混合性焦虑抑郁障碍的中医证候与体质相关因素的临床调查分析

发布时间：2018-03-19 18:34

  本文选题：混合性焦虑抑郁障碍　切入点：中医证候　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的和意义:探索分析混合性焦虑抑郁障碍(Mixed Anxiety and Depressive Disorder,简称MADD)患者的中医证候特点及体质类型,总结该病的常见证型及易感体质,进一步探讨分析MADD患者的中医证候与体质的相关性,把"辨病-辨体-辨证"这一诊疗模式有效地运用到临床中,以进行个体化诊疗,从而更好地提高临床疗效。研究方法:本研究是在2016年北京中医药大学研究生自主课题的支持下进行的。收集2016年8月至2017年1月北京中医药大学东方医院脑病二科门诊符合纳入及诊断标准的MADD患者61人,以及北京中医药大学东方医院体检科健康人群30人作为研究对象,填写中医体质分类与判定量表,对比二者之间体质类型的异同,同时采集MADD患者的证候要素并分析其分布规律特点,最后分析MADD患者的中医证候与体质的相关性。统计方法:使用Excel表格建立数据库,用SPSS20.0统计处理分析。一般资料采用描述性分析,计数资料采用卡方检验,等级资料采取非参数检验,均以p0.05作为有统计学意义的标准。结合四诊收集的临床信息,运用系统聚类分析提取证候要素,归纳总结证候要素分布、组合、演变特点。研究结果:(1)MADD的一般情况:本次研究共收集病例61例,其中女性多于男性;年龄段主要集中在青壮年;受教育程度以本科或大专为主;婚姻状况以已婚为主;病程主要集中在1年之内;患者的焦虑抑郁状况与性别、年龄没有明显差异。(2)中医证候分布特点:61例MADD患者的中医证型分布出现的频次由高到低依次为痰气郁结证、肝气郁结证、气郁化火证、心脾两虚证、心肾阴虚证及心神不养证,其中痰气郁结证为主要证型。根据患者临床的症状和体征以及运用系统聚类分析的方法得出,MADD的病性证素多为气滞、痰浊、血瘀、阴虚及阳虚,同时结合导师临床经验及相关研究进展归为三类:分别为类痰气郁结证、类气滞血瘀证及类阴阳两虚证。此外,MADD的证候分布不受年龄、病程及焦虑抑郁状况的影响。(3)中医体质分布特点:61例MADD患者中气郁质最多,其次是气虚质、阳虚质及湿热质,阴虚质、痰湿质及血瘀质在本病中少见;30例对照组健康人群以平和质最多,其次是阳虚质及湿热质多见,二者均有阳虚质及湿热质,但MADD患者以气郁质表现为主伴气虚质,而对照组以平和质最多。同时,本调查提示61例MADD患者中阴虚质、痰湿质、湿热质、血瘀质以焦虑表现为主,阳虚质、气郁质以抑郁表现为主,气虚质以焦虑抑郁表现差异相等为主。此外,据调查,MADD患者的中医体质与年龄的增长及病程的长短没有明显差异,提示个体体质的分布不轻易改变,其本身固有的特性是相对恒定的。(4)中医证候与体质的相关性:61例MADD患者中,肝气郁结证中气郁质(46.2%)最多;气郁化火证中气郁质(36.4%)多见;痰气郁结证中痰湿质和气郁质多见(23.8%);心脾两虚证中气虚质(44.4%)最多;心神不养证为血瘀质最多(100.0%);心肾阴虚证中气郁质最多(50.0%)。同时,气郁质(18人)中肝气郁结证出现的频次最高(6人),气虚质(9人)中心脾两虚证出现频次最高(4人),阳虚质(9人)中痰气郁结证(4人)出现频次最高,湿热质(9人)中以肝气郁结证及气郁化火证(3人)出现频次最高,阴虚质(7人)中以气郁化火证及心肾阴虚证(2人)出现频次最高,痰湿质(6人)中痰气郁结证出现频次最高(5人),血瘀质(3人)痰气郁结证出现频次最高(2人)。研究结论:(1)MADD的患病人群以女性、已婚者及受教育程度处于中等水平者较多,而文化水平偏低及偏高者较少,且MADD患者的发病年龄呈年轻化的趋势。(2)气滞、痰浊、血瘀、阴虚及阳虚与MADD的发病密切相关。由此可见,MADD中医证素分布复杂多样,证候类型虚实夹杂,导致病情反复发作,缠绵难愈。(3)MADD患病组与正常组相比,患病人群多为气郁质,而正常人群多为平和质,二者均有阳虚质及湿热质。阴虚质、痰湿质、湿热质、血瘀质以焦虑表现为主,阳虚质、气郁质以抑郁表现为主,气虚质以焦虑抑郁表现差异相等为主。因此,临床中辨病与辨体相结合,及时纠正或改善偏颇质,可减少个体体质对疾病的易感性,从而做到未病先防,既病防变。(4)以证候为要素探讨MADD的发病时,其与患者自身的体质具有明显相关性,而以体质为要素求证MADD患者的证候时,患者的体质与证候并不完全一致,但仍有一定的相关性。由此可见,临床仍应以辨证为基础,同时结合辨病与辨体,才能在诊治疾病的过程中发挥更好的疗效。
[Abstract]:The research purpose and significance: exploratory analysis of mixed anxiety and depressive disorder (Mixed Anxiety and Depressive Disorder, referred to as MADD) the characteristics of TCM syndrome and constitution of patients, summarize the common syndromes of this disease and predisposition, to further explore the correlation analysis between TCM syndromes and physical MADD patients, the disease - resolution body - differentiation "this treatment model effectively applied to clinical, for individualized treatment, which can effectively improve the clinical curative effect. Methods: This study was conducted in 2016 graduate of Beijing University of Chinese Medicine under the support of the independent subject. From August 2016 to January 2017 encephalopathy of Dongfang Hospital of Beijing University of Chinese Medicine two out-patient patients met the inclusion and MADD diagnosis the standard of 61 people, and the Department of physical examination of Oriental Hospital of Beijing University of Chinese Medicine 30 healthy people as the research object, fill in the Chinese constitution classification and determination of scale. Than the differences between the two types of constitution, and acquisition of syndrome elements in MADD patients and analysis the characteristics of distribution, correlation analysis between TCM syndrome and constitution in patients with MADD. The final statistical method: the use of Excel database, analyzed by SPSS20.0 statistical processing. The general data using descriptive analysis, chi square test with count data take, rank data non parametric test, with P0.05 as the significant standard. Combined with clinical information collected by the four diagnostic methods, using the cluster analysis to extract syndrome factors, summarized the distribution of syndrome elements, evolution characteristics. Results: (1) the general situation of MADD: This study collected a total of 61 cases, with more women than men; age mainly concentrated in young adults; education in university or college; marital status to married; duration in patients within 1 years; The anxiety and depression status and gender, no significant differences in age. (2): the distribution characteristics of TCM Syndromes of TCM Syndromes of 61 cases of MADD patients with the distribution of the frequency from high to low were sputum stagnation syndrome, liver qi stagnation, qi stagnation fire, deficiency of two heart and spleen, heart and kidney yin deficiency and heart of God without a permit among them, gas stagnation as the main syndromes. According to clinical symptoms and signs, obtained by cluster analysis method, MADD disease syndrome are qi stagnation, phlegm, blood stasis, yin and Yang, combined with my tutor's clinical experience and related research progress were classified into three classes: class Tanqi two kinds of qi stagnation syndrome, qi stagnation and blood stasis syndrome and the Yin and Yang syndrome. In addition, the distribution of MADD is not affected by the influence of age, course of disease and anxiety depression. (3) physical distribution characteristics of traditional Chinese medicine: 61 cases of MADD patients in stagnation most, followed by qi deficiency, Yang deficiency and dampness heat, yin deficiency Quality, phlegm and blood stasis in this rare disease; 30 cases of control group of healthy people with normal quality most, followed by the Yang deficiency and damp heat to see, the two were Yang deficiency and damp heat, but MADD patients with qi stagnation mainly manifested with Qi deficiency, while in the control group and quality most. At the same time, the survey showed 61 cases of patients with MADD Yin deficiency and phlegm dampness, dampness heat, blood stasis, mainly to anxiety Yang deficiency, Qi Stagnation with depression, anxiety and depression of qi deficiency to equal difference. In addition, according to the survey, there was no significant difference between the growth and the course of Chinese Constitution with the age of patients with MADD of the length distribution suggest that the individual constitution is not easily changed, the intrinsic characteristics is relatively constant. (4) the correlation of TCM syndrome and Constitution: 61 cases of MADD patients, syndrome of stagnation of liver Qi Qi Stagnation (46.2%); gas stagnation (qi stagnation fire more than 36.4%) 瑙，

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