【作者】 黄顺杰；

【导师】 陈群；

【作者基本信息】 广州中医药大学 ， 中医诊断学， 2010， 博士

【摘要】 目的本课题采用横断面流行病学研究方法,对160例围绝经期综合征妇女出现的常见症状、舌象、脉象及人口学资料进行观察,并对其中医证候规律进行了较为深入的研究,这样从实际出发概括出来的分型,避免了理论推测的盲目臆断性,可以探索围绝经期综合征的证候分型特征及影响因素,为临床提供具有重要理论与实践价值的资料,进而为制定相应的中医或中西医结合治疗方案提供依据。方法主要通过横断面流行病学的研究方法,对台湾社区人群的人口学资料情况、常见临床症状、舌象、脉象进行观察,根据被调查者填写内容,结合查体结果,参考《中药新药临床研究指导原则》制定的围绝经期综合征判断标准。将合格问卷录入Epidata3.02,采用SPSS15.0对录入数据进行描述性分析、x2检验、wilcoxon秩和检验等,统计分析台湾地区围绝经期综合征妇女的年龄、职业、经济收入、月经情况等一般资料、中医证候分型分布等。结果1.围绝经期综合征患者人口学特征共收到合格调查表143例,年龄在35-55岁之间,35-39岁占18.9%,40-44岁占25.9%,45-49岁占30.8%,50-55岁占24.5%,平均年龄49.49岁。职业家庭事务者占63.6%,有工作者共占36.4%。学历大专以上占23.1%,高中占26.6%,中专占33.6%,初中及以下占16.8%。所调查人群均为已婚女性。经济状况中等水平占79.0%,上等占8.4%,下等占12.6%。夫妻不和睦占58.0%,一般占28.0%,和睦占14.0%。亲友支持占总人数50.3%,一般占33.6%,不支持占16.1%。月经初潮年龄14-17岁,约占62.2%,小于13岁约占19.6%,大于18岁约占18.2%。绝经占21%,平均绝经年龄为49.56岁,月经规律者约占25.9%,月经不规律约占53.1%。轻度痛经约占48.3%,无痛经约占41.9%,重度痛经约占9.8%。月经周期≤22天者,约占7.7%,23-28天者约占66.4%,≥29天者,约占25.9%,性格特征：内向95人,占总人数66.4%；外向48人,占33.6%；内向性格居多。2.围绝经期综合征影响因素调查被调查围绝经期综合征妇女有轻度症状的有38人,约占26.6%；中度症状的有87人,约占60.8%；重度症状的有18人,约占12.6%。调查结果显示：学历水平、有无工作、经济情况、夫妻和睦、亲友支持、性格特征等因素与围绝经期综合征病情程度相关(P＜0.05或P＜0.01)。学历越高,无工作、经济较好、夫妻亲友不支持、性格内向者,围绝经期综合征症状较重。其它因素如婚姻状况、月经情况、绝经情况、痛经情况等与围绝经期综合征病情程度比较,差异无统计学意义(P＞0.05)。因本调查样本量较小,此结论还需要大样本流行病学调查进一步佐证。3.围绝经期综合征临床主要症状特征围绝经期综合征患者临床主要症状出现最多的症状有烦躁易怒(72.72%)、骨关节痛(70.62%)、疲倦乏力(68.53%)、失眠(67.13%)、潮热出汗(65.73%)、头晕(64.34%)、头痛(62.24%)、抑郁(61.54%)。由此可以看出围绝经期综合征病机以肝郁、肾阴虚、阳亢为主。4.围绝经期综合征证型分布情况143例围绝经期综合征妇女当中,证型以心肝火旺居多,占72.7%,其次为肾阴虚型,占70.6%。肝肾阴虚型占36.4%,肝郁气滞型占26.6%,肾阳虚型占17.5%,肾阴阳俱虚型、脾肾阳虚型所占比例最少,合占11.2%。围绝经期综合征患者主要以肝、肾两脏的病变为主。5.围绝经期综合征舌诊分布情况143例围绝经期综合征妇女当中,舌诊临床上主要观察如下：肝郁气滞型组,检查舌质色淡红,舌缘印有齿痕,舌苔白黄色偏腻。心肝火旺组偏盛以红舌为最多见,伴如黄苔易见于全舌,偶舌尖独赤起刺。肝肾阴虚或肾阴虚组舌质以红舌为最多见,舌苔以偏白黄苔为主,偶见舌下脉络瘀黑。肾阳虚和肾阴阳俱虚组舌质以淡红舌胖嫩有齿痕为最多见,苔薄一般,偶舌苔偏白滑润。脾肾阳虚湿滞组明显时,白苔粘滑厚腻,为最常见的舌诊表现。6.围绝经期综合征脉诊分布情况143例围绝经期综合征妇女当中,临床上主要观察如下：心肝火旺组脉诊弦数脉为多,肝肾阴虚或肾阴虚组脉诊细数脉多见,肝郁气滞型脉诊多见弦或脉细数,肾阳虚脉诊沉细弱脉多见,肾阴阳俱虚组脉诊沉弱脉多见,脾肾阳虚组脉诊沉细脉可见。结论围绝经期综合征可能病机以肝郁化火、肾阴虚、阴虚于下阳亢于上为主,且与患者的情志因素、社会家庭支持、生活习惯有关。故调理情志、体育锻炼、饮食起居调养、药物预防等进行早期干预,将有效降低围绝经期综合征的发病率,调理肝肾在围绝经期综合征的治疗与预防中将起重要作用。更多还原

【Abstract】 ObjectiveThis study takes T-sect epidemiological methods, observes the common symptoms, tongue demonstration, pulse demonstration and demographical information of 160 women of perimenopausal syndrome and makes in-depth research of Chinese Medicine syndrome rules. The differentiated types avoid blindness of theoretical inference. It discusses the syndrome classification and affecting factors of perimenopausal syndrome, provides theoretical and practical reference for clinical treatment as well as basis for making Chinese Medicine or Integrated Chinese and Western Medicine treatment plans.MethodsThis study takes T-sect epidemiological methods, observes the common clinical symptoms, tongue demonstration, pulse demonstration and demographical information of Taiwan community populations. The author refers to the diagnostic standard of perimenopausal syndrome of Guidelines for Clinical Research of Chinese Medicine New Drug based on the answers of the interviewees the physical examination results. Input the qualified questionnaires into computer with software EPIDATA 3.1 and make descriptive analysis, x2 test and Wilcoxon rank sum test with software SPSS 15.0. Make statistical analysis of the general information including age, occupation, income and menstruation and the Chinese Medicine syndrome distribution, etc.Result1. Demographic Features of Perimenopausal Syndrome Patients143 qualified questionnaires are collected. Subjects are between 35 and 55 with 18.9% of 35-39,25.9% of 40-44,30.8% of 45-49,24.5% of 50-55 years old and the average age is 49.49 years old.63.6% are occupational homemakers and 36.4% have jobs. Education degree:23.1% received junior college education or above,26.6% received senior high school education,33.6% received occupational school education, and 16.8% received junior high school education or below.95.8% have married and have spouses and 4.2% haven’t.79.0% have medium,8.4% superior and 12.6 low economical status.58.0% have good,28.0% have mediocre and 14.0% have bad husband and wife relationships.50.3% have relatives’ support,33.6% have mediocre support and 16.1% don’t have the support.62.2% have the menarche at 14-17,19.6% below 13 and 18.2% above 18 years old.73.4% have menopause and the average menopause age is 49.56 years old.8.4% have regular menstruation and 18.2% have irregular menstruation. 18.3% have mild difficult menstruation,41.9% don’t have difficult menstruation and 9.8% have serious difficult menstruation.7.7% of the subjects have a menstruation cycle of≤22 days,66.4% between 23-28 days and 25.9%≥29 days. Personalities:95 subjects (66.4%) are introvert and 48 (33.6%) are extrovert with the majority of introvert personality.2. Affecting Factors of Perimenopausal SyndromeAmong the investigated perimenopausal syndrome women,38 (26.6%) have mild symptoms,87 (60.8%) have medium symptoms and 18 (12.6%) have serious symptoms.The investigation results show that factors like education level, working status, economical situation, spouse relationship, relatives’support and personalities are related to the severity degree of this disease (P<0.05 or P<0.01). Patients who have higher education degree haven’t jobs, have good economical conditions and introvert personalities without relative’s and spouse’s support usually have more serious perimenopausal syndrome symptoms.Compare other factors including marriage status, menstruation, menopause and difficult menstruation and the severity of the perimenopausal syndrome and the author finds the difference has no statistical significance (P> 0.05). Since the sample size is small, this conclusion needs further confirmation with large-sample epidemiological investigation.3. Major Clinical Symptoms of Perimenopausal SyndromeThe most frequently occurred symptoms of perimenopausal syndrome are fidgety (72.72%), osteoarthritis (70.62%), languor and debility (68.53%), insomnia(67.13%), hectic fever and perspiration (65.73%), vertigo(64.34%), headache (62.24%) and depression (61.54%). It can be found that its pathogenesis is mainly liver depression, kidney yin deficiency and yang excess. 4. Type Distribution of Perimenopausal SyndromeAmong the 143 perimenopausal syndrome women patients, the major syndrome type is heart and liver fire (72.7%). The next is kidney yin deficiency (70.6%), liver and kidney yin deficiency (36.4%), liver depression and qi stagnation (26.6%), kidney yang deficiency (17.5%), both of kidney yin and yan deficiency together with spleen and kidney yang deficiency (11.2%). Perimenopausal syndrome patients mainly have liver and kidney pathological changes.5. Tongue Demonstration of Perimenopausal SyndromeThe tongue demonstration of the 143 subjects shows that subjects in the liver depression and qi stagnation group have pale red texture, fat tongue body, indentation at tongue border, thin lingual fur, white color and greasy feature; the heart and liver fire group subjects have mainly red tongue, yellow fur on the whole tongue, and sometimes red tongue tip only with pricks; the liver and kidney yin deficiency group or the kidney yin deficiency group subjects mainly have red tongue and white yellow fur; the kidney yang deficiency group and the kidney yin and yang deficiency group subjects have pale red tongue, thin fur and sometimes white and slippery fur; spleen and kidney yang deficiency group subjects have white, slippery, thick and greasy fur with fat tongue body and indentation marks as the most frequent demonstrations.6. Pulse demonstration of Perimenopausal SyndromeThe clinical observation of the 143 perimenopausal syndrome women is listed as follows:the heart and liver fire group subjects mainly have the string-like pulse; the liver and kidney yin deficiency and the kidney yin deficiency group mainly have the fine and quick pulses; the liver depression and qi stagnation group mainly have string-like pulses; the kidney yang deficiency group mainly have heavy and feeble pulses; the liver yin and yang deficiency group mainly have fine pulses; the spleen and kidney yang deficiency group mainly have heavy and fine pulses.ConclusionThe possible pathogenesis of perimenopausal syndrome is mainly fire derived from liver depression, kidney yin deficiency, yin deficiency and yang excess. It’s related to the sentiment, social and family support and living habits. Therefore conducting the early-stage interference like adjusting sentiment, taking physical exercises, adjusting living habits and applying medical prevention, etc will effectively decrease the incidence ratio. Regulating liver and kidney plays an important role in the prevention and treatment of perimenopausal syndrome.更多还原