【作者】 薛亮；

【导师】 王小云；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 研究背景：绝经前后诸证,亦称”经断前后诸症”,是指妇女在绝经期前后,围绕月经紊乱或绝经而出现烘热汗出、烦躁易怒、潮热面红、乍寒乍热、眩晕耳鸣、心悸失眠、腰背酸楚、面浮肢肿、皮肤蚁行感、情志不宁等症状。相当于现代医学的绝经期综合征(menopausal syndrome, MPS)。传统的生物学观点把围绝经期出现的症状均归咎于卵巢功能减退、内分泌改变等。但随着生物医学模式向生物—社会—心理医学模式的转变,人们已经越来越意识到心理社会因素在疾病的发生、发展和转归中起着重要作用。而人们在日常生活中遇到的各种各样的社会生活的变动,即生活事件,如结婚,升学,亲人亡故等对人的思想、心理起到重要的影响作用,因而各种心理变化影响到疾病的发生研究目的：本课题对广州某医院的围绝经期妇女的心身症状进行调查研究。在中医“整体观”、“心身合一”、“情志致病”理论指导下,探讨社会因素、生活事件、及其产生的心理应激与绝经前后诸证疾病的相互关系,分析其可能的危险因素,为中医“情志致病”理论和防治方案提供科学证据。研究方法：本研究为横断面研究,从现代医学心理学、中医情志病因学角度,采用心理测量学、临床流行病学和循证医学等科研方法,以国内改良Kupperman Index (KI)量表、团体用心理社会应激调查表(PSSG)、绝经综合征评定量表、90项症状自评量表(SCL-90)等为研究载体,对广州某医院178例更年期妇女的心身症状进行问卷调查,探讨社会因素、生活事件、及其产生的心理应激与绝经前后诸证心身症状的发生变化规律,为进一步探讨中医“情志致病”理论内涵和临床防治方案提供科学依据。研究结果：.背景资料分析本研究共纳入了170例符合标准的更年期妇女,其中病例组86例,对照组84例。其中病例组根据KI量表总分显示,轻度有38例,占44.20%,中度有45例,占52.30%,重度有3例,占3.50%。KI量表总分及各条目比较,显示两组女性的各绝经前后诸证症状的严重程度均有明显差异。分析86例绝经前后诸证患者KI量表各条目症状特点,最常见的五大症状按出现频率排序依次为：失眠(91.86%)；疲乏(88.37%)；易激动(87.21%)；潮热出汗(84.88%)；骨关节肌肉痛(83.72%)二.绝经前后诸证患者与对照组的比较(一)两组生活事件及其心理应激的比较比较病例组和对照组的生活事件总数、负性生活事件总数、消极情绪、积极情绪、消极应对、应激总分有统计学差异(P<0.05)。其中对于病例组86例患者,发病前5年内的生活事件出现频率最高的依次为：个人健康变化(74.40%)；过度劳累(60.50%)；子女前途问题(40.70%)；亲人亡故(34.90%)；亲人重病(34.90%)；职业变化(33.70%)；家庭不和或婚姻问题(19.80%)。(二)两组绝经前后诸证身心症状的比较。两组的身心症状均提示有统计学差异(P<0.05)。病例组86例患者的SCL-90各因子得分较高的依次为：其他因子(睡眠饮食)、强迫症状因子、躯体化因子、抑郁因子、焦虑因子等。三.绝经前后诸证组按病情轻重分级,分组比较生活事件及其心理应激。比较轻度病例组及中、重度病例组,两组的消极应对、应激总分组间差异有统计学意义(P<0.05)。四.病例组按生活事件多寡分组比较高生活事件组与低生活事件组在躯体症状、心理症状、社会职能工作等方面得分都存在差距,两组差异具有统计学意义(P<0.05)。另外,躯体领域差异较心理领域差异少。五.病例组按应激总分高低分组比较比较高应激总分组及低应激总分组,绝经综合征评定量表各维度,两组的绝经综合征总分、心理领域、社会职能与工作能力组间差异均有统计学意义(P<0.05)。对于SCL-90量表各维度,两组的SCL-90总分、躯体症状、心理症状组间差异均有统计学意义(P<0.05)六.高生活事件组按应激总分高低分组比较高生活事件高应激总分组与高生活事件低应激总分组比较,两组的心理症状得分组间差异均有统计学意义(P<0.05)。七.病例组的生活事件、应激总分与绝经身心症状的Spearman相关性分析。生活事件总数和绝经综合征的身心症状均有正相关性,并且所有相关系数通过了显著性检验。同理,负性生活事件总数和绝经综合征的身心症状均有正相关性,并且所有相关系数通过了显著性检验。正性生活事件总数和绝经综合征的身心症状无明显相关性,未能通过显著性检验。而应激总分和绝经综合征的身心症状均有正相关性。其中与心理领域、SCL-90总分、心理症状呈强相关性,并且所有相关系数通过了显著性检验。八.绝经前后诸证不同中医证型之间的比较86例绝经前后诸证患者中,肾阴虚14例(16.28%)；肾阳虚6例(6.98%)；肾阴阳两虚16例(18.60%)；肾虚肝郁42例(48.84%)；心肾不交7例(8.14%)；阴虚火旺1例(1.16%)。肾虚肝郁组与其他证型组比较,两组的生活事件总数、负性生活事件总数、消极情绪、消极应对、应激总分组间差异有统计学意义(P<0.05)对于绝经综合征评定量表各维度,两组的绝经综合征总分、心理领域、社会职能与工作能力组间差异均有统计学意义(P<0.05)。对于SCL-90量表各维度,两组的SCL-90总分、躯体症状、心理症状组间差异均有统计学意义(P<0.05)。研究结论：1.本研究发现绝经前后诸证症状出现频率之高十分显著,KI量表中13个条目症状,其中12个条目症状出现的频率均在50%以上,有5个条目症状出现频率在80%以上。而通过调查SCL-90量表发现,心理症状较为严重的因子依次为：强迫症状、抑郁、焦虑。2.86例绝经前后诸证患者发病前5年内的生活事件有6项出现频率超过30%,依次为：个人健康变化,过度劳累,子女前途问题,亲人亡故,亲人重病,职业变化。3.生活事件增多对绝经前后诸证心、身症状皆有影响。而当生活事件发生,不良的心理应激会大大加重绝经前后诸证的心理症状。4.绝经前后诸证多个中医证型里,显示肾虚肝郁证的负性生活事件数、消极情绪、消极应对方式明显高于其他证型。肾虚肝郁证的心理症状比其他证型严重得多,躯体症状差异不大。更多还原

【Abstract】 BackgroundMenopausal syndromes, refers to women in the before and after menopause, around the menstrual disorders or menopause appear Hongrehanchu, irritability, hot flashes red, chills and fever, dizziness, palpitation and insomnia, tinnitus, waist sour, floating face swollen limbs, skin creepss, emotional restless and so on.The traditional view of the biology of perimenopausal symptoms are attributed to ovarian dysfunction, endocrine changes. But with the biomedical model changing to biopsychosocial medical model, it has been more and more aware of psychological and social factors in the occurrence of diseases and development plays an important role in. But the people encountered in daily life to a variety of social life changes, i. e., life events, such as marriage, education, family death affect people’s thought and psychological activity, so the various psychological changes affect disease occurrence.ObjectiveThe subject is about perimenopausal women with somatic and psychological symptoms investigated in a hospital in Guangzhou. Under the guidance of traditional Chinese medicine, including "holistic view"," psychosomatic unity"," the emotional pathogenic theory", we explore the relationship among social factors, life events, psychosocial stress and menopausal syndromes. And analysis the possible risk factors. All of them is for providing scientific evidence of traditional Chinese medicine" the emotional pathogenic theory" and control scheme. MethodsThis study is a cross-sectional study. From modern medical psychology, traditional Chinese medicine emotional pathogenic etiological perspective, using psychometric, clinical epidemiology and evidence-based medical research method, with the domestic modified Kupperman Index, Psychosocial Stress Survey for Groups (PSSG), Chinese Menopause Rating Scale, Self-reporting Inventory (SCL-90), investigate178perimenopausal women with somatic and psychological symptoms in a hospital in Guangzhou. Explore somatic and psychological symptoms of menopausal syndromes occurring regularity by the effects of social factors, life events, and psychosocial stress. All of them is for providing scientific evidence of traditional Chinese medicine" the emotional pathogenic theory " and control scheme.Results1. Background Analysis.The study included170menopausal women, among them86cases of Menopausal Syndromes Group,84cases of Healthy Group. The Menopausal Syndromes Group according to KI Scale total score display, mild38cases, accounted for44.20%, moderate in45cases, accounting for52.30%, severe3cases, accounting for3.50%. of. KI Scale total score and each item comparison show the severity of menopause symptoms from two groups of women obviously different. Analysising KI each symptom of86menopausal syndrome patients, the most common five symptoms according to the frequency of occurrence are:Insomnia (91.86%); fatigue (88.37%); irritability (87.21%); hot flashes and sweating (84.88%); joint and muscle pain (83.72%).2. Menopausal Syndromes Group and Healthy Group Comparison2.1Group of Two Life Events and Psychosocial Stress ComparisonComparison of the Menopausal Syndromes Group and Healthy Group in life events, negative life events, negative emotion, positive emotions, negative coping, positive coping, total stress are statistical differences (P<0.05).To Menopausal Syndromes Group, life events in the highest frequency in previous five years before suffering menopausal syndromes are:personal health changes (74.40%); overwork (60.50%); children’s future (40.70%); the death of their loved ones (34.90%); relatives of seriously i11(34.90%); occupation changes (33.70%); a family feud or marital problems (19.80%). 2.2Group of Two Somatic and Psychological Symptoms ComparisonTwo groups’somatosensory and psychological field scrores are statistically significant differences (P<0.05).The Menopausal Syndromes Group with each factor of SCL-90, the highest5factor scores are as follows:other factors (sleeping and eating), obsessive symptoms, somatization, depression, anxiety3. The Menopausal Syndrome Group according to severity grading, comparison of life events and psychosocial stress.Comparison of mild Menopausal Syndrome Group and moderate severe Menopausal Syndrome Group, negative coping, total stress are statistically significant differences (P<0.05).4. The Menopausal Syndrome Group according to the amount of life events groupcomparisonThe high number life event group and the low number life events group, their somatic symptoms, psychological symptoms, social function are put in difference. The difference of the two groups is significant (P<0.05). In addition, somatosensory areas difference is less than psychological differences.5. The Menopausal Syndrome Group according to total stress score group comparisonComparison of high total stress and low total stress groups, Chinese Menopause Rating Scale of each dimension, menopausal syndrome scores, psychological field, social function and the ability in work are statistically significant differences (P<0.05).For the SCL-90of each dimension, SCL-90scores, somatic symptoms, psychological symptoms between group differences are statistically significant differences (P<0.05).6. The high number life event group according to the total stress level group comparisonThe high number life event high total stress group and high low stress life events total group comparison, psychological field differences between group are statistically significant (P<0.05).7. Menopause syndrome group life events, total stress, somatic and psychological symptoms of menopause Spearman correlation analysis.Life events and both somatic and psychological symptoms of menopause have positive correlation, and all pass the test of correlation coefficient.Negative life events and both somatic and psychological symptoms of menopause have positive correlation, and all pass the test of correlation coefficient.Positive life events and both somatic and psychological symptoms of menopause have no correlation, and all fail the test of correlation coefficient.Total stress score and both somatic and psychological symptoms of menopause have positive correlation. Expecially with the psychological field, SCL-90total score and psychological symptoms were highly correlated, and all pass the test of correlation coefficient.8. A comparison among different syndromes of traditional Chinese Medicine of menopausal syndromes86cases of menopausal syndrome, with kidney yin deficiency in14cases(16.28%), kidney yang deficiency in6cases(6.98%), kidney yin and yang deficiency in16cases (18.60%), kidney deficiency and liver stagnation in42cases (48.84%), disharmony of the heart and kidney in7cases (8.14%) yin deficiency and fire excess in1cases (1.16%)Kidney deficiency and liver stagnation group and other syndromes of comparison, life events, negative life events, negative emotion, negative coping, total stress were statistically significant differences (P<0.05).Chinese Menopause Rating Scale of each dimension, menopausal syndrome, psychological field, social function and the ability in work show statistically significant difference between group(P<0.05).For the SCL-90of each dimension, SCL-90total scores, somatic symptoms, psychological symptoms show statistically significant difference between groups (P<0.05).Conclusion1. This study found that menopausal syndrome symptoms occur in high frequency. There are12entries of KI scale, and their frequency of symtoms is more than50%,5entries occur at a frequency of80%or more. Through the investigation of SCL-90was found, the most serisous psychological symptoms are as follows: obsessive symptoms, depression, anxiety.2. To Menopausal Syndromes Group, there are6life events’ frequency in previous five years before suffering menopausal syndromes higher than30%:health changes, overwork, children’s future, the death of their loved ones, relatives of seriously ill, occupation change.3. There are effect on menopausal syndrome both somatic and psychological symptoms with life events increasing. When life events occur of, the bad psychosocial stress will greatly increase the psychological symptoms of menopause syndrome.4. Menopausal syndrome with multiple syndromes of traditional Chinese medicine, kidney deficiency and liver stagnation showed that negative life events, negative emotion and negative coping were significantly higher than that of the other TCM syndromes. Psychological symptoms of kidney deficiency and liver stagnation are more serious than other syndromes, while somatic symptoms have no much difference.更多还原