痛风中医证型与患者影响因素及发病特点的临床研究

发布时间：2018-07-03 13:22

本文选题：痛风 + 中医证型　；参考：《广州中医药大学》2016年硕士论文

【摘要】：研究目的：本研究通过对从广州中医药大学附属深圳临床医学院收集的160例痛风患者进行中医证型分型,探讨痛风中医证型与患者影响因素的相关性及痛风中医证候的发病特点及规律,建立痛风统一的中医证候规范,为痛风病因预防、临床治疗等起到指导作用,从而有效降低痛风发病率及复发率。研究方法：本研究使用流行病学横断面调查的研究方法,设计临床调查表,收集符合原发性痛风中西医诊断标准的病例,由2名主治或以上医师进行证型辨证分型,辨证一致者入组,分别统计各证型患者的一般资料(性别、年龄、体重指数(BMI)、发病年龄、病程、诱发因素等)、症状指标(首发部位、痛风石、关节畸形等)、合并症(高脂血症、高血压、高血糖或2型糖尿病、脂肪肝、胆肾输尿管结石)及实验室指标(血尿酸、肌酐、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、血沉、C-反应蛋白)。用EpiData3.0建立数据库,应用SPSS19.0软件统计分析。对数据库中的计数资料采用描述性分析、频数分析及卡方检验,计量资料采用方差分析,P0.05提示有统计学意义。研究结果：1.发病特点：痛风患病率男：女=52.3：1,好发于31-40岁,平均发病年龄为38.17±11.89岁,超重和肥胖患者112例(70%),从事脑力职业的人数最多102例(63.8%),高中及以上学历133例(83.1%)。2.病史及临床症状情况：病程最短者2周,最长者30年,平均病程6.65±5.79年,以1-5年及5-10年最多,所占比例分别为31.3%、30%,病程与中医证型的关系经单因素方差分析示P0.01,有统计学意义,其中痰瘀痹阻型的病程最长,其余依次为脾虚湿阻湿热蕴结肝肾阴虚型；有家族史的患者39例(24.4%)；诱发因素是高嘌呤饮食饮酒劳累受寒外伤;首发部位依次为单侧跖趾关节单侧踝关节单侧足背单膝关节单侧足跟双侧跖趾关节、双侧足背、双膝关节双侧踝关节单侧腕关节；合并有脂肪肝61例(38.13%),高脂血症49例(30.63%),胆肾输尿管结石36例(22.5%),高血压29例(18.13%),高血糖或糖尿病14例(8.75%),患者的合并症与中医证型经卡方检验示P0.05,无统计学意义；本调查有痛风石的患者40例(25%),有关节畸形的患者22例(13.75%),痛风石、关节畸形与中医证型的关系分别经卡方检验示P值均0.05,有统计学意义,痰瘀痹阻型最易形成痛风石、关节畸形。3.实验室指标情况：血尿酸异常者128例(80%),最小值228umol/L,最大值939umol/L,平均值5.92±175.86umol/L,血尿酸水平与中医证型的关系经单因素方差分析示P0.05,有统计学意义,湿热蕴结证型的血尿酸平均值最大,其余依次为痰瘀痹阻型、脾虚湿阻型、肝肾阴虚型；血肌酐异常者37例(23.13%),最小值45umol/L,最大值274umol/L,平均值98.48±29.44umol/L,经Tamhane's T2检验示P0.05,有统计学意义,血肌酐平均值肝肾阴虚型痰瘀痹阻湿热蕴结脾虚湿阻型；甘油三酯(TG)异常者108例(67.5%),总胆固醇(TC)异常者112例(70%),高密度脂蛋白(HDL)异常者43例(26.9%),低密度脂蛋白(LDL)异常者58例(36.3%),空腹血糖(FBG)异常者59例(36.88%),血沉(ESR)异常者122例(76.25%)及C-反应蛋白(CRP)异常者116例(72.5%),血脂4项、FBG、ESR、CRP与痛风中医证型的关系分别经单因素方差分析示P均0.05,无统计学意义。结论：1.原发性痛风中医证型分布有一定的规律性,研究160例原发性痛风中医证型以湿热蕴结型最为常见,肝肾阴虚型最少见,痰瘀痹阻型又多于脾虚湿阻型。2.本研究表明痰瘀痹阻型的病程较最长,且最易形成痛风石及关节畸形。3.本研究提示血尿酸值、血肌酐值可分别作为痛风湿热蕴结型、肝肾阴虚型的一个客观辩证指标。4.本研究还发现痛风患者的血脂4项(TG、TC、HDL、LDL)及空腹血糖异常的概率较高。
[Abstract]:The purpose of this study was to study the relationship between the syndrome type of gout and the influencing factors of gout in 160 patients with gout collected from the clinical medical school affiliated to Shenzhen University of Traditional Chinese Medicine and to establish a unified Chinese medicine syndrome specification for gout . The study was conducted by two main or more physicians . The study was as follows : The study used the method of epidemiology cross - sectional investigation , the clinical investigation questionnaire was designed to collect the general data of the syndrome type patients ( including the age , the disease course , the induced factors , etc . ) , the symptoms ( hyperlipemia , hypertension , hyperglycemia or type 2 diabetes , fatty liver , gallbladder and kidney ureteral calculi ) and laboratory indexes ( blood uric acid , creatinine , total cholesterol , triglyceride , high density lipoprotein , low density lipoprotein , fasting blood sugar , ESR , C - reactive protein ) . The results were as follows : 1 . The incidence of gout is male : female = 52.3 : 1 , the average disease duration is 38.17 卤 11.89 years old , the average disease course is 6.65 卤 5.79 years , the ratio of the disease history and clinical symptoms is 31.17 卤 11.89 years old , the average disease course is 6.65 卤 5.79 years .
39 patients with family history ( 24 . 4 % ) ;
The inducing factors were high purine diet , alcohol consumption and cold injury . The first part was unilateral toe joint unilateral ankle joint unilateral foot sole single knee joint , bilateral plantar toe joint , bilateral foot back , bilateral ankle joint unilateral wrist joint ;
There were 61 cases of fatty liver ( 38.13 % ) , 49 cases of hyperlipemia ( 30.63 % ) , 36 cases ( 22.5 % ) , 29 cases of hypertension ( 18.13 % ) , hyperglycemia or diabetes in 14 cases ( 8.75 % ) .
There were 40 ( 25 % ) patients with gout , 22 cases ( 13.75 % ) with joint deformity , the relationship between gouty stone , joint deformity and traditional Chinese medicine syndrome ( P < 0.05 ) .
37 cases ( 23.13 % ) of blood creatinine were abnormal , the minimum value was 45 mol / L , the maximum value was 274渭mol / L , the average value was 98.48 卤 29.44渭mol / L , and the mean value was 98.48 卤 29.44渭mol / L . The mean value of Tamhane ' s T2 test showed significant difference .
There were 108 cases of abnormal triglyceride ( TG ) , 112 cases of total cholesterol ( TC ) , 112 cases of high density lipoprotein ( HDL ) , 58 cases ( 36.88 % ) of low density lipoprotein ( LDL ) , 122 cases ( 76.25 % ) of low density lipoprotein ( ESR ) , and more than spleen deficiency wet resistance type .
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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