喉源性咳嗽各证型发病因素调查研究

发布时间：2018-10-08 09:03

【摘要】：目的:阐明喉源性咳嗽各证型的发病原因及证候形成的相关因素。方法:选取2013年1月至2016年1月来自广西中医药大学第一附属医院及附属瑞康医院耳鼻喉科门诊符合纳入标准的喉源性咳嗽患者96例,对研究对象进行临床检查及问卷调查,包括诱因、发病时间等,间接鼻咽镜、间接喉镜及电子鼻咽喉镜检查、胸部X线片检查、外周血常规、C-反应蛋白、吸入性变应原筛查等实验指标的观察,对喉源性咳嗽的典型证候和一般证候进行随机对照研究以及处理,统计分析,提出喉源性咳嗽的基本证型。运用广义Logits模型(Generalized logits model)和判别分析(逐步判别、Fisher判别、Bayes判别)方法,对各证型喉源性咳嗽的相关因素和定量诊断进行分析,为进一步阐明喉源性咳嗽辨证标准及各证型证候演变规律提供依据。结果:1.本课题临床流行病学调查发现喉源性咳嗽的证型以卫表不固,禀质过敏型为主,占64.58%,其次为脾虚痰浊型,占22.92%,第三为阴虚火旺型,占6.25%,第四为风邪犯肺型,占6.25%。2.统计分析表明喉源性咳嗽各证型的发病与性别、年龄等人口学特征无关。3.喉源性咳嗽脾虚痰浊型的发病与烟酒嗜好、过敏史、感冒受凉等诱因有关,卫表不固、禀质过敏型与烟酒嗜好、辛辣饮食、过敏史、感冒受凉等诱因有关系,而风邪犯肺、阴虚火旺型因临床病例较少,暂不能得出明确结论。4.而病程的长短、干咳、咽痒、清嗓、咽干、咽后壁淋巴滤泡增生等临床特征在各证型见分布无明显差异,脾虚痰浊型咽异物感、鼻痒打喷嚏、咽充血等特征较为明显,卫表不固,禀质过敏型以鼻痒、打喷嚏、咽充血为主要特征。结论:1.统计分析表明喉源性咳嗽的发生与性别、年龄、职业、既往史、家族史、过敏史无关,与烟酒嗜好、辛辣饮食、感冒、受凉等诱因有关系,而咽干、病程的长短、鼻痒、眼痒、痰多等伴随症状在喉源性咳嗽各证型之间的分布情况有差异,但其具体联系还有待更大样本病例的采集及统计学的进一步分析及探讨。2.通过对喉源性咳嗽进行临床流行病学调查,获得了喉源性咳嗽中医证候的大样本临床流行病学资料以及对收集数据的整理和处理等具体经验,对喉源性咳嗽的临床辩证分型及发病因素的研究进行了有意义和成效的探索。
[Abstract]:Objective: to elucidate the pathogenesis of laryngeal cough and the related factors of syndrome formation. Methods: from January 2013 to January 2016, 96 patients with laryngogenic cough were selected from the first affiliated Hospital of Guangxi University of traditional Chinese Medicine and the Department of Otolaryngology of affiliated Ruikang Hospital. Including inducement, onset time, indirect nasopharyngoscope, indirect laryngoscope and electronic nasopharyngoscope, chest X-ray examination, peripheral blood routine C-reactive protein, screening of inhaled allergens, etc. The typical syndromes and general syndromes of laryngogenic cough were studied and treated randomly, and the basic syndromes of laryngogenic cough were put forward. Using the generalized Logits model (Generalized logits model) and discriminant analysis (stepwise discriminant Logits discriminant Bayes discriminant), the related factors and quantitative diagnosis of laryngogenic cough of various syndromes were analyzed. To further clarify the laryngogenic cough syndrome differentiation criteria and the evolution of syndrome patterns to provide the basis. The result is 1: 1. The clinical epidemiological investigation found that the syndrome type of laryngogenic cough was not solid, the type of intrinsic hypersensitivity was 64.58, followed by spleen deficiency and phlegm turbid type, accounting for 22.92um, the third type was Yin deficiency and fire flourishing type (6.2525), the fourth type was wind evil invading lung type (6.25g. 2). Statistical analysis showed that the onset of laryngeal cough was not related to the demographic characteristics of sex, age, etc. The onset of larynx cough, spleen deficiency and phlegm turbid type is related to smoking and wine addiction, allergic history, cold and other inducements. The health table is not strong. The intrinsic hypersensitivity type is related to smoking and alcohol addiction, spicy diet, allergic history, cold, etc., while wind evil invades the lung. Yin deficiency fire flourishing type because of the clinical cases are less, temporarily unable to reach a clear conclusion. 4. However, the clinical features of the disease course, dry cough, itchy pharynx, clear throat, dry pharynx, lymphoid follicular hyperplasia in the posterior pharynx wall were not significantly different in all syndromes. The characteristics of foreign body in pharynx with spleen deficiency and phlegm turbidity, nasal itching and sneezing, and hyperemia of pharynx were obvious. It is characterized by itching of nose, sneezing and hyperemia of pharynx. Conclusion 1. Statistical analysis showed that the occurrence of laryngeal cough was not related to sex, age, occupation, past history, family history, allergic history, but related to smoking and alcohol addiction, spicy diet, cold, and so on, while dry pharynx, duration of disease, nasal itch, eye itch, etc. There are differences in the distribution of sputum and other associated symptoms among the syndromes of laryngogenic cough, but the specific relationship needs to be collected from larger sample cases and further analyzed and discussed by statistics. 2. Through the clinical epidemiological investigation of laryngogenic cough, we obtained the large sample of clinical epidemiological data of laryngogenic cough syndrome, and the specific experience of collecting data and processing, etc. The clinical dialectical classification of laryngogenic cough and the study of its pathogenic factors were explored.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1

【参考文献】