【作者】 徐月琴；

【导师】 符林春；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2012， 硕士

【摘要】 目的：分析HIV/AIDS患者的舌象特点,并探讨舌象与不同阶段CD4+T淋巴细胞计数的关系,揭示HIV/AIDS患者的主要病机,为HIV/AIDS患者的中医辨证治疗、判断其转归和预后提供参考。方法：横断面研究的172例HIV/AIDS患者和纵向研究的62例HIV/AIDS患者,来源于2010年3月～2011年4月广州市第八人民医院的门诊和住院病人(以门诊患者为主),经广东省疾病预防控制中心(CDC)进行免疫印迹确认试验(WB)HIV抗体阳性。HIV阴性组的舌象,来源于文献资料。运用中医舌象数字化分析仪(上海道生科技医疗科技有限公司生产,型号：ZBOX-Ⅰ型),于上午8点到12点在门诊进行数据采集,部分患者进行了多次按月随访,课题主要有以下几个方面内容：(1)将横断面观察的172例HIV/AIDS患者不同CD4+T淋巴细胞计数分组的舌象进行分析,并将其与阴性组进行对比,探讨HIV/AIDS患者舌象特点及其与不同阶段的CD4+T淋巴细胞计数之间的关系。(2)将172例HIV/AIDS患者分为服用抗病毒药物至少半年(服药组)91例、未服用过任何治疗艾滋病的药物(未服药组)81例,分别探讨两组的舌象特点及其与不同阶段CD4+T细胞计数之间的关系。(3)对62例HIV/AIDS患者的舌象进行纵向研究,观察时间点为HAART (Highly Active Anti—Retroviral Therapy, HAART,“高效抗逆转录病毒疗法”)治疗前(0月)、HAART治疗6月、HARRT治疗12月,探讨HAART治疗前后舌象变化及其与CD4+T淋巴细胞计数的关系。结果：横断面研究的172例HIV/AIDS患者和纵向研究的62例HIV/AIDS患者舌象特点显不：HIV/AIDS患者的舌象以瘀血类舌象(瘀斑舌和暗红舌)为主,裂纹舌和齿痕舌较多,舌苔以黄苔、白苔、厚苔、腻苔为主。服药组和未服药组患者的舌象与CD4+T细胞计数关系相同,纵向研究的三次随访表现的舌象与CD4+T细胞计数的关系也与其相同,均表现为：CD4+T细胞计数>350/mm3的患者淡红舌、白苔的检出率高于CD4+T细胞计数<200的患者(p<0.05),CD4+T细胞计数<200/mm3的患者的暗红舌、裂纹舌、少苔的检出率高于CD4+T细胞计数>350/mm3的(p<0.05),CD4+T细胞计数在200-350/mm3之间的患者腻苔的检出率高于CD4+T细胞计数>350/mm3的(p<0.05)和CD4<200/mm3的(p<0.05),CD4+T细胞计数>350/mm3的患者的润苔的检出率高于CD4+T细胞计数≤350/mm3的患者。纵向研究还发现：HAART治疗6月和12月的舌象分别与HAART治疗0月相比,均发现暗红舌增多(p<0.05),淡白舌减少(p<0.05),少苔的检出率增加(p<0.05)。结论：横断面研究和纵向研究分析了HIV/AIDS患者的中医舌象特点,并探讨了舌象与CD4+T淋巴细胞计数的关系,能够为艾滋病的中医辩证治疗、判断其转归和预后提供依据。HIV/AIDS患者的病情复杂,多呈现气阴两虚兼瘀血、湿邪阻滞的中医病理变化。更多还原

【Abstract】 ObjectiveTo analyze the tongue presentation of HIV/AIDS patients, and to explore the relationship between the tongue demonstration and the CD4+T lymph cell values, which can announce the pathology characters of HIV/AIDS patients, and would be helpful for the diagnosis, prognosis and clinical treatment.Methods172cases of HIV/AIDS patients(studied by cross-sectional) and62cases patients(researched by longitudinal) were the outpatients and inpatients of the people’s hospital of Guangzhou eighth(mainly to outpatients), they were both diagnosed with HIV antibody positive by immune imprinting confirmation tests (WB) by the centers for disease control and prevention (CDC) of Guangdong province, the normal people whose tongue pictures were from literature.The tongue pictures were collected by special system Tongue image digital analyzer(ZBOX-1type)applied by Shanghai DaoSheng medical technology Company. The data were collected from8to12am in the outpatient department. The date of partial patients had been collected on many times monthly, the research including several aspects as follows:(1)To analyze tongue characteristics of172cases by cross-sectional observation HIV/AIDS patients different CD4+T lymphocyte count as the tongue of the group, then compared with normal people, to analyze the tongue characteristics of HIV/AIDS patients and to explore the relationship between the tongue demonstration and the different stages of CD4+T lymphocyte count. (2) To divide172cases of HIV/AIDS patients into two groups, one group were the91cases patients who had taken anti—HIV drugs for at least half an year (drug group), the other group were the81cases patients who had not taken any HIV medicine (not drug group), to explore the tongue characteristics of the two groups and the relationship between the tongue demonstration and the different stages of CD4+T lymphocyte count.(3) The tongue demonstration of62cases HIV/AIDS patients were researched by the longitudinal study, observation time point as before given (Highly Active Anti—Retroviral Therapy, HAART) treatment (0month), given HARRT treatment for six month and twelve month, discuss the tongue change between before and after given HAART treatment, to explore the tongue characteristics of HIV/AIDS patients and the relationship between the tongue demonstration and the different stages of CD4+T lymphocyte count.ResultsThe tongue features of172cases of HIV/AIDS patients by cross-sectional study and62cases of HIV/AIDS patients by longitudinal study all showed that: The blood stasis tongue including the ecchymosis tongue and the dull tongue was dominant in HIV/AIDS patients, more HIV/AIDS patients showed fissured tongue and tongue with teeth print, As to tongue coating presentation, more patients showed white, yellow,thick and greasy coating.The patients showed the same relationship between the tongue demonstration and the CD4+T lymphocyte count during the drug group and not drug group of the cross-sectional study and the three follow-up of the longitudinal study, which showed that:the rate of the light red tongue and white coating of patients with CD4+T cell count>350/mm3was found more than those patients with CD4+T cell count<200/mm3(p<0.05), the rate of the dull tongue and fissured tongue and little liver coating of patients with CD4+T lymphocyte count<200/mm3was found more than those patients with CD4+T lymphocyte count>350/mm3(p<0.05), the rate of the greasy coating of patients with CD4+T lymphocyte count between200-350/mm3was found more than both the patients with CD4+T lymphocyte count>350/mm3(p<0.05) and CD4+T lymphocyte count<200/mm3(p<0.05), while the rate of moist coating of the patients with CD4+T lymphocyte count>350/mm3was found more than those patients with CD4+T lymphocyte count≤350/mm3. The longitudinal study also found that, compared with HAART treatment for o month, the tongue demonstration of the HAART treatment for six month and twelve month, the rate of dark red tongue was found increased (p<0.05), the rate of pale tongue was found reduced (p<0.05), while the rate of little liver coating was found increased (p<0.05).ConclusionThrough the analysis of the tongue characteristics of HIV/AIDS patients and the discussion of the relationship between the tongue demonstration and the CD4+T lymphocyte count by the cross-sectional study and longitudinal study which would be helpful for the diagnosis, prognosis and clinical treatment. The state of illness of HIV/AIDS patients was complex, Qi and Yin Deficinecy with obstruction of Blood Stasis and damp evil are more commonly seen TCM pathological changes in HIV/AIDS patients.更多还原