【作者】 王红艳；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2013， 博士

【摘要】 目的：通过对抑郁症(轻中度)临床横断面流行病学调查研究，分析主要宏观表现，抑郁症影响因素、症状频次及差异，证候及其规律，明确抑郁症(轻中度)主要宏观表现及各证候分布规律，为抑郁症证候辨证规律及从肝论治抑郁症的临床疗效作用机制提供数据参考，增添从肝论治抑郁症的新认识，为提高和拓展从肝论治抑郁症提供理论依据。方法：依据研究取得的新发现，创制并运用抑郁症临床流行病学现况调研调查表，以ICD-10的抑郁症发作诊断标准为主，借鉴现代心理学量表，在文献梳理分析和病证结合的基础上，采用临床横断面流行病学调查的方法在山东、河南同步调查，完成符合研究筛选标准的抑郁症患者的临床中医症状、证候信息的大样本采集。运用SPSS13.0软件根据指标分别进行描述性、对比性、回归性统计分析。结果：①经统计男性115人（36.3%）、女性202人（63.7%），男∶女=1∶1.76；最小年龄18岁，最高年龄65岁，平均年龄38岁；在婚况上已婚者252例(79.5%)最多，其次是未婚者48例(15.1%)；教育程度上小学142例(44.8%)最多，其次是大学99例(31.2)；汉族314例(99.1%)；职业中农民最多187例(59.0%)，其次是学生29例(9.1%)。②精神症状共20个症状，在轻度中出现频次最多的是“神思迟钝”206例(65.0%)，其次为懒动懒言(61.7%)，社会或经济行为能力下降(60.1%)，健忘(58.4%)，焦虑(58.2%)，最少的是“妄见妄闻”(12.9%)；在中度中出现频次最多的是“情绪低落”129例(40.7%)，其次为抑郁(38.1%)，胆怯易惊(31.5%)，疲劳(31.2%)，兴趣降低(27.9%)，最少的是“妄见妄闻”11例(3.5%)。躯体症状中分为轻中重的共有25个，在轻度中出现频次最多的是“头晕”148例(46.6%)，依次为短气(44.6%)，腰膝痠软(43.9%)，口干咽燥(43.6%)，心悸(41.4%)，出现例数最少的是“性欲减退”42例(13.4%)；在中度中出现频次最多的是“善太息”77例(24.3%)，依次为口干咽燥(17.5%)，头晕(16.6%)，纳呆(12.9%)，心悸及腰膝痠软(11.4%)，出现例数最少的是“目眩”4例(1.2%)。③舌脉象：舌色以淡红舌157(49.5%)、淡白舌69(21.8%)、红舌50(15.8%)多见；舌形以正常舌213(67.2%)、齿痕舌61(19.2%)、胖舌50(15.8%)多见；苔色以白苔133(42.0%)、淡黄苔65(20.5%)及淡白苔63(19.9)多见；苔质以薄苔139(43.8%)、厚苔127(40.1%)、腻苔118(37.2%)多见；脉象出现频率前五位的症状依次为：弦脉211(66.6%)、沉脉107(33.8%)、滑脉97(30.6%)、细脉89(28.1%)、数脉46(14.5%)。④男女的教育程度及婚况差异，性别在轻中度的症状分布上有统计学意义(P＜0.05或P＜0.01）；性别的主证型分布无统计学意义(P＞0.05)，地域在主证型分布上有差异的是下述四种证型肝气郁证、心脾两虚证、肝郁痰阻证、肝郁脾虚证(P＜0.05）。⑤在主证证型中最多者是肝气郁证146例(46.1%)，其它前五位依次是肝郁痰阻证59例(18.6%)，肝郁肾虚证22例(6.9%)，肝郁脾虚证15例(4.7%)，心脾两虚证14例(4.4%)；logistic多元回归分析显示，以下症状分别纳入各证型的回归方程：肝气郁证：焦虑、短气、脉沉数、苔淡黄；肝郁痰阻证：神思迟钝、目光呆滞、咽中异物感、舌暗、苔厚腻、脉滑；肝郁肾虚证：盗汗、耳鸣、失眠、脉弦；肝郁脾虚证：悲观厌世、目涩、脘腹胀痛、便溏、舌胖、苔白、脉细；心脾两虚证：目光呆滞、失眠、舌淡白、舌胖、脉弱。结论：①抑郁症在女性、已婚未婚者、小学以下大学以上人群、农民及学生患病率较高；性别在教育程度及婚况等社会心理因素方面的差异对其患病率产生影响。②男女在教育程度及婚况上的差异，不同性别的症状分布差异有统计学意义。③性别在主证型分布无差异，地域在主证型分布上有差异的是肝气郁证、心脾两虚证、肝郁痰阻证、肝郁脾虚证。④抑郁症的诊断包括核心症状、心理症状群及躯体症状群；以情绪低落，兴趣缺乏及乐趣丧失为核心症状，轻中度抑郁症的核心病机是肝主疏泄调畅情志的功能失职而致的“肝郁”。中医辨证基础证型是肝气郁结证，主要证型还有肝郁痰阻、肝郁肾虚、肝郁脾虚、心脾两虚证，在脏腑定位上以肝为主，涉及脾心肾。⑤经logistic多元回归分析，抑郁症各证型的证候分布规律为：肝气郁证：焦虑、短气、脉沉数、苔淡黄；肝郁痰阻证：神思迟钝、目光呆滞、咽中异物感、舌暗、苔厚腻、脉滑；肝郁肾虚证：盗汗、耳鸣、失眠、脉弦；肝郁脾虚证：悲观厌世、目涩、脘腹胀痛、便溏、舌胖、苔白、脉细；心脾两虚证：目光呆滞、失眠、舌淡白、舌胖、脉弱。更多还原

【Abstract】 Objective: to analyze the macroscopic symptom of the depressive disorder (slight ormidrange), the influential factor, the frequency and difference of symptom and thesyndrome regularity through the epidemiological cross-sectional study of the depressedpatients. We could clarify the syndrome regularity of the depressive disorder (slight ormidrange) and would explore the pathogenesis of the liver failing to control the dispersionand to accommodate the emotion. To provide the reference data for the treatment of thedepressive disorder (slight or midrange) the next phase, to add the fresh cognition so as toimprove and develop the treatment initiated from the liver.Methods: The epidemiological investigation was adopted to research the patients whowere diagnosed according to ICD-10and pop psychology measuring scale. Based on thedocuments and the combination of disease with syndrome, we have created the scheduletable and have finished the cases’ collection of the depressive disorder in ShandongProvince and Henan Province in the epidemiological cross-sectional study. We havegathered the syndrome and applied SPSS13.0software to analyze the data.Results:①Male115cases（36.3%）、Female202cases（63.7%）, they are in the ratioof1∶1.76. The mean age is38years. During the cases,18years is the minimum and65years is the maximal. There are252cases (79.5%) whom have been married and48cases(15.1%) that were single. The education level: primary school142cases（44.8%）andcollege99cases（31.2%）; Race: Han people314cases (99.1%)；The occupation: thepeasants187cases (59.0%) and the students29cases (9.1%).②20psychiatric symptomswere investigated in the research. There was the frequency sequence of symptoms in thelight depressive disorder, such as thinking torpidity206cases (65.0%), hypoaction and hypologia (61.7%), the capability of society or economy decrease (60.1%)，morbidforgetfulness (58.4%)，anxiety (58.2%)，visual hallucination and auditory hallucination(12.9%)；There was the frequency sequence of symptoms in the midrange depressivedisorder, such as emotion drawdown129cases (40.7%), depress(38.1%)，afraid and pavor(31.5%), defatigation (31.2%)，interest degrades(27.9%), visual hallucination and auditoryhallucination(3.5%). There were25somato-symptoms in the depressive disorder. Therewas the frequency sequence of symptoms in the light depressive disorder, such as dizziness148cases (46.6%), shortness of breath(44.6%), sore and weak loins and knees (43.9%)，dry mouth and dry swallow (43.6%), palpitation (41.4%), debility sexualis42cases(13.4%); There was the frequency sequence of symptoms in the midrange depressivedisorder, such as sigh77cases (24.3%), dry mouth and dry swallow (17.5%),dizziness(16.6%)，anorexia(12.9%)，palpitation and sore and weak loins and knees (11.4%),dizziness(1.2%).③Tongue demonstration and pulse tracings: The colour of tongue:carnation tongue157cases (49.5%)、pale tongue69cases (21.8%)、red tongue50cases(15.8%); The lingual contour: normal tongue213cases (67.2%)、teeth-marked tongue61cases (19.2%)、swollen tongue50cases (15.8%); The colour of coated tongue: whitecoating133cases (42.0%)、light yellow coating65cases (20.5%) and light white coating63cases (19.9%); The appearance of coated tongue: thin coating139cases (43.8%)、 thickcoating127cases (40.1%)、 greasy coating118cases (37.2%); The pulse tracings: wirypulse211cases(66.6%)、sunken pulse107cases (33.8%)、slippery pulse97cases (30.6%)、thready pulse89cases (28.1%)、frequent pulse46cases(14.5%).④There were significantdifference on the gender for the patients who had educational level and marriage. Therewas statistical significance for the patients who had different gender (P＜0.05or P＜0.01）;There wasn’t significant difference on the pattern of syndrome of the gender. We havefound frequently four syndrome differentiations in the investigation such as stagnation ofliver-QI, deficiency of both heart and spleen, stagnation of liver-QI and stagnation ofphlegm, stagnation of liver-QI with deficiency of the spleen.⑤We discovered the most principal syndrome was stagnation of liver-QI,146cases(46.1%) in the investigation. For the rest stagnation of liver-QI and stagnation ofphlegm59cases (18.6%), stagnation of liver-QI with deficiency of kidney22cases (6.9%),stagnation of liver-QI with deficiency of the spleen15cases (4.7%), deficiency of both heart and spleen14cases (4.4%). There were some symptoms included in the principalsyndrome regression equation through the logistic multiple regression analysis. Stagnationof liver-QI: anxiety, short breath, sunken pulse and frequent pulse, light yellow tonguecoating; stagnation of liver-QI and stagnation of phlegm: thinking torpidity, dementia,globus hystericus, gloomy tongue, thick and greasy tongue coating, smooth pulse;stagnation of liver-QI with deficiency of kidney: night-sweat, tinnitus, insomnia, wirypulse; stagnation of liver-QI with deficiency of the spleen: pessimistic, dryness of eye,distension and fullness of gastric cavity, loose stool, swollen tongue,white coating, threadypulse; deficiency of both heart and spleen: dementia, insomnia, light white tongue,swollen tongue,delicate pulse.Conclusion：①The disease incidence of the depressive disorder was high in thepatients who was female, married or single, infra-primary school or super-college, peasantand student.②There were significant difference on the gender for the patients who hadeducational level and marriage. There was statistical significance for the patients who haddifferent gender.③There was no significant difference on the gender for the principalsyndrome. We have found frequently four syndrome differentiations in different regionssuch as stagnation of liver-QI, deficiency of both heart and spleen, stagnation of liver-QIand stagnation of phlegm, stagnation of liver-QI with deficiency of the spleen.④Thediagnosis of the depressive disorder include the central symptom, psycho-symptom andsomato-symptom. Depression, interest degrades and anhedonia were the central symptomof the depressive disorder. The key pathogenesis of the depressive disorder is stagnation ofliver-QI, which is the misalignment of liver controlling the dispersion and accommodatingthe emotion. The principal syndrome of the depressive disorder in TCM was stagnation ofliver-QI, which was located and initiated from the liver. There were four syndromedifferentiations frequently for example stagnation of liver-QI with stagnation of phlegm,stagnation of liver-QI with deficiency of kidney, stagnation of liver-QI with deficiency ofthe spleen, deficiency of both heart and spleen.⑤The logistic multiple regression analysisshowed the different syndrome have various principal symptoms. Stagnation of liver-QI:anxiety, short breath, sunken pulse and frequent pulse, light yellow tongue coating;stagnation of liver-QI and stagnation of phlegm: thinking torpidity, dementia, globushystericus, gloomy tongue, thick and greasy tongue coating, smooth pulse; stagnation ofliver-QI with deficiency of kidney: night-sweat, tinnitus, insomnia, wiry pulse; stagnation of liver-QI withdeficiency of the spleen: pessimistic, dryness of eye, distension and fullness of gastriccavity, loose stool, swollen tongue,white coating, thready pulse; deficiency of both heartand spleen: dementia, insomnia, light white tongue, swollen tongue,delicate pulse.更多还原