阻塞性睡眠呼吸暂停低通气综合征中医证候与PM监测指标相关性研究
发布时间：2018-08-07 20:15
【摘要】：研究目的：基于脏腑辨证理论研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的中医证候分布特点,并分析中医证候与体重指数(BMI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、Epworth嗜睡量表评分(ESS评分)之间的相关性,试图为OSAHS的中医辨证寻求更加客观的参考指标,为OSAHS的临床个体化治疗方案的选择提供依据,以进一步提高临床疗效及患者的依从性。研究方法：选取2013年12月至2015年12月在中国中医科学院望京医院睡眠呼吸障碍专病门诊就诊的打鼾患者,使用便携式睡眠呼吸监测仪(PM)对其进行睡眠呼吸监测,纳入符合OSAHS诊断标准的病例240例。测量并记录患者的身高、体重、颈围、睡眠监测结果,计算体重指数,填写鼾眠患者基本信息表和Epworth嗜睡量表,由两位主治以上医师收集患者中医四诊资料(包括症状、舌象、脉象、面色等),并依据中医脏腑辨证分型标准确定最终中医证候。将收集到的资料及信息输入计算机,使用EpiData建立数据库,并生成Excel文件,所有数据均应用统计软件SPSS 20.0进行统计分析。研究结果：1、240例OSAHS患者中,男性182例(占75.8%),女性58例(24.2%),男性发病率明显高于女性；2、240例患者的平均年龄为(52.4±14)岁,其中年龄在45-60岁的患者108例(占45%),发病群体以中年人居多；3、240例患者的平均体重指数(29.13±4.1)Kg/m2,其中肥胖者(BMI≥128)共计142例,占59.2%,半数以上OSAHS患者合并肥胖；4、中医证候分布比例为：痰热壅肺证74例(占30.8%),寒湿困脾证70例(占29.2%),肺脾气虚证52例(占21.7%),心血瘀阻证22例(占,9.2%)肾阳亏虚证20例(占,8.3%),肝郁气滞证2例(占0.8%)；OSAHS患者并非都是单一证候,混合证候占29.2%,常见的证候相兼组合为：寒湿困脾证+肺脾气虚证、寒湿困脾证+心血瘀阻证、肺脾气虚证+心血瘀阻证；5、四诊资料分布：出现频率在40%以上的症状依次为：打鼾、嗜睡、口渴、健忘、疲乏无力、胸脘满闷、肢体困重、自汗、口苦,主要舌质为淡白舌(占63.3%),主要舌苔为白腻苔(40%)、黄腻苔(31.2%)、薄白苔(23.3%),主要脉象为滑脉、细脉、数脉、弦脉；6、在240例OSAHS患者中合并高血压者最多,共156例,占65%；其次为高脂血症70例(占29.2%)、冠心病59例(占24.6%)、糖尿病48例(占20%)、脑血管病26例(占10.8%)、心律失常17例(7.1%)。其中高血压多见于寒湿困脾证(47例)、痰热壅肺证(45例)、肺脾气虚证(27例),冠心病多见于心血瘀阻证(17例)、寒湿困脾证(14例),高脂血症在寒湿困脾证中最多(33例),其次为痰热壅肺证(17例)；糖尿病在痰热壅肺证中最多(16例),其次为寒湿困脾证(10例),脑血管病多发生于。肾阳亏虚证。7、不同中医证候间AHI、最低血氧饱和度的差异无统计学意义(P0.05)；痰热壅肺证的BMI水平高于肺脾气虚证、心血瘀阻证及肾阳亏虚证(P＜0.05),肾阳亏虚证的颈围低于痰热壅肺证、寒湿困脾证、肺脾气虚证及心血瘀阻证(P0.05),痰热壅肺证的最长暂停时间高于寒湿困脾证、心血瘀阻证及肾阳亏虚证(P0.05),痰热壅肺证的平均暂停时间高于肺脾气虚证及肾阳亏虚证(P＜0.05)：8、在OSAHS中医证候与PM监测指标及BMI、ESS评分的相关性研究中,采用Logistic回归分析,归纳出回归方程如下：痰热壅肺证：Logit (p)=0.728X1+1.88X4-5.198寒湿困脾证：Logit(p)=1.82X1+0.528X2-3.39肺脾气虚证：Logit (p)=0.799X2-0.846X3-1.474心血瘀阻证：Logit (p)=1.65X2-3.344X3+2.077X4-4.276肾阳亏虚证：Logit (p)=1.65X2-2.311X3-2.69其中,X1、X2、X3、X4分别代表BMI、AHI、LSaO2、ESS评分研究结论：OSAHS中的中医证候分布特点为：痰热壅肺证寒湿困脾证肺脾气虚证心血瘀阻证肾阳亏虚证肝郁气滞证,其发病与五脏功能失调相关。OSAHS 一般存在多种合并症,并且合并症与中医证候间有一定的关系,如高血压多见于痰热壅肺证、寒湿困脾证,高脂血症多见于寒湿困脾证,冠心病多见于心血瘀阻证,脑血管病多见于肾阳亏虚证。痰热壅肺证的体重指数、嗜睡程度、暂停时间均明显高于其他证候,说明痰热是OSAHS的重要病理因素。不同证候类型与PM监测指标及BMI、ESS评分的相关性不同,痰热壅肺证主要与BMI、ESS评分相关,寒湿困脾证主要与BMI相关,肺脾气虚证主要与AHI、LSaO2相关,心血瘀阻证主要与LSaO2相关,肾阳亏虚证主要与AHI、LSaO2相关,提示对于痰热壅肺证及寒湿困脾证的患者治疗方面可以首先考虑减肥、控制体重为主,对于肺脾气虚证、心血瘀阻证及肾阳亏虚证患者应首先考虑以持续气道正压通气(CPAP)治疗为主,以降低呼吸暂停低通气指数、改善缺氧状态。
[Abstract]:Objective: To study the characteristics of TCM Syndrome Distribution in obstructive sleep apnea hypopnea syndrome (OSAHS) based on viscera syndrome differentiation theory, and analyze the correlation between TCM syndrome and body mass index (BMI), apnea hypopnea index (AHI), minimum oxygen saturation (LSaO2), Epworth somnolence scale (ESS score), and try to be a OSAHS The TCM syndrome differentiation seeks more objective index to provide basis for the selection of clinical individualized treatment schemes for OSAHS, and to further improve the clinical efficacy and compliance of the patients. A portable sleep breathing monitor (PM) was used to monitor 240 cases of the patients' height, weight, neck circumference, sleep monitoring, body mass index, the basic information table of snoring patients and the Epworth somnolence scale, which were collected by two doctors and above. The data of four medical diagnosis (including symptoms, tongue image, pulse image, face color, etc.), and determining the final TCM syndrome according to the syndrome differentiation and classification standard of traditional Chinese medicine. The collected data and information are input to the computer, the database is set up by EpiData, and the Excel file is generated. All the data are statistically analyzed by the statistical software SPSS 20. The results of the study are 1240 cases of O Among the patients with SAHS, 182 were male (75.8%) and 58 women (24.2%). The average age of male was significantly higher than that of women; the average age of 2240 patients was (52.4 + 14) years, of which 108 (45%) were in 45-60 years of age (45%), the average body mass index of 3240 patients (29.13 + 4.1), and the obese (BMI > 58). A total of 142 cases, accounting for 59.2%, more than half of OSAHS patients merged with obesity; 4, the proportion of TCM syndrome distribution was 74 cases of phlegm heat syndrome (30.8%), 70 cases of cold dampness and spleen syndrome (29.2%), 52 cases of spleen qi deficiency syndrome (21.7%), 22 cases of heart blood stasis syndrome (occupied, 9.2%) kidney yang deficiency syndrome 20 cases (occupied, 8.3%), and stagnation of liver qi stagnation syndrome in 22 cases (accounting for 29.2%); the patients of OSAHS were not all It was a single syndrome, mixed syndrome accounted for 29.2%, common syndromes and combination were: cold dampness and spleen syndrome + spleen qi deficiency syndrome, cold dampness and spleen syndrome + heart blood stasis syndrome, lung spleen qi deficiency syndrome + heart blood stasis syndrome; 5, four diagnosis data distribution: the frequency of symptoms above 40% were: snoring, drowsiness, thirst, forgetfulness, fatigue and weakness, chest cavity full stuffy, limb sleepiness Heavy, self perspiration, bitter taste, the main tongue is pale tongue (63.3%), the main tongue fur is white and greasy fur (40%), yellow greasy fur (31.2%), thin white moss (23.3%), the main pulse is slippery pulse, vein, pulse, chord pulse; 6, 240 cases of OSAHS patients with hypertension, a total of 156 cases, accounting for 65%, followed by hyperlipidemia in 29.2% (29.2%), coronary heart disease 59 cases (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, diabetes mellitus (29.2%), diabetes mellitus (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (31.2%), and diabetes mellitus (24.6%), and diabetes mellitus There were 48 cases (20%), 26 cases of cerebrovascular disease (10.8%) and 17 cases of arrhythmia (7.1%). Among them, hypertension was mostly found in cold dampness and spleen syndrome (47 cases), phlegm heat syndrome (45 cases), lung spleen qi deficiency syndrome (27 cases), coronary heart disease in 17 cases (17 cases), cold dampness and spleen syndrome (14 cases), hyperlipidemia in cold dampness and spleen syndrome (33 cases), and second was sputum heat obstructing syndrome (1). 7 cases (7 cases), the most (16 cases) in the syndrome of phlegm heat obstructing the lung, followed by the syndrome of cold dampness and spleen (10 cases), cerebrovascular disease occurred mostly in the deficiency of kidney yang deficiency syndrome (AHI), the difference of the lowest blood oxygen saturation between different TCM syndromes was not statistically significant (P0.05); the level of phlegm heat obstructing lung syndrome was higher than that of lung spleen qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P < 0.). 05) the neck circumference of kidney yang deficiency syndrome is lower than that of phlegm heat obstructing the lung syndrome, cold dampness and spleen syndrome, lung spleen qi deficiency syndrome and heart blood stasis syndrome (P0.05), the longest suspension time of phlegm heat obstructing lung syndrome is higher than that of cold dampness and spleen syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P0.05), the average temporary stopping time of phlegm heat obstructing lung syndrome is higher than that of lung qi deficiency syndrome and kidney yang deficiency syndrome (P < 0.05):8. OSAHS TCM syndrome and PM monitoring indexes and the correlation of BMI and ESS scores were analyzed by Logistic regression analysis, and the regression equation was summarized as follows: phlegm heat obstructing lung syndrome: Logit (P) =0.728X1+1.88X4-5.198 cold dampness and spleen syndrome: Logit (P) =1.82X1+0.528X2-3.39 lung qi deficiency syndrome: Logit =1.65X2-3.344X3+2.077X4-4.276 kidney yang deficiency syndrome: Logit (P) =1.65X2-2.311X3-2.69, X1, X2, X3, X4 represent BMI, AHI, LSaO2, and ESS score study conclusion: the characteristics of TCM Syndrome Distribution: phlegm heat obstructing the lung syndrome, cold dampness syndrome, spleen syndrome, spleen qi deficiency syndrome, kidney yang deficiency syndrome, kidney yang deficiency syndrome liver qi stagnation syndrome, its disease and five zang organs work Disorders related.OSAHS generally have a variety of complications, and there is a certain relationship between complications and TCM syndromes, such as hypertension often seen in phlegm heat syndrome, cold dampness and spleen syndrome, hyperlipidemia often seen in cold dampness and spleen syndrome, coronary heart disease often seen in heart blood stasis syndrome, cerebrovascular disease is mostly found in kidney yang deficiency syndrome. The degree of sleep and the time of pause were obviously higher than other syndromes, indicating that phlegm fever is an important pathological factor of OSAHS. The correlation of different syndromes with PM monitoring index and BMI, ESS score is different. The syndrome of phlegm heat accumulation is mainly related to BMI, ESS score, and the syndrome of spleen and spleen is mainly related to BMI, and the deficiency of spleen and spleen is mainly related to AHI, LSaO2 and blood stasis syndrome. To be related to LSaO2, the deficiency syndrome of Kidney Yang is mainly related to AHI and LSaO2, which suggests that the treatment of phlegm heat obstructing lung syndrome and cold dampness and dampness of spleen syndrome can first consider weight loss and control weight, and the patients with Qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome should be first considered with continuous positive airway pressure ventilation (CPAP) treatment, in order to reduce the deficiency syndrome. Apnea hypopnea index improves anoxia.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1
本文编号：2171227
[Abstract]:Objective: To study the characteristics of TCM Syndrome Distribution in obstructive sleep apnea hypopnea syndrome (OSAHS) based on viscera syndrome differentiation theory, and analyze the correlation between TCM syndrome and body mass index (BMI), apnea hypopnea index (AHI), minimum oxygen saturation (LSaO2), Epworth somnolence scale (ESS score), and try to be a OSAHS The TCM syndrome differentiation seeks more objective index to provide basis for the selection of clinical individualized treatment schemes for OSAHS, and to further improve the clinical efficacy and compliance of the patients. A portable sleep breathing monitor (PM) was used to monitor 240 cases of the patients' height, weight, neck circumference, sleep monitoring, body mass index, the basic information table of snoring patients and the Epworth somnolence scale, which were collected by two doctors and above. The data of four medical diagnosis (including symptoms, tongue image, pulse image, face color, etc.), and determining the final TCM syndrome according to the syndrome differentiation and classification standard of traditional Chinese medicine. The collected data and information are input to the computer, the database is set up by EpiData, and the Excel file is generated. All the data are statistically analyzed by the statistical software SPSS 20. The results of the study are 1240 cases of O Among the patients with SAHS, 182 were male (75.8%) and 58 women (24.2%). The average age of male was significantly higher than that of women; the average age of 2240 patients was (52.4 + 14) years, of which 108 (45%) were in 45-60 years of age (45%), the average body mass index of 3240 patients (29.13 + 4.1), and the obese (BMI > 58). A total of 142 cases, accounting for 59.2%, more than half of OSAHS patients merged with obesity; 4, the proportion of TCM syndrome distribution was 74 cases of phlegm heat syndrome (30.8%), 70 cases of cold dampness and spleen syndrome (29.2%), 52 cases of spleen qi deficiency syndrome (21.7%), 22 cases of heart blood stasis syndrome (occupied, 9.2%) kidney yang deficiency syndrome 20 cases (occupied, 8.3%), and stagnation of liver qi stagnation syndrome in 22 cases (accounting for 29.2%); the patients of OSAHS were not all It was a single syndrome, mixed syndrome accounted for 29.2%, common syndromes and combination were: cold dampness and spleen syndrome + spleen qi deficiency syndrome, cold dampness and spleen syndrome + heart blood stasis syndrome, lung spleen qi deficiency syndrome + heart blood stasis syndrome; 5, four diagnosis data distribution: the frequency of symptoms above 40% were: snoring, drowsiness, thirst, forgetfulness, fatigue and weakness, chest cavity full stuffy, limb sleepiness Heavy, self perspiration, bitter taste, the main tongue is pale tongue (63.3%), the main tongue fur is white and greasy fur (40%), yellow greasy fur (31.2%), thin white moss (23.3%), the main pulse is slippery pulse, vein, pulse, chord pulse; 6, 240 cases of OSAHS patients with hypertension, a total of 156 cases, accounting for 65%, followed by hyperlipidemia in 29.2% (29.2%), coronary heart disease 59 cases (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, diabetes mellitus (29.2%), diabetes mellitus (24.6%), diabetes mellitus, diabetes mellitus, diabetes mellitus, diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (24.6%), and diabetes mellitus, and diabetes mellitus (31.2%), and diabetes mellitus (24.6%), and diabetes mellitus There were 48 cases (20%), 26 cases of cerebrovascular disease (10.8%) and 17 cases of arrhythmia (7.1%). Among them, hypertension was mostly found in cold dampness and spleen syndrome (47 cases), phlegm heat syndrome (45 cases), lung spleen qi deficiency syndrome (27 cases), coronary heart disease in 17 cases (17 cases), cold dampness and spleen syndrome (14 cases), hyperlipidemia in cold dampness and spleen syndrome (33 cases), and second was sputum heat obstructing syndrome (1). 7 cases (7 cases), the most (16 cases) in the syndrome of phlegm heat obstructing the lung, followed by the syndrome of cold dampness and spleen (10 cases), cerebrovascular disease occurred mostly in the deficiency of kidney yang deficiency syndrome (AHI), the difference of the lowest blood oxygen saturation between different TCM syndromes was not statistically significant (P0.05); the level of phlegm heat obstructing lung syndrome was higher than that of lung spleen qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P < 0.). 05) the neck circumference of kidney yang deficiency syndrome is lower than that of phlegm heat obstructing the lung syndrome, cold dampness and spleen syndrome, lung spleen qi deficiency syndrome and heart blood stasis syndrome (P0.05), the longest suspension time of phlegm heat obstructing lung syndrome is higher than that of cold dampness and spleen syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome (P0.05), the average temporary stopping time of phlegm heat obstructing lung syndrome is higher than that of lung qi deficiency syndrome and kidney yang deficiency syndrome (P < 0.05):8. OSAHS TCM syndrome and PM monitoring indexes and the correlation of BMI and ESS scores were analyzed by Logistic regression analysis, and the regression equation was summarized as follows: phlegm heat obstructing lung syndrome: Logit (P) =0.728X1+1.88X4-5.198 cold dampness and spleen syndrome: Logit (P) =1.82X1+0.528X2-3.39 lung qi deficiency syndrome: Logit =1.65X2-3.344X3+2.077X4-4.276 kidney yang deficiency syndrome: Logit (P) =1.65X2-2.311X3-2.69, X1, X2, X3, X4 represent BMI, AHI, LSaO2, and ESS score study conclusion: the characteristics of TCM Syndrome Distribution: phlegm heat obstructing the lung syndrome, cold dampness syndrome, spleen syndrome, spleen qi deficiency syndrome, kidney yang deficiency syndrome, kidney yang deficiency syndrome liver qi stagnation syndrome, its disease and five zang organs work Disorders related.OSAHS generally have a variety of complications, and there is a certain relationship between complications and TCM syndromes, such as hypertension often seen in phlegm heat syndrome, cold dampness and spleen syndrome, hyperlipidemia often seen in cold dampness and spleen syndrome, coronary heart disease often seen in heart blood stasis syndrome, cerebrovascular disease is mostly found in kidney yang deficiency syndrome. The degree of sleep and the time of pause were obviously higher than other syndromes, indicating that phlegm fever is an important pathological factor of OSAHS. The correlation of different syndromes with PM monitoring index and BMI, ESS score is different. The syndrome of phlegm heat accumulation is mainly related to BMI, ESS score, and the syndrome of spleen and spleen is mainly related to BMI, and the deficiency of spleen and spleen is mainly related to AHI, LSaO2 and blood stasis syndrome. To be related to LSaO2, the deficiency syndrome of Kidney Yang is mainly related to AHI and LSaO2, which suggests that the treatment of phlegm heat obstructing lung syndrome and cold dampness and dampness of spleen syndrome can first consider weight loss and control weight, and the patients with Qi deficiency syndrome, heart blood stasis syndrome and kidney yang deficiency syndrome should be first considered with continuous positive airway pressure ventilation (CPAP) treatment, in order to reduce the deficiency syndrome. Apnea hypopnea index improves anoxia.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1
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