379例静脉吸毒HIV/AIDS患者症状、证候研究

【作者】 沙莎；

【导师】 李洪娟；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2012， 硕士

【摘要】 研究目的通过回顾性分析广西、云南、新疆三地静脉吸毒感染HIV／AIDS患者共379例,6次访视共1826频次访问信息,研究静脉吸毒HI V／AIDS患者的主要临床症状体征、病性病位等证候特征,为中医药治疗不同途径感染艾滋病提供一定依据。第一部分为研究静脉吸毒HIV／AIDS患者的主要临床症状体征、病性病位等证候特征总体分布规律；第二部分为研究不同分期静脉吸毒HIV／AIDS患者的症状证候差异性；第三部分为不同性别静脉吸毒HIV／AIDS患者的症状证候差异性；第四部分为比较静脉吸毒和采供血两种途径感染HIV／AIDS患者的症状证候差异性；第五部分运用因子分析提取静脉吸毒感染HIV／AIDS患者的中医证候要素(主成分)。本研究依托中国中医科学院“十一五”国家科技重大专项课题完成。研究方法对静脉吸毒HIV／AIDS患者进行回顾性研究,采用临床流行病学横断面调查的方法,填写由中国中医科学院中医药防治艾滋病研究中心编制的“艾滋病中医证候四诊信息采集表”进行临床症状调查。该表根据HIV／AIDS患者常见临床表现以及中医诊断学四诊常见症状制定,预实验表现信度和效度良好。所有HIV／AIDS患者由云南、广西、新疆、河南、安徽等地区合作医院按照课题要求筛选入组,病例信息采集后由课题组人员采用双录入校验的方法统一录入艾滋病中医证候研究数据库。按照不同感染途径分类,分别抽出静脉吸毒感染人群379例,6次访视共1826频次访问信息和采供血感染人群533例,6次访视共2895频次；其中静脉吸毒感染人群379例,作为本课题研究基础数据,对症状体征、病性病位等证候特征的出现率进行频次统计,并对静脉吸毒HIV／AIDS患者主要症状体征进行因子分析,提取静脉吸毒HIV／AIDS患者的中医证候要素(主成分)。同时,对采供血感染人群和静脉吸毒感染人群进行证候特征的差异性研究,统计方法用x2检验。研究结果1.静脉吸毒HIV／AIDS患者主要临床症状、证候特征。主要临床症状为腰膝酸痛、乏力、情绪抑郁、神疲、健忘、烦躁、失眠、口苦；舌象以淡红舌、红舌,薄白苔或薄黄苔多见,伴有齿痕、薄瘦、痿软；脉象以细脉、弦脉、数脉为多见,病性以气虚、阴虚、气滞等为主；病位主要累及肾、肝、脾三脏。静脉吸毒HIV／AIDS患者证候特征主要以气阴两虚、肝肾阴虚、肝郁气滞、脾气虚等为主。2.静脉吸毒HIV／AIDS患者不同分期的主要临床症状、证候特征及其差异性。无症状HIV感染期症状以腰膝酸痛、情绪抑郁、乏力、烦躁、神疲、健忘、失眠、口苦等症状为主；舌象以淡红舌薄白苔多见,其次为红舌、少津、润泽、齿痕舌、痿软舌、薄瘦舌、光滑舌；脉象以细脉、弦脉、数脉、沉脉、滑脉为主；病性以气虚、阴虚、气滞为著；病位主要涉及到肾、肝、脾三脏。根据上述提示无症状HIV感染期证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾虚等为主。艾滋病期症状以乏力、腰膝酸痛、健忘、咽干口燥、神疲等为主；舌象以淡红舌薄白苔多见,其次为黄苔、红舌、少津、厚苔、胖大舌、齿痕舌、薄瘦舌；脉象以细脉、弦脉、数脉、沉脉、虚脉为主；病性以气虚、阴虚、阳虚、火热、气滞为著；病位主要以肾、脾、肝三脏为主。根据上述提示艾滋病期证候特征以气阴两虚、肾阴虚、脾虚、肝肾阴虚、肝火炽盛等为主。3.静脉吸毒HIV/AIDS患者不同性别的主要临床症状、证候特征及其差异性。男性静脉吸毒HIV/AIDS患者主要症状为腰膝酸痛、乏力、情绪抑郁、神疲、烦躁、健忘、失眠；舌象以淡红舌薄白苔为主,其次为红舌、少津、苔黄、润泽、齿痕舌、苔厚、薄瘦舌、痿软舌、苔腻、胖大舌；脉象以细脉、弦脉、数脉、沉脉、滑脉等为主；病性以气虚、阴虚为主,兼夹气滞；病位主要涉及肾、肝、脾三脏。通过上述统计分析,男性患者的证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾虚等为主。女性静脉吸毒HIV/AIDS患者主要症状为健忘、腰膝酸痛、乏力、烦躁、口苦、情绪抑郁、神疲、失眠、头晕；舌象以淡红舌薄白苔为主,其次为红舌、少津、苔黄、光滑舌、齿痕舌、薄瘦舌、苔厚、润泽、苔腻、痿软舌；脉象为细脉、弦脉、数脉、沉脉、滑脉、虚脉等为主；病性以气虚、阴虚、气滞、血虚为主；病位主要累及为肾、肝、脾三脏。通过上述统计分析,女性患者的证候特征以气阴两虚、肝阳上亢、肝郁气滞、气血两虚、脾虚湿盛等为主。4.静脉吸毒和采供血两种不同途径HIV/AIDS患者主要临床症状、证候及其差异性。静脉吸毒HIV/AIDS患者的症状体征主要以腰膝酸痛、乏力、情绪抑郁、神疲、健忘、烦躁、失眠、口苦为主；舌象以淡红舌、红舌,薄白苔或薄黄苔多见,伴有齿痕、薄瘦、痿软；脉象以细脉、弦脉、数脉为多见,病性以气虚、阴虚、气滞等为主；病位主要累及肾、肝、脾三脏。静脉吸毒H1V/AIDS患者证候特征主要以气阴两虚、肝肾阴虚、肝郁气滞、脾气虚等为主。采供血HIV/AI DS患者主要以乏力、健忘、烦躁、神疲、气促、腰膝酸痛、情绪抑郁、心悸、口苦、咽干口燥、感冒、头晕、失眠、纳呆、畏寒、口腻、口淡等症状为主；舌象以淡红舌、红舌、胖大舌、齿痕舌、薄瘦舌为主,舌苔以白、薄、腻、厚为主；脉象以细脉、沉脉、数脉、弦脉为主；病性以气虚、湿、火(热)为主；病位以脾、肺、肾、肝为主；提示采供血HIV/AIDS患者主要以脾气虚、心脾两虚、肝肾阴虚、肝火炽盛、肝郁脾虚、脾虚湿盛、心肾不交的证候特征为主。5.用SPSS17.0统计软件对经静脉吸毒HIV／AIDS患者主要症状体征进行因子分析,提取静脉吸毒HIV／AIDS患者的中医证候要素(主成分)。通过对经静脉吸毒HIV／AIDS患者55项变量(症状、体征)进行因子分析,结合中医专业理论知识进行分析后,比较明显的静脉吸毒HIV／AIDS患者证候要素主要有肝肾阴虚、胃火亢盛、脾气虚等,还有部分因子包含的症状组合或复杂或单一,需要结合其他伴随症状才能进一步辨证分析。结论1.静脉吸毒HIV／AIDS患者病性主要以气虚、阴虚、气滞为主；病位主要累及肾、肝、脾三脏。证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾气虚等为主。2.静脉吸毒HIV／AIDS患者在无症状HIV感染期证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾虚等为主。艾滋病期主要以气阴两虚、肾阴虚、脾虚、肝肾阴虚、肝火炽盛等为主。3.静脉吸毒HIV／AIDS患者中,男性HIV／AIDS患者证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾虚等为主。女性HIV／AIDS患者证候特征主要以气阴两虚、肝阳上亢、肝郁气滞、气血两虚、脾虚湿盛等为主。4.静脉吸毒HIV／AIDS患者证候特征以气阴两虚、肝肾阴虚、肝郁气滞、脾气虚等为主；病性以气虚、阴虚、气滞为主；病位以肾、肝、脾为主。采供血HIV／AIDS患者证候特征以脾气虚、心脾两虚、肝肾阴虚、肝火炽盛、肝郁脾虚、脾虚湿盛、心肾不交为主。病性以气虚、湿、火(热)为主；病位以脾、肺、肾、肝为主。采供血组的病情普遍比较严重,其中73.78%的主要临床四诊信息的出现率采供血组高于静脉吸毒组x2检验的结果显示：两组患者的主要临床四诊信息中有107项(占65.24%)P<0.05,有统计学意义。5.从静脉吸毒HIV／AIDS患者主要症状体征进行因子分析来看,结合中医专业理论知识进行分析后,部分研究结果与临床四诊信息统计后的证候特征有一定的共同性。更多还原

【Abstract】 ObjectiveTo review and analyze the clinical data of1826HIV/AIDS patients infected by intravenous drug in statistics. To study the Chinese Medicine syndromes included the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease. So as to provide some evidences for the treatment of TCM of different kind of route of transmission and know more information about AIDS.The first is to study the general distribution of Chinese Medicine syndromes included the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease. The second is to study difference of Chinese Medicine syndromes of HIV/AIDS patients under different stages.The third is to study difference of Chinese Medicine syndromes of HIV/AIDS patients under different sex.The forth is to study difference of Chinese Medicine syndromes of HIV/AIDS patients infected by intravenous drug and paid blood transfusion.The fifth is to utilize SPSS17.0to do factor analysis, extracting TCM syndromes essence(principal constituent) of the HIV/AIDS patients infected by intravenous drug.MethodsAfter the retrospective study on HIV/AIDS patients infected by intravenous drug, based on the method of cross-sectional study, filled in the table of AIDS TCM,and main clinical symptoms were investigated.According to the different routes of infection classification,extracting HIV/AIDS patients infected by intravenous drug as the basic data of research to study occurrence rate of frequency of the symptoms and signs and o do factor analysis, extracting TCM syndromes essence(principal constituent) of the HIV/AIDS patients infected by intravenous drug. At the same time, according to the different routes of infection classification, extracting HIV/AIDS patients infected by paid blood transfusion and intravenous drug to study difference of Chinese Medicine syndromes of HIV/AIDS patientsResults1.To summarize the Chinese Medicine syndromes of HIV/AIDS patients infected by intravenous drug, included the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease.Statistics show that the main clinical symptoms and signs such as lumbar debility,weakness,depression,contracture of the body, forgetfulness,dysphoria,contracture of sleep, mouth bitter. Tongue condition:pink tongue, red tongue are common, combining teeth-marked tongue, thin tongue, limp wilting tongue. Palse condition:thin pulse,angry pulse, rapid pulse are common.Nature of the disease mainly have qi deficiency, yin deficiency,stagnation of qi.locations of the disease mainly have kidney, liver,spleen. Mainly clinical stage of the HIV/AIDS Patients infected by intravenous drug are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency.2.To analyze the Chinese Medicine syndromes of HIV/AIDS patients under different stages, included the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease. Get the message of the disparity of the two groups.Patients at asymptomatic stage has main symptoms such as lumbar debility, depression,weakness, dysphoria, contracture of the body, forgetfulness, contracture of sleep, mouth bitter. Tongue condition:pink tongue, thin white fur are common, combining teeth-marked tongue, thin tongue, limp wilting tongue. Palse condition:thin pulse,angry pulse, rapid pulse, deep pulse, slippery pulse are common. Nature of the disease mainly have qi deficiency, yin deficiency stagnation of qi.Locations of the disease mainly have kidney,liver,spleen. Mainly clinical stage are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency.Patients at AIDS stage has main symptoms such as weakness,lumbar debility, forgetfulness, thirsty, contracture of the body. Tongue condition:pink tongue, thin white fur are common, combining teeth-marked tongue, thin tongue, limp wilting tongue. Palse condition:thin pulse,angry pulse, rapid pulse, deep pulse, weak pulse are common. Nature of the disease mainly have qi deficiency, yin deficiency, yang deficiency,stagnation of qi.Locations of the disease mainly have kidney, spleen, liver. Mainly clinical stage are qi and yin deficiency, kidney yin deficiency, spleen qi deficiency,liver and kidney yin deficiency, the flaming of liver fire.3. To analyze the Chinese Medicine syndromes of HIV/AIDS patients under different sex, included the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease. Get the message of the disparity of the two groups.The male patients has main symptoms such as lumbar debility,weakness,depression,contracture of the body, forgetfulness,dysphoria,contracture of sleep, mouth bitter. Tongue condition:pink tongue, thin white fur are common, combining teeth-marked tongue、 thin tongue, limp wilting tongue. Palse condition:thin pulse,angry pulse, rapid pulse, deep pulse, slippery pulse are common. Nature of the disease mainly have qi deficiency, yin deficiency stagnation of qi.Locations of the disease mainly have kidney,liver,spleen. Mainly clinical stage are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency.The remale patients has main symptoms such as forgetfulness, lumbar debility, weakness, dysphoria, mouth bitter, depression,contracture of the body, contracture of sleep, dizzyiness. Tongue condition:pink tongue, thin white fur are common, combining teeth-marked tongue, thin tongue. Palse condition:thin pulse,angry pulse, rapid pulse, deep pulse, slippery pulse,weak pulse are common. Nature of the disease mainly have qi deficiency, yin deficiency,stagnation of qi,bloody deficiency.Locations of the disease mainly have kidney,liver,spleen. Mainly clinical stage are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi, qi and bloody deficiency,spleen qi deficiency.4.To analyze the Chinese Medicine syndromes of HIV/AIDS patients infected by intravenous drug and paid blood transfusion, includes the main clinical symptoms and signs (included tongue appearance and Pulse condition), nature and locations of the disease. Get the message of the disparity of the two groups.HIV/AIDS patients infected by intravenous drug has main symptoms such as lumbar debility,weakness,depression,contracture of the body, forgetfulness,dysphoria.contracture of sleep, mouth bitter. Tongue condition:pink tongue, red tongue, thin white fur,thin yellow fur are common, combining teeth-marked tongue,thin tongue, limp wilting tongue. Palse condition:thin pulse,angry pulse, rapid pulse are common.nature of the disease mainly have qi deficiency, yin deficiency,stagnation of qi.locations of the disease mainly have kidney, liver,spleen. Mainly clinical stage of the HIV/AIDS Patients infected by intravenous drug are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency.The HIV/AIDS patients infected by paid blood transfusion has main symptoms such as weakness, lbrgetfulness,dysphoria, contracture of the body, lumbar debility, depression, mouth bitter,dry throat and dry mouth, dizzyiness, contracture of sleep, Tongue condition:pink tongue, thin white fur are common, combining teeth-marked tonguc、thin tongue,limp wilting tongue. Palse condition:thin pulse, deep pulse, rapid pulse, angry pulse are common. Nature of the disease mainly have qi deficiency, fluid retention.Locations of the disease mainly have spleen, lung,kidney,liver. Mainly clinical stage of the HIV/AIDS patients infected by paid blood transfusion are spleen qi deficiency, weakness of heart and spleen, liver and kidney yin deficiency, the flaming of liver lire. 5.Utilizing SPSS17.0to do factor analysis, extracting TCM syndromes essence(principal constituent) of the HIV/AIDS patients infected by intravenous drug.Utilizing SPSS17.0to do factor analysis, extracting TCM syndromes essence(principal constituent) of the HIV/AIDS patients infected by intravenous drug, Mainly clinical TCM syndromes essence are liver and kidney yin deficiency, spleen qi deficiency.Other factors in order to analysis that need to be combined with other accompanying symptoms.Conelusions1.Nature of HIV/AIDS patients infected by intravenous drug mainly have qi deficiency,yin deficiency, stagnation of qi.Location mainly have kidney,liver,spleen. Mainly clinical stage are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency.2. Mainly clinical symptoms of patients at asymptomatic stage are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency. Mainly clinical symptoms of patients at AIDS stage are qi and yin deficiency, kidney yin deficiency, spleen qi deficiency,liver and kidney yin deficiency, the flaming of liver fire.3. Mainly clinical symptoms of the male patients are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency, the remale patients are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi, qi and bloody deficiency,spleen qi deficiency.4. Mainly clinical stage of the HIV/AIDS Patients infected by intravenous drug are qi and yin deficiency, liver and kidney yin deficiency,stagnation of liver qi,spleen qi deficiency. Mainly clinical stage of the HIV/AIDS patients infected by paid blood transfusion are spleen qi deficiency, weakness of heart and spleen, liver and kidney yin deficiency, the flaming of liver fire.5. The results of Faetor Analysis using Professional knowledge:some conclusions links with experiential differentiation of symptoms and signs, using data analysis with no supervising to obtain the AIDS syndrome essence and induction has reference.更多还原