功能性消化不良中医证候分布规律及生活质量状态评价研究

【作者】 林芳任；

【导师】 王新月；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 博士

【摘要】 目的：本研究在中医理论指导之下,探讨功能性消化不良(Functional Dyspepsia, FD)患者的中医证候(TCM syndrome)特征及证候分布(distribution of syndrome)规律。另外,评价功能性消化不良患者的生活质量(quality of life)状况,以及抑郁(depression)与焦虑(anxiety)的程度与中医证候之间的关系,以提供未来做为临床治疗功能性消化不良的指引。方法：收集自东直门医院消化内科门诊就医的功能性消化不良113例患者为研究对象,经其同意后,由医师指导患者自行填写FD证候调查表、生活质量评价问卷调查健康量表(SF-36)、Zung氏抑郁自评量表(SDS)、与Zung氏焦虑自评量表(SAS)等。将所得全部数据键入Excel表格,以备统计分析之用。接着统计分析功能性消化不良患者的性别、年龄、身高、体重、婚姻状况、职业、文化程度、饮食偏嗜、烟酒嗜好、与药物过敏的分布比例。再来根据中西医症状积分量表所得积分,判定患者在功能性消化不良的四种中医证型之中,属于那一种证型。首先分别计算每一位患者的生活质量积分、抑郁积分、焦虑积分,然后算出四种中医证型所属全部患者的生活质量积分、抑郁积分、焦虑积分的平均数±标准差,最后检定比较那一种中医证型的生活质量积分最高,那一种中医证型的抑郁积分和焦虑积分最低。结果：患者性别、年龄、婚姻状况、民族、与职业,在功能性消化不良的中医证型分布中无统计学上显著差异(p>0.05)。又功能性消化不良中医症状以胃脘胀满,食后胀甚、饮食减少、嗳气、疲乏无力、胃脘疼痛出现频率最高。在饮食偏嗜中又以辛辣(37.2%)和饮酒(23%)占多数：在四种中医证型的分布规律方面为湿热壅滞17.7%,脾虚气滞20.3%,肝胃气滞25.7%,肝胃郁热36.3%。对于不同身高、体重、文化程度、饮食偏嗜、烟酒嗜好、与药物过敏的分布比例,在功能性消化不良的中医证型分布中无统计学上显著差异(p>0.05)。各种不同中西医症状在功能性消化不良的中医证型分布中有统计学上显著差异(p<0.01)。又功能性消化不良的患者中抑郁患者占54%、焦虑患者占28.3%。在四种中医证型方面以脾虚气滞的生活质量积分(68.71±28.04)最高,抑郁积分(43.75±8.07)和焦虑积分(40.16±6.93)最低。结论：功能性消化不良的中医证型分布与年龄、性别、身高、BMI、婚婚状况、学历、职业、饮食偏嗜无关。功能性消化不良中医证候分布与中西医症状、舌脉象、抑郁、焦虑、生活质量有关。功能性消化不良中医证型分布以肝胃郁热和肝胃气滞较多见。生活质量积分、抑郁积分、和焦虑积分以脾虚气滞的中医证型最好。更多还原

【Abstract】 Objective:This study aimed to explore the characteristics of the traditional Chinese medicine (TCM) syndrome, and the distribution of syndrome of functional dyspepsia (FD) under the explanation of the theory of TCM. It provided the guidelines to clinical treatments for FD in the future following evaluating the condition of quality of life, as well as the severity of depression and anxiety determined from FD patients.Methods:A total of 113 subjects were recruited from patients with FD visiting at outpatient clinic of digestive medicine in Dongzhimen Hospital. After obtaining written consent, the FD patients themselves filled up four kinds of reliable questionnaires, such as Investigative Table of FD Syndrome, SF-36, Zung’s SDS, and Zung’s SAS, anddirected by a physician nearby. All data were keyed into the Microsoft Excel for subsequent calculations. Proportions of sex, nation, age, body height, body weight, marriage, vocation, food preference, cigarette preference, alcohol preference, cultural level and hypersensitivity to drug were analyzed. Which type of TCM type identification of FD was determined by the scores of symptoms of TCM and Western medicine. Scores of SF-36, SDS, and SAS of each patient were also calculated. Same TCM type identification of FD patients was collected together. Means and standard deviations of scores of SF-36, SDS, and SAS of every TCM type identification were then measured. Finally, the highest score of SF-36 and lowest scores of SDS as well as SAS of TCM type identification were interpreted.Results:Among TCM types identification of FD, there were not statistically significant differences in sex, age, marriage, nativity, and vocation of all study subjects (p>0.05). Epigastric fullness, postprandial distention, poor appetite, belching of gas, lassitude and epigastric pain were most frequently suffered in TCM symptoms of FD. In food preference, the proportion of eating chili pepper subjects was 37.2%, while the proportion of touching alcohol subjects was 23%. In four TCM types identificationof FD, the frequencies of their individual distribution regulation were as follows: dampheat-crowd-stagnancy was 17.7%, spleen-vacuity-current-stagnancy was 20.3%, liver-stomach-current-stagnancy was 25.3%, liver-stomach-depression-heat was 36.3%. There were not significant differences in proportions of body height, body weight, cultural level, food preference, cigarette-alcohol preference, and hypersensitivity to drug(p> 0.05). In TCM type identification of FD, there were significant differences in various symptoms attributing to TCM and Western medicine (p<0.01). The proportion of depression patients was 54% of subjects, while the proportion of anxiety patients was 28.3%. In four types of TCM syndromes of FD, the score of SF-36 in spleen-vacuity-current-stagnancy was 68.71±28.04, whereas the score of SDS was 43.75±8.07, and the score of SAS was 40.16±6.93.Conclusions:There were not correlations between distribution of TCM type identification of FD and sex, age, body height, BMI, marriage, cultural level, as well as food preference. There were close correlations with distribution of TCM type identification of FD and TCM symptoms, symptoms of Western medicine, images of tongue and pulse, quality of life, depression, as well as anxiety. Liver-stomach-depression-heat and liver-stomach-qi-stagnancy were more frequently occurred in TCM type identification distribution of FD. The scores of SF-36, SDS, and SAS were most favorably appeared in spleen-vacuity-qi-stagnancy listed in TCM type identification distribution of FD.更多还原