【作者】 林本荣；

【导师】 俞守义；

【作者基本信息】 南方医科大学 ， 流行病与卫生统计学， 2008， 博士

【摘要】 研究背景:亚健康这一概念最早是由前苏联学者Bermkna在20世纪80年代提出的。亚健康状态是介于健康和疾病之间的健康低质量状态及其体验,是机体尚无器质性病变仅有某些功能性改变的“灰色状态”,实际上是心身疾病的潜临床状态或病前状态。亚健康状态主要表现为身体虚弱、易疲劳、活力减退和免疫力低下等,被认为是21世纪危害人类健康的新杀手。亚健康状态的人群在许多国家和地区呈上升趋势。虽然亚健康在症状上表现的是医学领域问题,但从整体看,它与职业因素、社会环境、经济文化、心理因素及身体功能密切相关,是影响人类生活质量的重要问题,因此,加强该领域的研究具有非常重要的现实意义。目的意义:本研究的主要目的是运用西医理论初步建立适合中国军人行业特点的亚健康诊断分类方法,研制亚健康症状测评量表,评价军人亚健康状况,进行有针对性的干预并评价其效果。研究结果不仅有利于军队人群的亚健康研究和健康促进,也有利于促进我国亚健康研究工作的发展。研究方法:1.以世界卫生组织的健康概念研究亚健康1947年世界卫生组织(WHO)健康定义是:“健康不仅为疾病和赢弱之削除,而系体格,精神与社会之完全健康状态”。根据这一理论,健康至少应包含3个层面的含义:①躯体健康;②心理健康;③社会适应健康。合称之为“三维健康”观念。根据这一定义又把人的健康划分为三种状态即:健康状态、疾病状态和亚健康状态(处于健康与疾病之间的状态)。1989年WHO把道德修养纳入了健康的范畴,提出了“身体健康、心理健康、道德健康、社会适应良好”四个方面的健康新标准。内容包括:“健康者不以损害他人的利益来满足自己的需要,具有辨别真与伪、善与恶、美与丑、荣与辱等是非观念,能按社会行为的规范准则来约束自己及支配自己的思想行为。此称之为“四维健康”观念。2.以医学模式的转变研究亚健康医学模式变迁是亚健康分型研究的理论基础。随着经济社会的发展,医学模式也随之改变,传统医学模式(生物医学模式)向现代医学模式(生物-心理-社会医学模式)转变是健康理论不断深入研究的促进剂。其次,“四维健康”观念的形成把社会和人对自我整体健康要求上升到了新的高度。以现代生物-心理-社会医学模式取代以往单纯的生物医学模式对于亚健康的分型提供了方法论上的帮助。3.对亚健康实施分型亚健康(sub-health)是指人的一种低质状态,呈现出活力和适应能力降低。机体虽无明确的疾病,但在躯体上、心理上会出现种种不适应的感觉和症状,游离于健康与疾病之间的身心欠健康状态。人体处于亚健康状态时,可无器质性损害,临床表现多为不定陈述综合症。现代医学缺乏特异性的诊断手段和客观的疗效评价指标,从而给临床诊治和研究带来了困难。亚健康状态的产生,是由于环境、心理、生理、社会、道德和病源6个方面因素导致机体的神经、内分泌、免疫系统整体功能失衡、紊乱而导致的一系列次临床症状表现。分型方法有:(1)根据“亚健康”概念的构成要素分型:建立亚健康症状谱和对亚健康症状谱进行分类。范围包括:①身体不适综合征:表现出身心上有不适感觉,躯体物理检查与实验数据均正常;②亚临床状态综合症,具有某些明确的倾向性疾病的临床表现前期(潜伏)症状;③原因不明综合征:此类症状不具有病理意义但也查不出具体原因;④病原体携带状态综合症:个体为病原体携带者,他们躯体功能正常,心理、社会适应状态正常,或病原体检查实验值异常;⑤检验高低值临界状态;某些临床检查的值处于高、低限值状态;⑥躯体健康处于高致病性危险因子状态,如超重等。(2)根据金标准分型。这些标准有:①道德健康金标准分型。随着传统医学模式向现代医学模式转变,WHO已经把道德健康被纳入了个体健康范畴。道德是由人们的物质生活条件所决定的,评价人们的思想和行为的善与恶、荣誉与耻辱、正义与非正义、公正与偏私、诚实与虚伪等问题上的观念、原则和规范的统一体。它实际上不是个人的道德,而是社会集团每个成员的道德,是人们在为人处世过程中应遵循的起码的行为原则。是公民道德规范中最低层次的道德规范。②根据人文与生态环境金标准分型。这些金标准已经被国家以法律文件形式确定。③根据人体系统功能分型。每个系统的组织器官在正常人体的新陈代谢中发挥着相应的功能。当某个器官功能失调时机体会表现出相应的不适应症状或躯体不适应信息,这时身体的整体感觉处于失衡状态或出现新陈代谢的紊乱,机体为了保持自体新陈代谢的平衡,促使机体发生一系列异常条件反射反应。使个体自身整体处于不适应状态,而表现出各种不同的不适综合症状现象。4.编制亚健康症状测评量表《Sub-health Syptom Evaluation Scale(SSES)(军人)》以世界卫生组织生存质量测定量表简表The World Health OrrganizationQuality Of Life(WHOQOL)-BREF为参照标准,研制亚健康症状态测评量表(SSES)。构建《亚健康症状态测评量表(SSES)》(军人)的理论亚型。在亚健康分型的基础上,以人体亚健康分型理论为基础,根据对既往文献的分析和开放式问卷调查结果,设计出各型亚健康症状问卷表。根据在临床实践中对亚健康症状的认识程度,按照医学理论原则筛选出亚健康的主要临床症状表现。邀请有丰富经验的预防医学、消化、心血管、泌尿、精神心理、传染病和社会学等资深专家,根据权重系数原理对每一项症状进行论证。确定SSES的效度和信度,构建正式SSES。5.提出亚健康症状对症干预方法。通过对亚健康症状实施干预,研究总结出亚健康干预方法有:药物疗法、运动疗法、饮食疗法、维生素治疗、心理疗法和物理医学康复等技术。研究结果:1.本研究首次在国内西医领域提出了亚健康分型的理论和方法,即环境污染亚健康型、身体功能亚健康型、生活方式亚健康型、精神心理亚健康型、道德亚健康型和病源因素亚健康型。6个亚健康类型的划分,基本涵盖了全部亚健康症状内容。分型方法符合医学原理要求,提供了亚健康症状诊断依据。2.测定了亚健康症状评定量表(SSES)与世界卫生组织生存质量测定量表简表(WHOQOL—BREF)相关性、效度和信度关系。通过一人回答二份量表(WHOQOL—BREF与SSES)方式,对200例军人生存质量与亚健康症状携带状况测定。结果表明:SSES问卷信度值cronbach’sα=0.786,WHOQOL-BREF信度值cronbach’sα=0.844。cronbach’sα值用于衡量量表各条目间的内在一致性,当n＞100时,α＞0.75即为高信度量表。两份量表cronbach’sα值均大于0.75,因此SSES为高信度量表。采用WHOQOL-BREF为效标效度对SSES进行效度检验分析。结果表明:亚健康症状评定量表SSES与世界卫生组织WHOQOL—BREF具有同等的信度与效度。可以作为中国军人亚健康症状评定的可靠工具。3.初步提出了亚健康干预措施。运用SSES分别两次(2007.5,2007.12)对南京军区某两个全训团官兵共8300人次进行亚健康症状测评,在第一次测评中,统计分析结果表明,官兵亚健康症状总体发生率为45%。根据课题安排,课题组研究人员对被调查的携带亚健康症状的官兵实施健康干预,干预方式为:根据6个类型亚健康症状,实施对症干预。这些对症干预措施主要有:控制污染、改善生活和工作环境,健康指导和促进,生活方式干预,心理咨询与治疗和道德观念引导等亚健康症状干预技术。6个月后,运用SSES第二次对同样人群进行亚健康症状测评,其亚健康症状总体出现率降至33%。证明干预措施是有效的。结论:(1)在国内首先提出了“亚健康类型”的理论和方法,建立了6个亚健康类型。(2)研制了亚健康症状评定量表(SSES),与世界卫生组织生存质量测定量表简表(WHOQOL—BREF)比较有较好的相关性,有较好的效度和信度,可作为中国军人亚健康症状评定的可靠工具。(3)通过流行病学调查,发现中国军人的亚健康状态发生率为45%。(4)通过健康教育、运动和心理等干预措施,可使该人群亚健康状态降低为33%。更多还原

【Abstract】 BackgroundSub-health is a low-health state between health and disease,and is a grey state in which the body hasn’t pathologic change,and is a potential clinical state.The symptoms of sub-health mostly include weak,fatigue,decreased vigor and low immunity,and sun-health is known as the new killer of people’s health in 21 century. The sub-health incidence is increasing in many countries.Even though sub-health is a medical matter in symptoms,but it is an important problem affecting the human’s quality of life,which is correlative highly with vocational factor,social circumstances, economy,culture,psychologic factors and body function.It is very important to enhance the studies in this field.Objective and significanceThe objectives of this study are to establish the diagnostic classification method of sub-health which is suitable for people in the army of china,and develop sub-health measuring scale,and evaluate the sub-health state of people in the army of China,and estimate the intervention effect.The study results are good to the sub-health study of people in the army of China.Methods1.To study sub-health according to the concept of health defined by WHOThe concept of health defined by WHO in 1947 was that health was not only disease and weak,but also health in body,spirit and society.According to the theory, health at least includes three significances:body health,mental health and social adaptation.According to the concept,health state includes health state,disease state and sub-health state.The new standard of health which was proposed by WHO in 1989 included body health,mental health,morality health and good social adaptation.2.To study sub-health according to new medical modeThe change of medical mode is the theory base of sub-health classification.The medical mode has changed with the development of the society and the economy.The promoter of health theory is the traditional medicine mode(biomedical mode) has changed to modern medicine mode(biology-mental-social medicine).The new health concept has increased the health demand to a new level.3.The classsification of sub-healthSub-health is a weak state in which the vigor and adaptability degrade.There is no organ damage.There is no specific diagnosis method and objective therapeutic effect index with model medicine by now.The factors that cause sub-health are environment,mental,physiology,society and disease sources.The grouping methods of sub-health are as follow.(1) According to sub-health concept:①Discomfortable symptom:having discomfortableness,but the physical examination and checkout results are normal.②Sub-clinical syndrome:having some definite clinical situations.③Unknown origin symptom:having no pathology significance and specific reasons.④Pathogen carrier state syndrome:physical function,psychological and social adaptability are normal, and the result of pathogen checkout is abnormity.⑤Borderline state:The results of clinical examination are between the high limit value and the low limit value.⑥High pathogenicity state:such as overweight.(2) According to gold standard:①Morality health gold standard.Morality is decided by the material life conditions,and evaluates the virtue and the evil,the honor and the disgrace,the justice and the non-justice,the honest and the false,the principle and the specification.②Ecological environment gold standard.③According to the system function of human.4.To establish the Sub-health Symptom Evaluation Scale(SSES)To establish the Sub-health Symptom Evaluation Scale takes the World Health Organization Quality Of Life(WHOQOL)-BREF as the reference standard.On the basic of sub-health classification,we design the sub-health symptom questionnaire.The clinical symptoms are selected according to the clinical practice and theory of medicine.The medical experts demonstrate sub-health symptoms.The senior experts in the fields of phylaxiology,digestion,cardioangiology,urology,psychology,lemology and sociology,are invited to demonstrate the symptoms according to the theory of weight coefficient.The pre-investigation is carried out,and the validity and reliability of SSES are evaluated.5.The intervention measures of sub-healthThe intervention easures of sub-health in this study include drug therapy, exercise therapy,dietary therapy,vitaminization and physical medical rehabilitation.Results1.In this study,the sub-health classificition theory and methods are proposed in the western medicine in China for the first time.Sub-health includes six subgroups,such as environmental pollution sub-health,body function sub-health,lifestyle sub-health, psychological sub-health,morality sub-health and disease sources sub-health.2.The correction,validity and reliability between SSES and WHOQOL—BREF.The results of 200 objectives showed that cronbach’s a of SSES and WHOQOL—BREF was 0.786 and 0.844,respectively.The reliability of SSES is good.The validity analysis is carried out with WHOQOL-BREF as criterion.The correction analysis results showed that the validity of SSES is reliability.3.The intervention methods of sub-health are established.The sub-health of 8300 officers and soldiers of Nanking military district was evaluated using SSES in May, 2007 and December,2007,respectively.The sun-health incidence rate was 45%in May,2007,and that was 33%in December,2007 after intervention.This indicated that the intervention methods are effective.ConclusionsThe classification theory and methods are proposed for the first in China,and six sub-health subgroups are established,and SSES is developed which has high correlation,good validity and reliability with WHOQOL—BREF,and is a reliable means to evaluate the sub-health of Chinese soldiers.The epidemiological investigation results showed that the sub-health incidence of people in Chinese army is 45%,which is reduced to 33%after intervention such as health education,exercise and psychological,etc.更多还原