【作者】 范黎柏；

【导师】 郑泽棠；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2009， 博士

【摘要】 目的慢性前列腺炎的临床辨证分型繁多,但关于证型证候研究仍以病案分析、专家经验报告等回顾性分析为多,对于中医证型证候的指标前瞻性研究甚少,采用循证医学(EBM)的更少。在辨证方面缺乏统一的标准和科学、客观的指标,西医的主观评分系统、客观指标与中医证型是否存在内在联系,因此,迫切需要对慢性前列腺炎的证型证候与西医的主观评分系统、客观指标进行相关性研究。本课题引入反映CP治疗效果的患者主观症状(NIH-CPSI评分)和客观指标(EPS常规检查)的改变与中医证型结合起来,探索中医证型的客观化及其依据,将有助于提高CP中医辨证的准确性,从而更好地指导临床用药,同时还为以后中西医结合学会修订慢性前列腺炎中医诊断治疗指南提供基础数据。方法Ⅰ:系统整理CP中医证型文献资料,调查总结我院2005、2006年CP中医证型1、系统整理CP中医证型文献资料,调查我院2005、2006年符合纳入标准的病例(1)年龄介于20岁至50岁之间。(2)符合参照《中国泌尿外科疾病诊断治疗指南2006版》(那彦群主编)中的前列腺炎诊断治疗标准。(3)符合参照中华人民共和国卫生部《中药新药临床研究指导原则评分标准》(人民卫生出版社,1997)。中医证型为(湿热下注证、寒凝肝脉证、阴虚火旺证、肾阳虚损证、气滞血瘀证5种证型)精浊的辨证标准。2.调查内容系统整理CP中医证型文献资料,总结我院病例资料,我院课题组最后确立慢性前列腺炎的中医证型。Ⅱ入选病例首诊调查1.纳入病例标准(1)年龄介于20岁至50岁之间。(2)符合参照《中国泌尿外科疾病诊断治疗指南2006版》(那彦群主编)中的前列腺炎诊断治疗标准。(3)符合参照《中国慢性前列腺炎中西医结合诊疗指南(试行版)》(中国中西医结合学会男科专业委员会制定,2007)。中医证型为(湿热下注证、气滞血瘀证、肝气郁结证、肾阳亏虚证4种证型)的前列腺炎的辨证标准。2.调查内容(1)首诊进行NIH-CPSI调查(2)中医证型的调查(3)尿分析检查(4)EPS常规检查Ⅲ入选病例治疗1个月后调查调查内容(1)进行NIH-CPSI调查(2)中医证型的调查(3)尿分析检查(4)EPS常规检查Ⅳ入选病例治疗3个月后调查调查内容(1)进行NIH-CPSI调查(2)中医证型的调查(3)尿分析检查(4)EPS常规检查Ⅴ研究内容(1)研究分析首诊中医证型和NIH-CPSI的调查记录,及其与EPS常规检查的结果的关系。(2)研究分析治疗1个月后中医证型和NIH-CPSI的的调查记录,及其与EPS常规检查的关系。(3)统计分析并评价CP常见中医证型(湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型)与NIH-CPSI、EPS常规检查的关系。结果1.调查总结我院外科门诊2005,2006年CP患者260例中医证型,最常见的中医证型为湿热下注证77例占29.6%、寒凝肝脉证29例占11.1%、阴虚火旺证48例占18.5%、肾阳虚损证45例占17.3%、气滞血瘀证61例占23.5%,经我院课题组专家共识,初步得出CP中医证型,最后我院课题组确立慢性前列腺炎中医证型参照《中国慢性前列腺炎中西医结合诊疗指南(试行版)》(中国中西医结合学会男科专业委员会制定,2007),慢性前列腺炎常见中医证型为湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型。2.符合入选标准的病例资料200例,其中湿热下注证69例、气滞血瘀证63例、肝气郁结证26例、肾阳虚损证42例,其中诊断为良性前列腺增生症、前列腺肿瘤、精囊炎、慢性附睾炎患者6例不进入统计分析,对于治疗1个月内失访病例8例患者未能作NIH-CPSI调查和EPS常规检查,经统计学处理未纳入结果分析。本课题的3个月的追踪观察结果显示同一个患者在一疗程内不同时期中医证型亦表现为早期(首诊就医)湿热下注证、中期(治疗1个月后)气滞血瘀证、肝气郁结证,后期(治疗3个月后)肾阳亏虚证多见的证型变化规律。3.入选病例中医证型与NIH-CPSI、EPS常规检查的调查结果符合入选标准的病例资料200例,通过对NIH-CPSI评分Logistic回归分析统计初步观察发现:慢性前列腺炎中医证型结果为湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型与NIH-CPSI密切相关,尤其是湿热下注证、气滞血瘀证与NIH-CPSI的相关性较高。4.入选病例中医证型与EPS常规检查的调查结果符合入选标准的病例资料200例,通过对EPS常规检查白细胞计数Logistic回归分析统计初步观察发现:慢性前列腺炎中医证型结果为湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型与EPS常规检查白细胞计数无统计学意义的明显相关性。结论1.慢性前列腺炎是青壮年男性的常见病症之一,严重影响成年男性的生活质量。慢性前列腺炎中医证型结果为湿热下注、气滞血瘀、肝气郁结、。肾阳亏虚4种证型是就诊患者的主要证型。2.慢性前列腺炎的病机演变多认为湿热下注多出现在早期,中期多为气滞血瘀并出现肝郁脾虚,而后期多伴肾阳亏虚。本课题的3个月的追踪观察结果显示同一个患者在一疗程内不同时期中医证型亦表现为早期(首诊就医)湿热下注证、中期(治疗1个月后)气滞血瘀证、肝气郁结证,后期(治疗3个月后)肾阳亏虚证多见的证型变化规律。3.慢性前列腺炎中医证型结果为湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型与NIH-CPSI密切相关,将有助于提高CP中医辨证的准确性,发挥中医药在治疗慢性前列腺炎上存在独特的优势,还为中医证型的量化和客观化做出有益的探索,从而更好地指导临床用药,同时还为以后中西医结合学会修订慢性前列腺炎中医诊断治疗指南提供基础数据。4.慢性前列腺炎中医证型结果为湿热下注、气滞血瘀、肝气郁结、肾阳亏虚4种证型与EPS常规检查白细胞计数无统计学意义的明显相关性,为中医证型的量化和客观化做出有益的探索。本研究进一步证实,部分实验室指标对于中医证型诊断的价值不大,只能是中医证型判别手段的补充或参考。更多还原

【Abstract】 ObjectiveIt has been proved that the relationship between TCM Syndrome Type and urine flow rate,expressed prostatic secretion(EPS) routine.It is widely accepted by The National Institutes of Health that chronic prostatitis symptom index(NIH-CPSI) is the best method to detect the severity of clinical symptoms of chronic prostatitis(CP).In this research,in order to explore the relationship between TCM Syndrome Type with subjective symptoms (NIH-CPSI),and the therapeutic efficacy objective index for EPS routine. This research may be helpful to explore the objective indexes of Chinese Medical Syndrome Differentiation of CP and instruct the clinical medication. In the future,multi-center,large sampled and prospective random comparison therapeutic study based on evaluative criteria constituted by Traditional Chinese Medicine-Western Medicine Integrating Institute provide basic information and evidences. MethodⅠ:The clinical data of CP outpatients of the first affiliated Hospital of Guangzhou University of TCM from 2005 to 2006 were analyzed retrospectively. The target establishment of this investigation to find out TCM Syndrome Type of CP outpatients after TCM therapy.By using the methods of literature data, CP patients aged 20-50 years,diagnosis criteria of CP was according to Clinical Practice Guidelines for patients with urologic diseases(Na Yah Quan as the Chief Compiler ).The diagnostic criteria referred to the classification and diagnostic standard of《Guiding Principles for Clinical Study of New Chinese Medicines》(Chinese Ministry of Health,1997 Edition3), TCM Syndrome Type including syndrome of downward flow of damp-heat,cold coagulation liver channel,hyperactivity of fire due to yin deficiency syndrome,Kidney-Yang Deficiency,Qi stagnation and blood stasis syndrome. ⅡProspective Study of CP outpatients investigative according to TCM Syndrome Type in the first visit to our hospital.Research by using the methods of prospective survey.CP outpatients aged 80-85 years,diagnosis criteria of CP was according to Clinical Practice Guidelines for patients with urologic diseases(Na Yan Quan as the Chief Compiler,2006 ).The diagnostic criteria referred to the classification and diagnostic standard of《Guideline for the diagnosis and treatment of chronic prostatitis (Traditional Chinese Medicine-Western Medicine Integrating Institute andrology,2007),TCM Syndrome Type including syndrome of downward flow of damp-heat,Qi stagnation and blood stasis syndrome,Liver Qi stagnation syndrome,kidney yang deficiency syndrome.Investigation content including NIH-CPSI,TCM Syndrome Type,urinalysis,EPS routine.ⅢProspective Study of CP outpatients investigative according to TCM Syndrome Type after one month of treatment.Investigation content includes NIH-CPSI,TCM Syndrome Type,urinalysis,EPS routine.ⅣProspective Study of CP outpatients investigative according to TCM Syndrome Type after three months of treatment.Investigation content including NIH-CPSI,TCM Syndrome Type,urinalysis,EPS routine.ResultLiterature Review and the clinical data of 260 CP outpatients of the first affiliated Hospital of Guangzhou University of TCM from 2005 to 2006 were analyzed retrospectively.Among them,syndrome of downward flow of damp-heat 77 cases,cold coagulation liver channel 29 cases,hyperactivity of fire due to yin deficiency syndrome 48 eases,Kidney-Yang Deficiency syndrome 48 cases, Qi stagnation and blood stasis syndrome 61 cases.The numerical results show that syndrome of downward flow of damp-heat,Qi stagnation and blood stasis syndrome,Liver Qi stagnation syndrome,kidney yang deficiency syndrome were the most common type.The investigation result showed that,TCM Syndrome Type of CP outpatients is closely related to NIH-CPSI,urinalysis,EPS routine. Three months follow-up analysis showed TCM Syndrome Type of CP outpatients in the first visit to our hospital the most common type is syndrome of downward flow of damp-heat.TCM Syndrome Type of CP outpatients after one month of treatment the most common type is Qi stagnation and blood stasis syndrome. TCM Syndrome Type of CP outpatients after three months of treatment the most common type is kidney yang deficiency syndrome. ConclusionThe article puts forward that syndrome of downward flow of damp-heat, Qi stagnation and blood stasis syndrome,Liver Qi stagnation syndrome,kidney yang deficiency syndrome were the most common type of CP outpatients.TCM Syndrome Type of CP outpatients in the first visit to our hospital the most common type is syndrome of downward flow of damp-heat.TCM Syndrome Type of CP outpatients after one month of treatment the most common type is Qi stagnation and blood stasis syndrome.TCM Syndrome Type of CP outpatients after three months of treatment the most common type is kidney yang deficiency syndrome.TCM Syndrome Type of CP outpatients is closely related to NIH-CPSI, urinalysis,EPS routine.This research may be helpful to explore the objective indexes of Chinese Medical Syndrome Differentiation of CP and instruct clinical medication.In the future,multi-center,large sampled and prospective random comparison therapeutic study based on evaluative criteria consfituted by Traditional Chinese Medicine-Western Medicine Integrating Institute provide basic information and evidences.更多还原