有硬结、月经来潮、舌质红、苔黄、脉弦;兼证：情绪抑郁或烦躁易怒、胸闷善太息、胸胁胀痛、口苦咽干、小便短赤。脾虚痰结型：占15%,主证：乳房胀满有硬结有压痛、月经来潮、白带增多、舌质淡红、苔白腻、脉滑;兼证：倦怠乏力懒言、形体偏胖、时腹痛便溏、口淡、痰多易咳。2.Logistic回归分析结果表明,服用营养滋补品,成人洗漱护肤品,食用含激素食物3类因素与ICPP的致病密切相关(P0.01或P0.05),其他研究因一素未进入回归方程。3.滋阴降火类中药治疗治疗阴虚火旺型ICPP女童疗效确切,采用独立样本t检验,结果显示,治疗前后临床症状各项积分P值均小于0.05,具有统计学意义。结论：根据聚类分析、调查量表、专家提问的方式,得出的结论为：台湾北部女童ICPP可辨证为阴虚火旺型、肝郁化火型、脾虚痰结型,没有其他型病例,各组所占比例为阴虚火旺型肝郁化火型脾虚痰结型。调查的10类危险因素中6类与性早熟的发病相关,其中经常服用营养滋补品、使用含激素食品和使用成人洗漱护肤品与性早熟的致病关系密切,并且对各型ICPP女童疾病的发生均有一定作用,家长、社会、政府应该增加重视程度,并采取相关有效地措施,如相关食品安全的政策的出台等,以期做好全面的预防工作。滋阴降火类中药治疗治疗阴虚火旺型ICPP女童疗效非常确切,采用独立样本t检验,结果显示,治疗前后临床症状各项积分P值均小于0.05,具有统计学意义,但其作用机理还没有被大家弄清楚,需要进一步去探索和证实。
[Abstract]:Objective: To study the distribution characteristics of TCM syndrome type of idiopathic central sexual precocious puberty (ICPP) in northern Taiwan, analyze the risk factors of the disease and the correlation between them, collect the cases of ICPP girls with Yin deficiency and fire type, and discuss the effect of the traditional Chinese medicine of nourishing yin and reducing fire on this type of syndrome, and establish a standard for the treatment of precocious puberty in Taiwan. Method: in this study, a cross-sectional case method combined with modern mathematical statistics was used. Through literature examination, expert consultation, early pre investigation and so on, a medical record questionnaire was designed to collect the general information of ICPP patients in northern Taiwan and the information of four diagnosis of traditional Chinese medicine. The quantified symptoms, tongue and veins were used as the syndrome variables to enter the computer, and the SPSS data were set up. The general data are analyzed by descriptive statistics, and the cluster analysis of the syndrome variables after the arrangement is analyzed by systematic clustering method. According to the combination of professional knowledge and the diagnostic criteria of syndrome differentiation, the pattern of cluster classification is determined, and then the distribution of each type of syndrome is obtained. According to the results of the survey, the SPSS19.0 statistical software was used to analyze the risk factors. Finally, according to the clinical questionnaire investigation, expert questions and the results of various types of statistical analysis, the number of yin deficiency and fire type in the children was determined. Results: 1. of the 92 cases of symptoms and signs and the statistical frequency of tongue and vein statistics, integral, SPSS19.0 statistical software for clustering analysis, according to professional knowledge combined with "syndrome differentiation" and diagnostic criteria to determine the type of cluster of syndrome, get three main syndrome types: Yin deficiency fire type: 52%, main syndrome: abnormal development of the breast, menstrual flow, lingual red, Little moss, pulse fine number, and syndrome: five heart trouble heat, dry mouth dry sweat, hot tide and night sweats, night and sleep, constipation, thin. Liver depression fire type: 25%, the main syndrome: breast swollen or hardened, menstrual tide, tongue red, yellow moss, pulse chords; and syndrome: emotional depression and irritability, chest tightness, flank pain, mouth and throat, stool swynch, short stool. Spleen asthenia sputum knot Type: account for 15%, main evidence: the breast is filled with hard knot and tenderness, menstrual flow, leucorrhea increase, tongue light red, white and greasy, pulse slippery; and syndrome: tired lassitude laziness, body fat, abdominal pain and loose stool, palate, sputum.2.Logistic regression analysis results show, take camp nourishing tonic, adult wash and skin care products, and eat hormone food containing hormone food 3 factors and The pathogenicity of ICPP is closely related (P0.01 or P0.05). Other studies are effective for the treatment of yin deficiency and fire flourishing ICPP girls because one vegetarian is not entering the regression equation,.3. Yin reducing fire type Chinese medicine. The independent sample t test is adopted. The results show that the integral P values of clinical symptoms before and after treatment are less than 0.05, with statistical significance. Conclusion: according to cluster analysis The results of the questionnaire and experts' questions were as follows: ICPP in the northern part of Taiwan can be divided into yin deficiency and fire type, liver depression fire type, spleen deficiency phlegm junction type, and no other type of cases. The proportion of each group is Yin deficiency and fire type liver depression and spleen deficiency phlegm type. The 6 types of 10 types of risk factors are related to the onset of precocious puberty, among which the patients are related to the onset of precocious puberty. The use of nutritious tonics, the use of hormone foods and the use of adult wash and skin care products is closely related to the pathogenesis of precocious puberty, and has a certain role in the occurrence of diseases of the various types of ICPP girls. Parents, society, the government should increase the degree of attention, and take relevant effective measures, such as the policy of related food safety, in order to do so. Good comprehensive prevention work. The effect of nourishing yin and reducing fire in the treatment of ICPP girls of yin deficiency and fire flourish is very accurate. The results of independent sample t test show that the P values of the clinical symptoms before and after treatment are less than 0.05, but the mechanism of its action has not been made clear, and it needs to be further explored and confirmed.
【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】：2015
【分类号】：R272

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