【作者】 蔡慧青；

【导师】 罗颂平；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2010， 博士

【摘要】 更年期(C1 imacterium)是每个妇女必经的特殊生理时期,据国内外有关资料统计报道,在45-55岁的年龄段,约有90%的妇女均有不同程度的临床表现。更年期综合征(C1 imacteric Syndrome),就是围绕在绝经前后时间出现的以植物神经系统功能紊乱为主的一组症候群。现代医学以激素替代疗法(hormone replacement therapy, HRT)为主治疗该病,具有潜在的危险性和不良反应,而传统医学在整体观的指导下对更年期综合征辨证论治,具有一定的特色和优势,减少了不良副作用影响。但是更年期综合征的临床症状纷繁复杂,目前存在多种辨证分型,各证型间彼此交错覆盖,不利于开展针对性治疗,因此有必要进一步完善更年期综合征的中医辨证体系。目的本课题主要通过横断面的流行病学研究方法,对女性更年期综合征的中医证候分布及健康状况进行了流行病学调查研究。期望进一步规范更年期综合征临床研究,获得较好的社会效益。为中医药防治更年期综合征的临床研究及其新药开发建立必备的评估系统和提供严谨的科研资料。方法采用问卷调查的方式,遵循临床流行病学调研方法,设计统一的临床调研表,包括女性更年期综合征体质调查表、临床证候及证型调查表,逐一询问患者并填写流调表,中医辨证由高年资深的专科中医教授结合临床经验进行,按照中、西医诊断标准诊断,得出中医证候。以妇科经带方面的情况、实验室血清E2和血清FSH、生存质量为观察指标。观察对象以组成更年期综合征的围绝经期和绝经后来分为两类,比较两类病人在各观察指标上的异同。结果本调查共收集病例208份,排除错漏、矛盾和缺损病例8份,有效病历200份,有效应答率96.15%。200例更年期患者中围绝经期患者和绝经后患者分别有100例。绝经年龄：200例更年期综合征患者,年龄42-65岁,绝经年龄46～53岁,平均48.07岁。比以往文献报道的提前1岁。提示现代女性工作、精神压力较大。更年期综合征评分：绝经后期患者Kupperman症状总得分高于围绝经期患者得分,差异有统计学意义(P＜0.05)。说明绝经后期患者更年期综合征症状较围绝经期严重,尤其表现在失眠、头晕、疲乏无力、心悸等症状上。妇科症状：月经紊乱、夹有血块、性欲减退、带下异常、阴部异常感是更年期综合征出现频率较高的妇科症状。绝经后期患者在阴部异常感和性欲减退方面明显多于围绝经期患者(P0.05),说明月经不调、性生活不和谐会导致更年期综合征的提前发生。中医临床症状：烘热汗出、口咽干燥、失眠、烦躁、健忘、腰酸、焦虑、乏力是更年期综合征出现频率较高的临床症状。以肝肾两经证候最为多见。提示女性更年期综合征患者的病理因素以阴虚、血虚、气滞、气虚等有关,涉及肝(郁)、肾(虚)、脾(虚)、心(虚)等脏。中医证型：调查发现肝肾阴虚证出现频次最多(99例,约占49.5%)；肝气郁结次之(84例,约42.0%)。心肾不交约占7.5%。单纯肾阴虚、肾阳虚证出现较少。围绝经期和绝经后期的中医证候构成比较,差异无统计学意义(P＞50.05)。情志：本次调查还发现更年期综合征患者常有不同程度的精神症状,200名患者精神抑郁101人,约50.7%；焦虑167人,约83.7%；烦躁170人,约85.2%。此外性欲减退(110人,55.0%)、阴部异常感(107人,53.5%)出现频次也较高。提示情绪异常与性生活不和谐可能是导致更年期综合征发生的关键因素。生存质量：围绝经期和绝经后期在PF、RP、VT、RE、MH五个维度评分比较,差异有统计意义(P0.05),从两类患者八个维度的得分可以看出,围绝经期患者躯体功能、躯体角色、精力评分高于绝经后期,而情感角色、心理健康评分低于绝经后期患者。结果表明绝经后期更年期综合征患者的生存质量显著降低。而围绝经期的患者情感角色和心理健康两个维度却比绝经后期要低。这可能与刚步入更年期的妇女心理不适应的缘故。结论更年期综合征的病位主要累及肝、肾,证型以肝肾阴虚、肝气郁结较多。绝经后期患者更年期综合征症状较围绝经期严重。绝经后期更年期综合征患者的生存质量显著降低,围绝经期的患者情感角色和心理健康两个维度降低。更多还原

【Abstract】 Climacterium is a special physiology stage that every women should come through. According to report from domestic or abroad, about 90% women have different kinds of clinical symptoms during the age of 45 to 55. Climacteric Syndrome is a series of symptoms mainly due to autonomic nerve system dysfunction which happen during this special stage. Modern medicine treats mainly with hormone replacement therapy (HRT), but this treatment has some potential risk and adverse effects. While traditional Chinese medicine which lowers the side-effects has its unique characteristic and predominance under the direction of entirety concept. However, the symptoms of Climacteric Syndrome are complicated, and have different kinds of dialectical patterns. Each pattern interlaces and mixes together, which is not good to carry out personal therapies, therefore it is necessary to consummate the dialectical system of Climacteric Syndrome. ObjectiveWe make the epidemiological investigation about the syndrome pattern distribution regularity and health status of women with Climacteric Syndrome through the cross-sectional epidemiological study, in order to standardize the clinical trail of Climacteric Syndrome, gain a good social effect, establish the evaluation system of the clinical trail and new drugs development, and provide rigorous data of scientific research.MethodsWe use the questionnaire, follow the investigation methods of clinical epidemiology, design unified clinical scales include constitution、clinical symptoms and syndrome patterns of women with Climacteric Syndrome, inquest patients one by one and complete the scales. The differentiations are made by senior professors of traditional Chinese medicine based on his experiences. The observation index due to menstruation and leucorrhea、blood-serum level of E2 and FSH、living quality. We divide the objects into two groups (peri-menopausal group and post-menopause group), compare the differences in the index of the two groups.ResultsWe collecte 208 cases, eliminate 8 mistaken and defect cases,200 cases left are valid, during which response rate was 96.15%. There are 100 patients in the peri-menopausal group and 100 in the post-menopause group.Menopausal age:200 patients, age from 42 to 65, menopausal age from 46 to 53,48.07 in average, younger than those reported, which shows that the stress that women suffered today was harder.Scores of Climacteric Syndrome:Kupperman scores of post-menopause patients is higher than the peri-menopausal ones. The disparity is statistically significant (P<0.05), which shows that the symptoms of the post-menopause patient is more serious than the peri-menopause ones, especially in insomnia、dizziness、fatigue and palpitation.Symptoms of gynecology:menstrual disorder、hyposexuality、leucorrhea disorder and vagina abnormality are symptoms happened frequently in Climacteric Syndrome. Hyposexuality and vagina abnormality in post-menopausal patients are more frequent than the peri-menopausal ones (P<0.05), which shows that menstrual disorder and disharmony of the sexual life may happen ahead of schedule.Clinical symptoms and signs of traditional Chinese medicine:hectic fever、pharyngoxerosis、insomnia、restlessness、forgetfulness、sore waist、anxiety and fatigue are symptoms happened frequently in Climacteric Syndrome, especially symptoms of the liver and kidney meridian, which shows that the pathogenesis of the Climacteric Syndrome mainly are yin asthenia、blood deficiency、qi-stagnation and qi-deficiency, related to liver(stagnant)、kidney(deficient)、spleen(deficient)、heart (deficient) and et cetera.Syndrome patterns:hepatic and renal yin deficiency happens most frequently (99 cases, about 49.5%), depression of liver-qi comes next (84 cases, about 42.0%). Imbalance between heart-yang and kidney-yin occupies 7.5%. The patterns of merely deficiency of kidney-yin and kidney-yang are less seen. There is no statistical significance in the syndrome patterns between post-menopausal and peri-menopausal patients(P>0.05).Sentiment:in the study we find different kinds of psychiatric symptoms of patients with Climacteric Syndrome, among 200 patients, there are 101 with deprementia, about 50.7%; 167 with anxiety; about 83.7%; 170 with restlessness, about 85.2%; 110 with hyposexuality, about 55.0%; 107 with vagina abnormality, about 53.5%. All of this shows that abnormal feeling and disharmony of the sexual life may be the key-point due to Climacteric Syndrome.Living quality:there is statistical significance in scores of PF、RP、VT、RE、MH between post-menopausal and peri-menopausal patients (P>0.05). In the comparison, the scores of physical function、body role and energy of the peri-menopausal ones are higher than the post-menopausal ones, while the scores of sentimental role、mental health of the peri-menopause ones is lower. The results show that the living quality obviously steps down in the post-menopausal patients. The sentimental role、mental health of the peri-menopause ones is worse than the post-menopausal ones, that may because women are not adaptation when step into the menopausal period. Conclusion1. There are 200 patients with Climacteric Syndrome in the study, whose menopausal ages are between 46-53, average in 48.5.2. The syndrome of hepatic and renal yin deficiency happens most frequently (49.5%), depression of liver-qi comes next (42.0%), Imbalance between heart-yang and kidney-yin occupies 8.6%, and the patterns of merely deficiency of kidney-yin and kidney-yang are 8.5%. There is no statistical significance in the syndrome patterns between post-menopausal and peri-menopausal patients (P>0.05).3. The constitutional symptoms which happen most frequenctly are as follows: hectic fever、pharyngoxerosis、insomnia、restlessness、forgetfulness、sore waist、anxiety、fatigue and etc. Symptoms of gynecology happen most frequently are as follows:menstrual disorder、hyposexuality、leucorrhea disorder and vagina abnormality. Hyposexuality and vagina abnormality in post-menopausal patients are more frequent than the peri-menopausal ones (P<0.05). 4. Kupperman scores of post-menopause patients is higher than the peri-menopausal ones. The disparity is statistically significant (p<0.05), which shows that the symptoms of the post-menopause patient is more serious than the peri-menopause ones, especially in insomnia、dizziness、fatigue and palpitation.5. The study also finds different kinds of symptoms in Climacteric Syndrome, including deprementia(50.7%)、anxiety(83.7%)、restlessness (85.2%)、hyposexuality(55.0%)、vagina abnormality(53.5%), which indicates that abnormal feeling and disharmony of the sexual life may be the key-point due to Climacteric Syndrome.6. There is statistical significance in scores of PF, RP、VT、RE、MH between post-menopausal and peri-menopausal patients (P>0.05). In the comparison, the scores of physical function、body role and energy of the peri-menopausal ones are higher than the post-menopausal ones, while the scores of sentimental role、mental health of the peri-menopause ones is lower. The results show that the living quality obviously steps down in the post-menopausal patients. The sentimental role、mental health of the peri-menopause ones is worse than the post-menopausal ones, that may because women are not adaptation when step into the menopausal period.更多还原