艾滋病常见中医证候的研究

【作者】 关静；

【导师】 梁嵘； 李峰；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2007， 博士

【摘要】 目的证候研究是中医临床治疗的基础,以往艾滋病的证候研究主要停留在临床医生的个人经验上,缺乏较规范的临床流行病学调查。本研究在国家自然科学基金委员会资助项目支持下,通过对艾滋病不同人群的症状、证候以及舌象特点进行研究,探讨艾滋病的症状、证候特点,以及不同人群的差异,为中医药治疗艾滋病提供一定依据,加深对艾滋病的中医认识。方法1理论研究对中医伏气温病理论的源流进行梳理、从病因病机、发病过程、临床特点等几方面探讨伏气温病理论与艾滋病的相通性和可借鉴性,对进一步认识艾滋病的因机论治提供启示。对现有艾滋病证候的有关文献进行统计,分析目前认为的艾滋病常见中医证候分型。2临床研究在对非洲艾滋病人群进行回顾性研究的基础上,采用临床流行病学横断面调查的方法,利用《艾滋病中医临床调查表》对334例因有偿采供血感染艾滋病人群和175例因吸毒感染艾滋病人群的进行了症状调查,采用证候评定软件进行证候评定,同时运用舌象拍摄和专家分析相结合的方法进行了舌象研究,对不同人群的症状、证候分布、舌象特点进行比较。最后运用逐步判别法来筛选变量,对艾滋病常见证候进行了计量诊断的探索性研究。结果1理论研究1.1用伏气温病理论能较好地阐述艾滋病的病机,艾滋病的临床表现与传统伏气温病之间有很多相似之处,同时也具有自身的一些特殊性,最后根据伏气温病的理论以及艾滋病自身的特点,提示艾滋病的治疗应注意清热祛邪、扶正固本、通降气机、活血化瘀四个方面。1.2在对1988-2005年艾滋病中医证候相关文献进行检索和统计的结果显示,到目前为止,对艾滋病证候的研究为数不多,而且主要仍以个人经验为主,分型繁杂,15篇期刊论文中共出现了58种证候。2临床研究2.1对非洲249例艾滋病患者的免疫指标（CD₄⁺、CD₄⁺%、CD₈⁺、CD₈⁺%、CD₄⁺/CD₈⁺）与外周血组分（WBC、Hb、LY、LY%）的关系、免疫指标与症状体征出现的关系以及此类人群的症状体征特点的回顾性研究显示,随着CD₄⁺计数的下降,外周血中LY、LY%、WBC、Hb也都呈明显下降趋势,而LY计数与CD₄⁺计数有显著相关性;症状总积分随CD₄⁺的降低而升高,且大部分症状体征的积分随着CD₄⁺细胞数的下降而升高。此外,非洲艾滋病患者症状体征的出现的频次依次为乏力、淋巴结肿大、咳嗽、发热等。2.2在非洲人群、因有偿采供血感染艾滋病人群与因吸毒感染艾滋病人群三者的比较中,因有偿采供血感染艾滋病人群的症状表现是最为严重的。在因有偿采供血感染艾滋病人群与因吸毒感染艾滋病人群证候分布的比较中,与症状相对应,因吸毒感染艾滋病人群证候出现率整体也是低于因有偿采供血感染艾滋病人群的,但痰湿证和湿热证的出现高于因有偿采供血感染艾滋病人群。2.3因有偿采供血感染艾滋病和吸毒感染艾滋病两类人群的舌象特点较为一致,舌色上均以红舌类最为突出,红赤、红绛、暗红舌合计出现率分别为63.64%和65.71%,瘀舌出现率分别为33.64%和41.14%,胖大/齿痕舌分别为40.45%和45.14%,裂纹舌为35.00%和26.86%,统计学分析无明显差异。从舌苔的结果来看,均以白苔居多,分别是71.82%、69.14%,黄苔则分别是23.18%、28%,腻、厚苔的出现率也较突出。2.4采用逐步判别法Bayes两类判别,筛选变量,建立了七个判别函数式,分别对气虚证、血虚证、阴虚证、肺虚证、脾虚证、肾虚证、痰湿证进行症状体征的变量筛选,进行两类判别讨论,气虚证、血虚证、阴虚证、肺虚证、脾虚证、肾虚证、痰湿证七个证型的回顾性误判概率分别为:4.3%、7.3%、8.1%、11.2%、10%、9.9%、10.1%,判别效果较好。结论1理论研究1.1艾滋病从整个疾病过程来看,与伏气温病有着很多相似之处,伏气温病理论有助于我们认识艾滋病的发病机制,同时,对于艾滋病的防治也具有一定的启示作用。此外,伏气温病理论对于艾滋病的早期治疗也可以提供一定思路。1.2目前中医界对艾滋病证候的临床研究较少,尚未形成较为统一的认识,文献报道中的证候分布较为分散,各家自成一派,急需开展艾滋病的证候学研究。2临床研究2.1 CD₄⁺可以较好地估计患者病情及预后;淋巴细胞计数可以看作是衡量患者免疫功能的一项重要指标,在不具备CD₄⁺检测的条件下可以测定淋巴细胞计数来代替。2.2因有偿采供血感染艾滋病与吸毒感染艾滋病人群两者的证候特点在本质上是相似的,均表现为虚实夹杂,虚证主要为气虚、脾虚、肾虚、肺虚、阴虚、血虚、肝虚、心虚,实证主要为痰湿、热毒、湿热、血瘀。不同人群由于病程和其他因素的影响其症状、证候的分布略有不同,同时,病程越长,虚证的表现越为突出。2.3两类人群舌象表现特点相似,总结艾滋病典型舌象的四大特点为:舌质红;苔厚腻、以白腻居多;舌体胖大或有齿痕;有瘀象。2.4从建立的判别回归方程的各症状系数的大小,可以初步看出它们对于各证型的影响程度,为评价各症状的诊断价值提供了数量上的依据,为艾滋病的证候标准化研究奠定了一定基础。更多还原

【Abstract】 ObjectiveStudy of syndromes is the base of TCM therapy. At present study of syndromes of AIDS still stays at personal experiences of doctors, and lacks a clinical epidemiologic survey. This study is supported by NSFC and it aims to research symptoms, syndromes and characteristics of tongues of different AIDS people, so as to provide some evidences for the treatment of TCM and know more information of AIDS.Methods1 Theoretical studyIn order to provide the inspiration to the treatment of TCM, theory of hidden exogenous seasonal disease is researched compared with AIDS from pathogenesis, course of invasion and clinical appearances.Literatures are analyzed on syndromes of AIDS available, so to get the present common syndromes.2 Clinical studyAfter the retrospective study on the Africa AIDS people, based on the method of cross-sectional study, 334 AIDS people infected from blood-supply and 175 AIDS people infected from drug abuse are investigated. A questionnaire and a software of syndrome evaluation are used in the research. Meanwhile tongue demonstration is researched through picture-taking combined with analyze of experts. Different people of AIDS are compared on the syndromes, symptoms and characteristics of tongues. At last, discriminate analysis is used on the quantitative diagnosis of AIDS syndromes.Results1 Theoretical study1.1 Theory of hidden exogenous seasonal disease could explain the pathogenesis of AIDS reasonably. The clinical manifestation of AIDS is alike with the hidden exogenous seasonal diseases. Meanwhile it has its own specificity. The theory indicates that to clear the heat, support healthy energy, smooth the Qi of the body and promote blood circulation to remove stagnations of blood should be take attention in the treatment of TCM1.2 Through searching and analyzing the literature from 1988 to 2005 on syndrome of AIDS, we could know that research on syndromes of AIDS is still not enough, and most of the research are based on personal experiences. In the 15 papers 58 types of syndrome appear. 2 Clinical study2.1 249 AIDS samples in Africa are analyzed on the relationships of their WBC、Hb、LY、LY%,CD₄⁺、CD₄⁺%、CD₈⁺、CD₈⁺%、CD₄⁺/CD₈⁺ and the 11 symptoms. The retrospective study appears that LY、LY%、WBC、Hb decline with the decrease of CD₄⁺ cell count and the LY were significantly correlated with CD₄⁺ cell count. Besides, the total scores of the symptoms increase with the decrease of CD₄⁺ cell count and most of the score of single symptoms increase with the decrease of CD₄⁺ cell count. Symptoms of AIDS people in Africa appear debilitation, lymphadenectasis, cough, fever, etc. in order.2.2 In the comparisons among AIDS people in Africa, AIDS people infected from blood-supply and from drug abuse, people infected from blood-supply appear the most severe symptoms. And in the comparison between AIDS people infected from blood-supply and from drug abuse, most the frequencies of syndromes of the latter are lower than the former except damp syndrome and damp-heat syndrome.2.3 Tongue demonstrations of the AIDS people infected from blood-supply and from drug abuse are similar. The two group of AIDS people appear 63.64% and 65.71% separately in the kind of red tongue, 33.64% and 41.14% in the kind of stagnant tongue, 40.45% and 45.14% in the kind of puffy tongue or teech-printed tongue, 35.00% and 26.86% in the kind of fissured tongue. And the two group of AIDS people appear more white fur （71.82% and 69.14% separately） than yellow fur （23.18% and 28% separately）. And greasy fur and thick fur are common.2.4 Step by step discriminate analysis is used to set up equations for each syndrome, including syndrome of deficiency of vital energy, deficiency of blood, syndrome with yin asthenia, pulmonasthenia, splenasthenic syndrome, nephrasthenia syndrome, damp syndrome.Conclusions1 Theoretical study1.1 From the whole duration of AIDS, it have many similarities with hidden exogenous seasonal diseases. The theory of hidden exogenous seasonal disease could help us to understand the pathogenesy of AIDS, and to search for more ways in the treatment of TCM. Meanwhile , the theory also provides some way on the early treatment of AIDS.1.2 At present there are only a few clinical researches on the syndromes of AIDS. A consensus on syndromes of AIDS hasn’t been formed. Distribution of the syndromes in the literature is disordered and a clinical epidemiologic survey is badly in need.2 Clinical study2.1 CD₄⁺ cell count could be used to estimate pathogenetic condition and prognosis of the patients. LY is an important index to measure immune level. When CD₄⁺ cell count can’t be detected LY could take the place.2.2 The characteristics of TCM syndromes of AIDS people infected from blood-supply and from drug abuse are similar. Both of them appear deficiency syndrome accompanied with excess syndrome. Deficient syndromes include deficiency of vital energy, splenic asthenia, renal deficiency, pulmonasthenia, yin asthenia, blood deficiency, hepatic asthenia and deficiency of heart, etc. Sthenia syndromes include phlegmatic hygrosis, toxic heat, humid heat and blood stasis. Different AIDS people could be a little different in symptoms and syndromes because of the period of disease and other factors. And appearances of deficient syndromes will be more obvious with the time goes by.2.3 Tongue demonstrations of the AIDS people infected from blood-supply and from drug abuse are similar. The characteristics could be summarized as four points:red, greasy and thick fur, most of which are white fur, puffy or teech-printed, and stagnant.2.4 From the coefficient of the symptoms in the regression equations, influence of them to the syndrome could be estimated. It could provide evidence for evaluate the diagnostic value of the symptoms and establish some groundwork for standardization of syndromes of AIDS.更多还原