从中医证候表现及证型分布探讨干燥综合征与中医肝生理病理的关系

发布时间：2018-05-29 12:28

本文选题：原发性干燥综合征 + 中医证候　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:临床上常发现原发性干燥综合征患者在临床表现、中医证候、病因病机及治疗方面均与中医肝生理病理密切相关,现代医学也发现该病患者具有抑郁、焦虑情绪或倾向,而抑郁、焦虑的表现往往与中医"燥证"、"郁证"、"脏燥"等有相似之处。导师纪伟教授总结多年临床经验,提出从肝论治理论,即治疗本病时,除单纯滋阴外,重视疏肝、平肝、清肝、养肝。本课题旨在研究原发性干燥综合征的中医证候特点及其与西医抑郁、焦虑的关系,进一步探讨该病与中医肝生理病理的关系,为干燥综合征从肝论治提供理论基础。方法:本研究收集2015-2016年期间江苏省中医院风湿科门诊及病房的原发性干燥综合征患者的临床资料,抽取部分患者进行抑郁、焦虑自评量表调查,并观察全部患者的中医证候表现及进行中医辨证分型。主要包括:一、采用自行编制的中医证候调查表(编制依据:通过文献资料研究及临床观察,初步筛选出原发性干燥综合征常见中医症状),对每位与纳入标准相符的患者进行临床资料收集整理,对其做出证候类型判断。本次研究共设肝肾阴虚、气阴两虚、阴虚血瘀及肺胃津伤证四个主要证型,及(肝郁)气滞、湿热、血瘀、热毒四个兼证。二、协助其中任意50位患者及20位健康体检者完成抑郁及焦虑自评量表。三、数据处理:应用SPSS22.0统计软件进行数据分析,其中计量资料统一用均数±标准差表示,计数资料用卡方检验,独立样本用t检验进行分析比较。P0.05代表差异有统计学意义。结果:一、一般资料:本次共调查原发性干燥综合征病例132例,全为女性,平均年龄在51.75±11.61岁,并将患者分为青年段(20-40岁)、中年段(41-60岁)、老年段(≥61岁),我们发现发病年龄集中在41-60岁(61%)。二、临床表现:与临床大部分研究结果相同,患者表现主要以口干、眼干多见,分别为128例(96.97%)、97例(73.48%),同时关节痛、乏力、猖獗齿、反复口腔溃疡、关节肿、发热等也较为常见,而舌脉表现主要以干、红、瘦舌、及细、沉、弦脉等最普遍。不同年龄段的患者在全身表现上(发热、乏力、关节痛、睡眠障碍)无统计学差异(P0.05);在局部外分泌腺表现上,老年段猖獗齿较青年段患者多见,青年段腮腺肿较中年段患者多见,差异有统计学意义(P0.05)。三、证型分布:(1)主要证型出现比例依次为肝肾阴虚证48例(36.36%)气阴两虚证40例(30.31%)阴虚血瘀证27例(20.45%)肺胃津伤证17例(12.88%)。四个证型中,肝肾阴虚证、气阴两虚证、阴虚血瘀证患者年龄显著大于肺胃津伤证患者年龄,差异有统计学意义(P0.05);中、老年段肝肾阴虚证及气阴两虚证多见,青年段肺胃津伤证比老年段多见,差异有统计学意义(P0.05);不同主证的患者在病程上无统计学差异(P0.05)。(2)兼证出现频次依次为(肝郁)气滞证45例(34.09%)湿热证20例(15.15%)血瘀证12例(9.09%)热毒证11例(8.33%)。不同年龄段患者在兼证的分布上,青年段兼证以气滞证多见,老年段兼证以湿热证多见,差异有统计学意义(P0.05);不同兼证患者的病程无统计学差异(P0.05)。四、抑郁及焦虑自评量表评分:50例患者的SDS、SAS标准分分别为42.20±8.49分、39.53±7.85分,9例(18%)患者存在抑郁症状,全部为轻度抑郁;存在焦虑症状的患者有10例(20%),其中中度焦虑患者1例(2%),轻度焦虑患者9例(18%),20例健康体检者SDS、SAS标准分分别为30.81±4.48分、30.94±4.71分,与原发性干燥综合征患者比较,均存在显著性差异(P0.05)。各主要证型之间SDS标准分差异无统计学意义(P0.05);各主要证型之间SAS标准分差异无统计学意义(P0.05);气滞证患者与全部患者的SDS标准分差异无统计学意义(P0.05),与全部患者的SAS标准分差异有统计学意义(P0.05);不同年龄段SDS标准分差异无统计学意义(P0.05);不同年龄段SAS标准分差异统计学无意义(P0.05)。结论:pSS中医证候分型目前尚无统一标准,从本研究可发现,(1)本病阴虚为本:以中老年女性多见,四个主证(肝肾阴虚、气阴两虚、阴虚血瘀、肺胃津伤证)均与阴虚密切相关,以前两个主证最为常见。(2)肝郁气滞是本病发病又一大主要因素:四个兼证中,(肝郁)气滞证最常见(34.09%),其出现的频次仅次于主证肝肾阴虚证(36.36%)。(3)现代医学研究表明本病常见抑郁及焦虑状态,而抑郁、焦虑又与中医"燥证"、"郁证"等相似,结合本课题抑郁及焦虑自评量表评分结果,不难发现本病与中医肝生理病理密切相关,肝郁气滞是一大发病因素,贯穿疾病始终,影响着其他病理变化及疾病进程。
[Abstract]:Objective: it is often found that the clinical manifestations, TCM syndromes, etiology, pathogenesis and treatment of primary Sjogren syndrome are closely related to the liver physiology and pathology of traditional Chinese medicine. Modern medicine also finds that the patients have depression, anxiety or tendency, and the depression and anxiety are often similar to "dryness syndrome", "stagnation" and "dirty dryness" in traditional Chinese medicine. Professor Ji Wei, a tutor, summed up many years of clinical experience, put forward the theory of liver theory, that is, in the treatment of this disease, in addition to simple nourishing Yin, pay attention to the liver, liver, liver and liver. This subject aims to study the characteristics of TCM syndrome of primary Sjogren syndrome and its relationship with western medicine depression and concern, and further explore the disease and liver physiology and pathology of traditional Chinese medicine. This study provides a theoretical basis for the treatment of Sjogren syndrome from the liver. Methods: This study collected the clinical data of the patients with primary Sjogren syndrome in the Department of rheumatism in the Department of rheumatism, Jiangsu Province Traditional Chinese Medicine Hospital during 2015-2016 years, and selected some patients to conduct depression, self rating Anxiety Scale, and observed the manifestations and progress of TCM syndromes in all patients. It mainly includes: first, using the self compiled TCM syndrome questionnaire (compilation basis: through the literature research and clinical observation, preliminary screening the common TCM symptoms of primary Sjogren syndrome), collect and collate the clinical data and make the type of syndrome. A total of four main syndromes of liver kidney yin deficiency, Qi Yin deficiency, yin deficiency and blood stasis and lung and stomach injury syndrome, and (liver depression) qi stagnation, damp heat, blood stasis and heat toxin four. Two, assist any 50 patients and 20 health examiners to complete the self rating depression and anxiety scale. Three, data processing: the application of SPSS22.0 statistical software for data analysis, among them measurement The data were unified with mean standard deviation, counting data were checked with chi square test, independent samples were analyzed by t test and compared with.P0.05 representative differences. Results: 1. General data: 132 cases of primary Sjogren syndrome were investigated, the average age was 51.75 + 11.61 years old, and the patients were divided into young patients (20-40 The age of age (41-60 years old), old age group (> 61 years old), we found that the age of onset was 41-60 years (61%). Two, the clinical manifestations were the same as most of the clinical findings. The patients showed mainly dry mouth and dry eye, 128 cases (96.97%), 97 cases (73.48%), joint pain, fatigue, rampant teeth, repeated oral ulcers, joint swollen, fever, etc. The most common manifestations of the tongue are dry, red, thin, and thin, heavy, and chord. There is no statistical difference between patients of different ages (fever, fatigue, joint pain, sleep disorders). In the local exocrine glands, there are more rampant teeth in the elderly than those in the young, and the parotidecs in the young are more than those in the middle age group. The difference was statistically significant (P0.05). (1) the distribution of syndrome type: (1) the proportion of main syndrome types in 48 cases (36.36%) Qi Yin two deficiency syndrome (30.31%) 27 cases of yin deficiency and blood stasis (20.45%) 17 cases (12.88%) of lung and stomach injury syndrome. Among the four syndrome types, the liver kidney yin deficiency syndrome, Qi Yin two deficiency syndrome, the age of yin deficiency and blood stasis syndrome were significantly greater than that of the lung and stomach. There were significant differences in the age of the patients with the syndrome of Tianjin injury (P0.05); in the elderly, the liver kidney yin deficiency syndrome and the Qi Yin two deficiency syndrome were more common, the lung and stomach injury syndrome in the young segment were more common than the elderly (P0.05); there was no statistical difference between the patients with different main syndromes (P0.05). (2) 45 cases (34.09) were (34.09) and 45 cases (34.09). %) 20 cases of damp heat syndrome (15.15%) blood stasis syndrome in 12 cases (9.09%) and 11 cases of heat toxin (8.33%). In the distribution of concurrent syndrome in different age groups, there were more syndrome in the youth segment and syndrome of qi stagnation. There was a significant difference between the elderly and the syndrome of damp heat (P0.05). There was no statistical difference in the course of disease in different cases (P0.05). Four, depression and anxiety self rating scale evaluation Score: 50 patients with SDS, SAS standard scores were 42.20 + 8.49, 39.53 + 7.85, 9 (18%) had depressive symptoms, and all were mild depression; there were 10 patients with anxiety symptoms (20%), 1 cases (2%) of moderate anxiety patients, 9 cases of mild anxiety (18%), and SAS standard score of SDS. .71 scores were significantly different from those with primary Sjogren syndrome (P0.05). There was no significant difference in SDS standard scores between the main syndromes (P0.05), and there was no statistical difference between the major syndromes (P0.05), and there was no statistical significance (P0.05) between the patients with qi stagnation and all patients with the SDS standard (P0.05). There were statistical significance (P0.05) in the standard difference of SAS standard in different age groups (P0.05), and there was no significant difference between the standard scores of SAS in different age groups (P0.05). Conclusion: there is no unified standard for the classification of SAS in different age groups (P0.05). From this study, there is no unified standard. (1) this study can be found, (1) the deficiency of this disease is the basis: the majority of the middle-aged and the elderly women are more common and four masters. Syndrome (liver, kidney yin deficiency, Qi Yin deficiency, yin deficiency and blood stasis, lung and stomach and Tianjin injury syndrome) are closely related to yin deficiency, and the previous two main syndromes are the most common. (2) stagnation of liver qi and qi stagnation is another major factor: the most common (34.09%) syndrome (liver qi stagnation) in four concurrent syndromes (34.09%) is second only to the main syndrome of liver and kidney yin deficiency syndrome (36.36%). (3) the modern medical research table The common depression and anxiety state of the disease, and depression and anxiety are similar to "dryness syndrome" and "depression" in traditional Chinese medicine. It is not difficult to find that this disease is closely related to the liver physiology and pathology of traditional Chinese medicine. The stagnation of liver depression is a major factor, which runs through the disease and affects the other pathological changes and the process of disease.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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