功能性胃肠病重叠综合征的证候规律研究

发布时间：2018-04-10 21:33

本文选题：重叠 + 功能性胃肠病　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:功能性胃肠病(Functional Gastrointestinal Disorders,FGIDs),即肠-脑互动障碍,是一组常见的消化科疾病。临床上,患者常存在多种症状重叠,甚至有两类或两类以上疾病重叠的现象,概括为功能性胃肠病重叠综合征,根据近些年临床流行病学调查显示,功能性胃肠病重叠综合征中功能性消化不良重叠肠易激综合征较为常见。功能性胃肠病重叠综合征归属于中医脾胃系疾病的范围,目前暂无与之相对应的病名,现将其归于"胃胺痛"、"嘈杂"、"痞满"、"吐酸"、"呕吐"、"泄泻"、"便秘"等病范围,各个疾病有各自的标准证型分类,但重叠征临床上证型繁多,存在主观因素,目前缺乏统一的辨证分型标准,一定程度上影响了中医对其的认识和临床治疗。故本研究拟以功能性消化不良重叠腹泻型肠易激综合征为例,探索总结功能性胃肠病重叠综合征的常见症状及中医证候,为建立证候要素、辨证论治体系奠定一定的流行病学基础,以期规范功能性胃肠病重叠综合征的中医辨证分型标准。方法:本研究病例均来源于2016年3月至2016年12月首都医科大学附属北京中医医院脾胃病科和北京中医医院延庆医院,共210例患者,且符合功能性消化不良重叠腹泻型肠易激综合征诊断标准。按照横断面调查方法,运用拟定的临床病例信息采集表收集资料,包括患者的一般资料及中医四诊信息等,运用SPSS 21.0统计软件对病例一般资料及症状进行构成比分析,采用聚类分析方法,探索总结功能性胃肠病重叠综合征中医证候的分布规律。结果:(1)一般资料:210例病人中,男性96例(45.71%),女性114例(54.29%),女性是男性的1.19倍。年龄最小的为18岁,最大的为85岁,青年人59例(28.10%),中年人75例(35.71%),老年人76例(36.19%),平均年龄为53.04± 15.17岁。(2)基于经验的中医证候类型,210例患者中,脾虚湿阻证76例,占36.19%,肝郁脾虚证69例,占32.86%,脾肾阳虚证24例,占11.43%,脾胃气虚证16例,占7.62%,寒热错杂证15例,占7.14%,脾胃湿热证7例,占3.33%,肝气郁结证3例,占1.43%。(3)聚类分析结果:210例患者,纳入出现频率25%以上中医四诊信息,剔除对辨证无明显意义的信息,最终纳入43条症状体征变量,运用系统聚类方法,得到三种证候类型:寒热错杂、脾胃虚弱、肝郁脾虚证。结论及意义:基于聚类分析,功能性胃肠病重叠综合征临床常见的证候类型为寒热错杂、脾胃虚弱、肝郁脾虚证。本研究运用聚类分析的方法,以功能性消化不良重叠腹泻型肠易激综合征为例,客观分析了功能性胃肠病重叠综合征的中医证候规律,避免了主观因素对辨证分型的影响,为临床规范化治疗功能性胃肠病重叠综合征提供了一定的理论基础。
[Abstract]:Objective: functional Gastrointestinal disordersFGIDsD, or intestinal-brain interaction disorder, is a group of common digestive diseases.Clinically, patients often have multiple symptoms overlap, or even two or more types of diseases overlap phenomenon, summarized as functional gastrointestinal overlapping syndrome, according to recent clinical epidemiological surveys show,Functional dyspepsia overlapping irritable bowel syndrome is more common in functional gastrointestinal overlapping syndrome.Functional gastroenteropathy overlap syndrome belongs to the scope of spleen and stomach diseases in traditional Chinese medicine. At present, it has no corresponding disease name. It is now classified as "stomach amine pain", "noise", "ruffiness", "acid vomiting", "vomiting", "diarrhea", "constipation" and other diseases, such as "stomach pain", "noise", "fullness", "vomiting", "diarrhea", "constipation" and so on.Each disease has its own standard classification of syndromes, but there are many clinical syndrome types of overlap syndrome, there are subjective factors, the lack of unified criteria of syndrome differentiation and classification, to a certain extent, affect the understanding and clinical treatment of TCM.Therefore, this study intends to take functional dyspepsia overlapping diarrhea type irritable bowel syndrome as an example, to explore and summarize the common symptoms and TCM syndromes of functional gastrointestinal overlapping syndrome, so as to establish syndromes.The system of syndrome differentiation and treatment lays a foundation for epidemiology in order to standardize the criteria of TCM syndrome differentiation and classification of functional gastrointestinal overlapping syndrome.Methods: from March 2016 to December 2016, 210 patients were involved in this study, including the Department of spleen and stomach Diseases of Beijing Medical University affiliated to Beijing Medical University and the Yanqing Hospital of Beijing traditional Chinese Medicine Hospital.It is in accordance with the diagnostic criteria of functional dyspepsia overlapping diarrhea irritable bowel syndrome.According to the method of cross-sectional investigation, the general data of cases and symptoms were analyzed by SPSS 21.0 software, including the general data of patients and the information of four diagnoses of TCM.Cluster analysis was used to explore the distribution of functional gastroenteric overlap syndrome (FGDS) in traditional Chinese medicine (TCM).Results of the 210 patients, 96 were male (45.71) and 114 were female (54.29). The number of female was 1.19 times that of male.The youngest was 18 years old, the largest was 85 years old, 59 young people (28.1010), 75 middle-aged people (35.71), 76 elderly (36.1919), the average age (53.04 卤15.17). Among the 210 patients with experience based TCM syndrome type, 76 cases were spleen deficiency dampness obstruction syndrome, 76 cases were spleen deficiency dampness obstruction syndrome.The information of four diagnoses of TCM appeared more than 25% frequently, eliminated the information which had no obvious meaning to the differentiation of symptoms and signs, and finally included 43 variables of symptoms and signs, and obtained three types of syndromes: cold and heat disorder, spleen and stomach weakness, liver stagnation and spleen deficiency.Conclusion and significance: based on cluster analysis, the common syndromes of functional gastroenteropathy overlap syndrome are cold and heat disorder, spleen and stomach weakness, liver stagnation and spleen deficiency.In this study, cluster analysis was used to analyze objectively the TCM syndromes of functional gastroenteric overlapping syndrome by taking functional dyspepsia overlapping diarrhea irritable bowel syndrome as an example, thus avoiding the influence of subjective factors on syndrome differentiation.It provides a theoretical basis for the standardized treatment of functional gastrointestinal overlap syndrome.
【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】：R259

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