溃疡性结肠炎证型分布研究

发布时间：2018-04-16 05:18

  本文选题：溃疡性结肠炎 + 中医证型分布　； 参考：《长春中医药大学》2016年硕士论文

【摘要】：目的:通过研究溃疡性结肠炎的中医证型分布与溃疡性结肠炎患者年龄、病程、临床类型、病情分期、病变范围,内镜下粘膜表现等数据间相关性,总结出溃疡性结肠炎证型分布规律、中医证型特点和诊治规律,为临床的诊断和治疗提供指导。方法:将收集到的有完整中医临床资料的90例患者的临床资料,进行整理和数据统计,采用SPSS19.0软件进行数据分析,分析年龄、病程、病变范围、临床类型、病情分期、内镜下粘膜表现与中医证型分布的关系。结果:本次研究的90例UC病例中,男女比例为1.14:1,性别对UC的发病无明显差异,发病的平均年龄为41.07±12.13岁,发病的高峰年龄段为35至50岁。研究的病例中证型比例由高至低依次为大肠湿热证、脾虚湿蕴证、肝郁脾虚证、脾肾阳虚证、寒热错杂证、阴血亏虚证,其中寒热错杂证、阴血亏虚证较少见。研究提示溃疡性结肠炎的患者的证型分布与年龄,病程,临床类型,病情分期,病变范围,内镜下粘膜表现等存在联系。病程的初期以实证为主,渐渐向虚实夹杂转化,后期转化为以虚证为主。病程小于5年的溃疡性结肠炎患者多见大肠湿热证,脾虚湿蕴证次之;病程5-10年的患者证型主要以肝郁脾虚证、脾虚湿蕴证为主;病程多于10年的溃疡性结肠炎患者以脾肾阳虚证为主。初发型以大肠湿热证(实证)为主,慢性复发性以脾虚湿蕴证、肝郁脾虚证(虚实夹杂)为主,慢性持续型以脾肾阳虚证(虚证)为主。活动期以大肠湿热、脾虚湿蕴为主;缓解期以脾肾阳虚,肝郁脾虚为主。病变部位以直肠、乙状结肠为主,其中大肠湿热证最为多见。内镜下粘膜表现比例由高到底依次为充血水肿、血管纹理模糊、糜烂溃疡、脓性分泌物、自发性出血、表面粗糙、息肉、肠腔狭窄、肠腔短缩、袋囊消失、粘膜桥。不同证型内镜下粘膜表现不同,大肠湿热、脾虚湿蕴、寒热错杂、肝郁脾虚、脾肾阳虚均以病变充血水肿、血管纹理模糊为主。大肠湿热还常见糜烂溃疡、脓性分泌物、粘膜质脆易出血。脾虚湿蕴证可见糜烂溃疡、脓性分泌物、自发性出血、表面粗糙。肝郁脾虚、脾肾阳虚、阴血亏虚证的表现中,有更高的出现表面粗糙、肠腔狭窄、肠腔短缩及袋囊消失可能,由以脾肾阳虚证显著。息肉常见于各种证型的患者表现。结论:本病发生与发展,是脾虚和湿热之邪的共同作用的结果,即本虚标实。根据不同时期应采用不同的治法治疗溃疡性结肠炎:活动期应以治疗实证为主,清化湿热,调理气血,通因通用,同时健脾益气,标本兼顾;缓解期以补虚为主,补脾益肾,兼清湿热之邪。不同患者采取不同治疗方案:大肠湿热证最为多见,在治疗上应注重清热利湿,调养气血;虚湿蕴则须注意健脾除湿;热错杂证应侧重温中补虚,扶正祛邪兼顾;郁脾虚应疏肝健脾,和中理气祛湿;肾阳虚应温补脾肾,祛湿化饮;阴血亏虚滋阴润肠,和络养血。采用局部治疗的同时也须注重整体观念:溃疡性结肠炎的病变多发生于直肠、乙状结肠处,局部症状明显,同时跟机体的整体病变关系也十分密切。因而调整整体的脏腑阴阳气血与治疗局部病变相结合,可以取得更好的疗效,调治脾胃和祛除湿邪同样重要。
[Abstract]:Objective: through the study of ulcerative colitis TCM Syndromes of ulcerative colitis and the age of patients, duration of disease, clinical type, disease staging, lesion, endoscopic mucosal manifestations such as correlation among data, summarize the ulcerative colitis syndromes distribution of TCM syndromes and treatment patterns, to provide guidance for clinical diagnosis and treatment methods: the collected clinical data of 90 cases of patients with complete clinical data of TCM, collation and statistical data, using SPSS19.0 software for data analysis, analysis of age, course of disease, extent of disease, clinical type, disease stage, endoscopic mucosal manifestations and syndromes distribution relationship. Results: 90 cases UC cases of this study, male to female ratio was 1.14:1, no significant difference in the incidence of gender on UC, the average age of onset was 41.07 + 12.13 years old, the peak age of onset was 35 to 50 years. The case study In the card type ratio from high to low is damp heat syndrome, spleen deficiency with dampness syndrome, liver stagnation and spleen deficiency, spleen kidney yang deficiency, cold and heat syndrome, yin and blood deficiency, the cold and heat syndrome, yin and blood deficiency is rare. The study suggests that the syndrome distribution of ulcerative colitis patients with age, duration of disease, clinical type, staging, lesion and associated endoscopic mucosal manifestations. The disease in the early days, gradually to the deficiency of transformation, later converted to deficiency. Less than 5 years history of ulcerative colitis were more common in damp heat syndrome, spleen deficiency and Dampness Retention syndrome; syndrome of 5-10 years duration mainly to stagnation and spleen deficiency syndrome, spleen deficiency and Dampness Retention syndrome; duration of more than 10 years in patients with ulcerative colitis of spleen and kidney yang deficiency syndrome. Early onset with damp heat syndrome (positive), chronic recurrent spleen deficiency with dampness syndrome, liver stagnation and spleen deficiency syndrome (the actual clip Miscellaneous), chronic persistent to spleen deficiency syndrome (deficiency). Active in damp heat syndrome, spleen deficiency wefness; remission with spleen kidney yang deficiency, liver stagnation and spleen deficiency. The lesions in the rectum, sigmoid colon, the damp heat syndrome is the most common. Endoscopic mucosal manifestations of the higher proportion of what were the hyperemia and edema, vascular fuzzy texture, erosion and ulcer, purulent secretions, spontaneous bleeding, rough surface, polyp, intestinal stenosis, intestinal shortening, bag disappear, mucosal bridge different syndromes. Endoscopic mucosal manifestations of different damp heat, spleen wet Yun, chills and fever, liver stagnation and spleen deficiency, spleen and kidney yang were hyperemia and edema lesions, vascular fuzzy texture. The damp heat syndrome is also common debaucjed ulcer, purulent secretions, mucous membrane is crisp and easy bleeding. Spleen wet Yun card visible erosion ulcers, purulent secretions, spontaneous bleeding, rough surface. Liver stagnation and spleen deficiency, spleen kidney yang deficiency, Yin and blood deficiency in performance, higher surface roughness, lumen stenosis, intestinal cavity shortening and may disappear from the bag, Yang deficiency of spleen and kidney significantly. Patients with polyps common in various syndromes. Conclusion: the occurrence and development of this disease is spleen deficiency and damp heat evil work together the result is the vacuity. According to different periods should be used in treatment of ulcerative colitis with different activity period should be mainly empirical treatment, clearing heat, regulating qi and blood, for the general at the same time, spleen qi, both specimens; remission to supplement the deficiency, spleen and kidney, clearing and damp heat evil. Different patients with different treatment regimens: Damp heat syndrome is the most common, the treatment should focus on clearing heat and removing dampness and dampness, Qi and blood deficiency nursed back to health; it must pay attention to the spleen dehumidification syndrome; heat should be empty, fill in the side to paying attention; spleen Yu Shu virtual liver and spleen, kidney qi and dampness; Virtual tonifying the spleen and kidney, dispelling dampness and drinking; Yin deficiency and nourishing Ziyin Runchang, using local treatment should also pay attention to the overall concept of ulcerative colitis lesions occurred in the rectum, sigmoid colon, local symptoms at the same time, with the whole body of the lesions are also very close. Therefore the adjustment of local lesion with the treatment of the whole viscera Yin and Yang Qi combination, can achieve better curative effect, treating the spleen and stomach and eliminate dampness are equally important.

【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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