遗忘型轻度认知损害中医证候特征研究

发布时间：2018-01-20 04:21

  本文关键词： 遗忘型轻度认知损害 证型 证候要素 症状　出处：《北京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：探讨分析遗忘型轻度认知损害的中医证候分布特征,旨在为遗忘型轻度认知损害的临床辨证提供理论依据。方法：(1)采用meta分析的理念,确立文献检索策略,在中国学术文献网络出版总库、中文科技期刊数据库与万方知识服务平台进行检索,检索出报告遗忘型轻度认知损害患者证候分型及各型病例数或临床表现病例数的文献,共纳入文献25篇,提取症状、证型与证候要素,规范名词术语,并进行证候要素与症状关系研究,采用描述性统计的方法分析症状、证型、证候要素出现频次,证候要素与症状关系研究采用系统聚类分析法。(2)利用描述性统计方法对临床病例的人口学资料进行统计,采用频数优势法筛选四诊条目,采用析因分析、聚类分析提取证候要素,利用描述性统计的方法报告证候要素的分布特征。(3)利用描述性统计方法、非参数检验对临床病例的人口学资料进行统计,采用二分类Logistic回归分析疾病与症状关系、疾病与证候要素关系以及证候要素与症状的关系。结果：现代文献研究：(1)频次5的主观感觉类症状包括健忘、善忘、神昏、神疲、嗜卧、倦怠、不寐、疲乏、多梦、少气、头晕、头痛、头重、耳鸣、耳聋、腰膝无力、四肢不温、心悸、胸闷、食欲不振、腹满、大便秘结。频次5的客观体征类症状包括口唇青紫、面色萎黄、便溏、苔白、舌红、苔腻、舌淡红、舌生瘀斑、舌胖大、苔黄、苔薄、脉细、脉弦、脉数、脉沉、脉滑、脉弱、脉涩。(2)共提取24个证型,百分比大于1%的证型依次是肾精亏虚证(10.5%)、痰浊蒙窍证(10.5%)、气血两虚证(10.5%)与热毒内盛证(10.5%),其他的依次为：腑滞浊留证(8.9%)、瘀阻脑络证(8.9%)、肝阳上亢证(6.5%)、阴虚阳亢证(4.85%)、痰浊证(4.03%)。(3)总共提取15个证候要素,其中,病位类证候要素5个,按百分比由高到低依次是肾(29.89%)、脑(27.59%)、肝(13.79%)、脾(9.2%)、心(6.9%)；病性类证候要素9个,按百分比由高到低依次是气虚(16.44%),其他的依次为痰浊(11.84%)、血瘀(11.84%)、血虚(11.18%)、阳亢(9.21%)、精亏(8.55%)、热毒(8.55%)、阴虚(7.89%)、腑实(7.24%)、浊邪(7.24%)。(4)确定证候要素—症状关系如下：肾：耳聋、耳鸣、腰膝无力、脉沉；脑：健忘、善忘、神昏、头晕、头痛；心：心悸、胸闷、多梦；肝：头晕、头痛、脉弦、耳鸣；脾：神疲、乏力、四肢不温、面色萎黄、舌体胖大、倦怠、食欲不振、便溏；气虚：少气、神疲、乏力、脉弱、倦怠、苔薄、舌体胖大；血虚：面色萎黄、心悸、头晕、脉细；精亏：耳聋、腰膝无力、耳鸣；阴虚：耳鸣、脉细；阳虚：四肢不温、便溏、苔白；痰浊：嗜卧、苔腻、脉滑、舌体胖大、头重、头晕；腑实：腹满、苔腻、食欲不振；血瘀：口唇青紫、舌生瘀斑、脉涩；阳亢：头晕、耳鸣、头痛、脉弦；热毒：苔黄、脉数、舌红。临床调查：(1)证候要素分布特征：病位类证候要素出现频次总计714次,按频次排序,由高到低分别是：脑165次,占总频次百分比为23.1%；肾165次,占总频次百分比为23.1%；脾152次,占总频次百分比为21.3；心126次,占总频次百分比为17.6%；肝106次,占总频次百分比为14.8%。病因、病性类证候要素出现频次总计1342次,按频次排序,由高到低分别是：痰浊166次,占总频百分比为12.4%；血虚160次,占总频次百分比为11.9%；精亏158次,占总频次百分比为11.8%；血瘀155次,占总频次百分比为11.5次；热毒145次,占总频次百分比为10.8%；阴虚137次,占总频次百分比为10.2%；阳虚127,占总频次百分比为9.5%；气虚123次,占总频次百分比为9.2%；腑实109次,占总频次百分比为8.1%；气郁62次,占总频次百分比为4.6%。(2)证候要素的病-证-症关系：中医四诊条目共154条,与遗忘型轻度认知损害相关的主观感觉类症状包括：畏寒、气短、忧虑、易怒、耳鸣如蝉、目眩、下肢酸重。客观体征类症状包括：痰多、痰色白、口唇色淡、口臭、眼睑紫暗、面色不华、肢体挛急、筋惕肉跳、肢体震颤、指甲苍白、舌紫、苔白、脉沉、脉迟、脉数、脉滑、脉虚、脉弦。确定15组证候要素—症状关系。与肾相关的症状：牙齿脱落、腰痛、腰酸；与脑相关的症状：头晕、头昏、头痛；与肝相关的症状：易怒、忧虑、口苦、耳鸣如蝉、脉弦；与脾相关的症状：神疲、乏力、四肢不温、舌淡、舌体胖大；与心相关的症状：心烦、失眠、心悸；与气虚相关的症状：乏力、气短；与血虚相关的症状：目昏花、面色不华、脉细；与精亏相关的症状：耳鸣如蝉、牙齿脱落；与阳虚相关的症状：畏寒、四肢不温、大便溏、喜热饮；与阴虚相关的症状：口干、咽干、耳鸣如蝉、目干涩、目昏花；与痰浊相关的症状：咯痰、苔厚、苔腻、反应迟钝,舌边齿痕、脉滑；与血瘀相关的症状：瘀斑瘀点、口唇紫暗、舌暗；与热毒相关的症状：苔灰黄、口干、口臭；与腑实相关的症状：口干、口臭、腹胀；与阳亢相关的症状：头晕、头痛、头昏；与气滞相关的症状：忧虑、情绪低落、表情淡漠。与遗忘型轻度认知损害相关的证候要素包括肾(P=0.028)、痰浊(P=0.010)与阴虚(P=0.004)。结论：遗忘型轻度认知损害的证型以肾精亏虚证、痰浊蒙窍证、气血两虚证为主,病位类证候要素以脑和肾为主,病因、病性类证候要素以痰浊、血虚、血瘀、精亏、阴虚为主,证候要素的证-症的量化关系还有待进一步研究。
[Abstract]:Objective: To investigate amnestic mild cognitive impairment and the TCM syndrome distribution characteristics, in order to provide theoretical basis for clinical diagnosis of amnestic mild cognitive impairment. Methods: (1) using meta analysis concept, establish the strategy of literature retrieval, in the academic literature China Network Publishing Database, Chinese journal database and Wanfang knowledge service platform for retrieval, retrieval report amnestic mild cognitive impairment syndromes and the number of cases or cases of clinical manifestations of literature, 25 articles were included, the extraction of symptoms, syndromes and syndrome elements, the term specification noun, and study the relationship between syndrome factors and symptoms, methodsdescriptive statistical analysis of symptoms, syndromes and syndrome elements of frequency, study the relationship between syndrome factors and symptoms using clustering analysis. (2) by using the method of descriptive statistics on demographic data in clinical cases For statistics, the frequency method for screening four entries by factorial analysis, cluster analysis to extract the syndromes distribution characteristics by using descriptive statistical methods to report the syndrome elements. (3) by using descriptive statistics, nonparametric test data on demographic clinical material statistics, using two Logistic regression analysis of disease the relationship between syndromes and symptoms, disease and syndrome and syndrome elements and symptoms. Results: the modern literature research: (1) the frequency of the 5 subjective symptoms including amnesia, forgetfulness, coma, lassitude, addicted to lying, burnout, fatigue, insomnia, dreaminess, dizziness, headache, shortness of breath, also, tinnitus, deafness, waist weakness, limb temperature, heart palpitations, chest tightness, loss of appetite, abdominal distention, constipation. 5 the frequency of objective signs symptoms including purple lips, pale complexion, loose stools, white fur, red tongue, greasy moss, pale tongue, ecchymosis on tongue, big fat tongue, 鑻旈粍,鑻旇杽,鑴夌粏,鑴夊鸡,鑴夋暟,鑴夋矇,鑴夋粦,鑴夊急,鑴夋订.(2)鍏辨彁鍙，

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