腹泻型肠易激综合征患者抑郁焦虑状态与中医证候相关性分析的研究

【作者】 魏建雄；

【导师】 王新月；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2010， 博士

【摘要】 目的肠易激综合征是现代医学心身疾病的一种,它是介于躯体疾病与神经症之间的一类疾病,由于其牵涉的学科范围广泛,目前对其病因及发病机制仍不十分清楚,而注重整体观的中医学对于情志致病早有所阐述。为了明白心身疾病的发病原因与机制,本研究对证候要素的得分及抑郁焦虑状态的关系进行探讨,借以了解肠易激综合征中医证候与抑郁焦虑状态之间的关系。方法本课题收录2009年4月至201 0年3月期间在北京东直门医院门诊就诊的病例,患者皆经西医诊断为腹泻型肠易激综合征,中医诊断为泄泻。研究采取问卷调查的方式,对腹泻型肠易激综合征患者的一般流行病学、证候要素、抑郁焦虑状态等资料进行收集后,将D-IBS患者区分为五种中医证型,以各证型的证候要素分值对其相关症状进行评分,再依计分公式对患者的证候要素计算出得分,然后并对照其抑郁焦虑状态分组,以统计学方法探讨各证型的抑郁焦虑分组的证候要素得分是否有显著性差异,从而获致证候要素与抑郁焦虑之间的是否有关联性的结论。结果一般流行病学资料：216例D-I BS患者当中,女性患者119例略多于男性97例,统计学上无明显差异。患者的年龄在20-59岁之间无显著差异,而又以20-29岁患者人数较突出。抑郁焦虑状态的统计结果,无抑郁焦虑者104人,伴抑郁者37人,伴焦虑者46人,伴抑郁焦虑者29人。文化程度方面,以发病时程以五年以上最多,占66.2%。发病原因以饮食不节93.5%最多,其他依次为外邪入侵88.0%情志失调8 0.6%精神紧张78.7%劳累过度29.0%。学历方面依次为大专以上46.3%,高中职42.6%及初中10.2%,而以初中程度63.6%的患者具有抑郁焦虑的比例最高。职业分布以企业职工31.9%最高,其他较多者尚有学生25.0%及农林渔牧劳动者1 0.2%。工作压力方面,感觉一般50.0%最高,劳累者占33.8%。患者饮食偏好热食81.9%最多,嗜食肥甘厚腻71.8%,而伴抑郁焦虑的患者饮食较偏好肥美味醇及富刺激性的食物。休闲娱乐以逛街51.9%、聊天49.5%、上网46.3%较常见。患者泄泻证型的统计方面,肝郁脾虚型占57.4%最多,其余依次是脾肾阳虚型19.0%、脾气虚弱型占15.3%、湿热阻滞型5.1%及寒湿困脾型3.2%。证候要素得分统计：针对个别证候要素的统计,全部63个证候要素当中,仅有眩晕、头胀痛等2个要素在不同的抑郁焦虑状态患者之间的表现,经统计是有意义的,但如以各种证型患者的主证及次证合征五种证型中,肝郁脾虚、脾气虚弱、脾肾阳虚等三型患者的四种抑郁焦虑状态分组的证候得分,经统计分析后P值均小于0.05,显示抑郁焦虑分组病患的证候得分彼此之间的比较是有意义的。而从证型的得分趋势图看来,表示抑郁焦虑状态与症状严重程度的关系呈正相关,此三型的患者是最多的,总数达病例数的92%。而湿热阻滞及寒湿困脾等二型的患者,因人数较少,抑郁焦虑分组的证候得分彼此之间不具统计学意义,然而从其箱式图可以观察出伴有抑郁焦虑分组的证候得分明显要较无抑郁焦虑分组为高,再从此二型的趋势图及五种证型的抑郁焦虑分组证候要素得分的综合统计图看来,亦可支持抑郁焦虑状态与症状严重程度呈正相关的状况。结论：肠易激综合征属于现代医学心身疾病的范畴,强调心与身不可分离的整体观,与中医学的情志致病的观点不谋而合。研究显示,腹泻型肠易激综合征患者的临床症状表现与其抑郁焦虑状态呈正相关。对于是类患者已知伴有抑郁焦虑的有必要给予更多的关注,配合适当的精神治疗,而对于尚未发现有抑郁焦虑状态的患者要注意发觉及预防发生,始有乐观的预后可期。更多还原

【Abstract】 ObjectiveIBS is the one of psychpohysiological disorders. It’s related to both of body disease and neurosis. Because of its concerning with many areas of medical sciences, the pathogenesis is not understood clearly. But there are principles and methods of treatment of emotional diseases in the theory of Chinese medicine which has paid attention to the concept of viewing the situation as a whole for hundreds of years. For the purpose of After we exploring the related informations and dealing with the scores in statistics we got the results of the relationships between the syndrome factors and the emotional suituationsMethodsWe selectde 216 outpatient cases from April 2009 to March 2010. Patients were diagnosed by Western medicine as diarrhea-predominant irritable bowel syndrome, Chinese medicine diagnosis of diarrhea. We conducted the study by using the questionnaire survey method. We collected general epidemiology, syndrome factors and depression and anxiety state datas. We scored the patients in the factors of diarrhoea syndrome of each one. According to one’s SAS and SDS score, we differntiate the patients into 4 groups of depress and anxiety at the same time. We also distinguished the patients into 5 type of diarrhea syndrome in TCM. Finally we used the syndrome points score formula, checked the situation of depression and anxiety and analyzed the scores in statistics,then we got the result of the relationship between the emotional ststement of D-IBS patients and diarrhea syndrome.ResultsGeneral epidemiological data:D-IBS patients with 216 cases among 119 cases of women with men slightly more than 97 cases, no statistically significant difference. Patients between the ages of 20-59 years of age no significant difference, but the number of patients with 20-29 prominent. Depression and anxiety state statistics, 104 people without depression, anxiety, and depression were 37,46 people with anxiety, depression and anxiety with 29 people. Education is concerned, when the disease process to more than five years at most, accounting for 66.2%. Etiology in 93.5% of the most improper diet, followed by exogenous pathogens invasion of other emotional disorders 88.0%80.6%78.7% nervous exhaustion over 29.0%. Aspects of college education were 46.3%,42.6% high school and junior high school 10.2% to 63.6% of junior high school level of depression and anxiety in patients with the highest proportion. Occupational distribution of the maximum 31.9% of enterprise workers, and other more were the students 25.0% and 10.2% agriculture, forestry, fishery and livestock workers. Work pressure,50.0% felt generally maximum, fatigue accounted for 33.8%. Food preferences were 81.9% up-to hot, thick greasy eat Feigan 71.8%, while patients with depression and anxiety than the preferred fat diet rich diethylene glycol and bland food.51.9%of entertainment to shopping, chat 49.5%,46.3% more common online. Diarrhea in patients with evidence-based statistics, the stagnation and spleen deficiency type was 57.4% up, followed by the spleen and kidney yang 19.0%, 15.3% weakness of temper, heat block type 5.1% and 3.2% in alpine-type spleen. Syndrome factor score Statistics:Individual syndrome elements of statistics, all 63 of them syndrome elements, only dizziness, head pain two elements in different states of depression and anxiety among patients with performance by the statistical sense, byt as to the nain types of syndromes and sub-license the weighyed evidence points add up to enough to show that depression and anxiety syndrome elements and the special relationship between the state. Diarrhea-predominant irritable bowel syndrome syndrome in five,liver depression and spleen, spleen qi, spleen and kindney yang,etc. The four patients with three types of deprdession and anxiety state scores syndromes grouped by statistical anslysis, P< 0.05 shows that patients with depression and anxiety syndrome group scored between the comparison is meaningful.Scores from the trends syndrome appears that symptoms of depression and anxiety and the relationship betweem the severity of positive correlation, the three types of patients is the largest, a total of 92% of the number of cases.Because of the fewer patients the statistics of the heat dampness disturbed type and the spleen besieged by cold-dampness type are not statistically significant. But their box-type diagram can be observed associated with depression and anxiety sub-groups syndrome than those without depression to score significantly higher anxiety group,and then from two types of trends and five groups of depression and anxiety syndrome factor score of comprehensive statistical plan view,also support the symptoms of depression, anxiety and severity correlated situation.更多还原