【作者】 李梅；

【导师】 刘凤斌；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：依据文献分析制定肠易激综合征临床信息采集表,通过对广州中医药大学第一附属医院2011年8月-2012年4月就诊的IBS患者临床信息调查研究,分析目前IBS临床流行病学特点,包括一般情况、诱发及加重因素等；根据中医四诊资料,分析TBS的中医证候特点,及其与“肝主疏泄”的相关性,进一步为IBS的预防、控制和治疗评价提供依据。方法：查询各数据库收录近年来有关IBS的现代研究文献,提取相关的症状、证候要素、证候,总结IBS可能的病因病机与证治规律,据此制定IBS临床信息采集表。应用IBS临床信息采集表对广州中医药大学第一附属医院2011年8月-2012年4月就诊的IBS患者进行临床信息采集,利用频数分析方法对流行病学资料进行分析,探讨肠易激综合征临床流行病学特点；利用频数分析、因子分析、聚类分析,结合证素辨证体系探索肠易激综合征的中医证候特点,并与调查时所使用的《中医消化病学诊疗指南》的辨证分型标准的证候进行比较,分析其适用性和指导意义；并进一步根据中医证候特点探讨肠易激综合征与“肝主疏泄”的相关性。结果：本研究共收集104例肠易激综合征患者,其中腹泻型占90.4%；女性占64.4%；男：女为1：1.81；青年者占69.2%；文化程度为大学和(或)以上者占52.9%；经济收入一般者占79.8%；在职者及学生合占比例为76.9%；平素饮食口味有偏好者占51.0%；IBS发生的诱因或加重的原因与季节相关的占29.8%,夏季比例最大(16.3%)。77.9%IBS患者病情反复或加重有其他原因诱发,劳累占21.2%,饮酒有10.6%,受凉占30.8%,饮食不慎占59.6%,情绪因素中紧张比例最大,占39.4%。IBS患者表现为腹胀者占57.5%,饭后腹胀或排便后腹胀缓解者占53.8%；IBS患者表现为腹痛者占71.2%,排便后腹痛缓解者占47.1%；大便次数增多者占88.5%,粪质偏烂者占91.3%；痛泻者占76.9%；有便秘(大便次数减少)者占16.3%。约2／3IBS患者具有情绪精神症状,烦躁者占56.7%；急躁易怒者占49.0%；精神抑郁者占57.7%；焦虑者占48.1%；忧郁者占43.3%；紧张者占53.8%；情绪低落者占37.5%。中医诊断,便秘者占5.8%；腹痛者占43.3%；泄泻者占51.0%；证候分型中肝郁脾虚比例最大,占85.6%：肝郁气滞者占2.9%；脾肾阳虚者占3.8%：脾胃湿热者占7.7%。通过因子分析、聚类分析、证素辨证体系及专家临床经验,初步认为在聚为5类,分为4型(脾胃虚弱、肝胂不和、肝郁脾虚、脾胃湿热)时,症状指标分散性良好,证型分布清晰,因此考虑本研究分为4种证型时最为符合统计学要求及临床实际情况。结论：IBS忠者各亚型中以腹泻型最多；女性比男性更易患病；发病人群分布以青年居多；文化程度较高、经济收入一般的人群更易患IBS:IBS患者饮食倾向于进食海鲜、辣椒,夏季常可诱发或加重IBS症状；IBS患者普遍有较差的精神状态,精神因素为IBS发病的重要原因之一。IBS常以腹痛、腹胀、腹泻、便秘为首发症状：IBS忠者同时容易出现功能性消化不良症状、结肠外症状。IBS中医病机常责之为肝郁脾虚,不同病变阶段的临床表现均不相同,但基本病机总离不开肝郁脾虚,肝郁脾虚贯穿于疾病发展的始终。分析得出的肠易激综合征的证候特点基本与经验辨证及临床相符,证明数理统计及数据挖掘方法是可以用来科学、客观的支持临床诊断的。《中医消化病诊疗指南》所提出的对肠易激综合征辨证分型标准能基本代表广州地区肠易激综合征的证候特点,对IBS的治疗有较强的指导意义。更多还原

【Abstract】 Object iveMaking a clinical information collection form based on literature research, through the clinical information research on the treatment of IBS patients by the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from August2011to April2012. Analyze the clinical epidemiological characteristics and TCM syndromes of IBS at present, and its correlation with Liver controlling dispersion, to provide the basis for the prevention, control and treatment evaluation of IBS.MethodsCheck the indexed modern research literature in recent years with IBS, extraction-related symptoms, the syndrome elements, syndrome, summed up the cause of IBS may pathogenesis and treatment of law, which established the IBS clinical information collection form. Use clinical information collection form to collect clinical information on the application of IBS patients who seek treatment in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from2012August to2011April, frequency analysis methods to analyze the epidemiological data, to investigate the clinical epidemiological features of irritable bowel syndrome, frequency analysis, factor analysis, cluster analysis, combined with syndrome differentiation system exploration of irritable bowel syndrome TCM syndromes, and compare with syndrome in "Chinese gastroenterol ogy diagnosis and treatment guidelines" when used the time of the survey syndrome, analyze its applicability and guiding significance, investigate IBS with "Liver controlling dispersion" according to TCM syndromes ResultsThis study collected a total of104cases of irritable bowel syndrome, which accounted for90.4%of diarrhea-predominant, women accounted for64.4%, Male:female was1:1.81, youth accounted for69.2%, educational level accounted for52.9%of universities and (or) more, general economic and income accounted for79.8%, the incumbent and the students together accounted for76.9%, usually tastes preferences accounted for51.0%, IBS occur incentives or increase the causes and season accounted for29.8%, summer proportion (16.3%) is the largest,77.9%of IBS patients with recurrent disease or aggravate other causes induced, fatigue accounted for21.2%, alcohol10.6%,30.8%in cold diet inadvertently accounted for59.6%, the largest proportion of tension in the emotional factors, accounting for39.4%.Performance of patients with IBS, abdominal distention (57.5%), bloating after meals, or bloating alleviate after defecation accounted for53.8%, manifested as abdominal pain (71.2%), after a bowel movement, abdominal pain accounted for47.1%, stool frequency increased by88.5%, partial rotten fecal matter accounted for91.3%, pain and diarrhea accounted for76.9%, constipation (stool frequency decrease) accounted for16.3%, about2/3of IBS patients with mood psychiatric symptoms, irritability, who accounted for56.7%, the irritability accounted for49.0%, depression accounted for57.7%, anxiety accounted for48.1%, depression accounted for43.3%, tension accounted for53.8%, depression accounted for37.5%, TCM diagnosis, constipation, accounting for5.8%, abdominal pain (43.3%), diarrhea accounted for51.0%, in syndrome type, the largest proportion of stagnation and spleen deficiency, accounting for85.6%, liver Qi stagnation, accounted for2.9%, spleen deficiency accounted for3.8%, spleen accounted for7.7%. Through factor analysis, cluster analysis, the syndrome differentiation system and expert clinical experience, the preliminary view that in clustered into five categories, divided into4types (spleen and stomach, liver and spleen, stagnation and spleen deficiency, spleen), the symptom index dispersion good, syndrome distribution is clear, so consider this study is divided into four kinds of card type is most consistent with the statistical requirements and the clinical practice.ConclusionSubtypes of IBS patients with diarrhea-predominant up to, women more susceptible than men, incidence population distribution the majority of youth, a higher educational level, general economic income of the population more prone to IBS, patients with IBS diet tend to eat seafood, peppers, summer important one of the reasons often can induce or aggravate symptoms of IBS, patients with IBS generally poor state of mind, mental factors for IBS incidence. IBS often with abdominal pain, bloating, diarrhea, constipation, as the first symptom, IBS patients are also prone to functional dyspepsia symptoms and symptoms of colon outside. Traditional Chinese medicine pathogenesis of IBS often responsible for the stagnation and spleen deficiency, different pathological stages of clinical manifestations vary, but the basic pathogenesis is always the stagnation and spleen deficiency, stagnation and spleen deficiency throughout the development of the disease is always. Analysis derived from irritable bowel syndrome syndrome characteristics are basically consistent with the dialectic of experience and clinical, mathematical statistics and data mining methods can be used to scientifically and objectively support clinical diagnosis. The Chinese gastroenterology diagnosis and treatment guidelines irritable bowel syndrome syndrome type standard basic on behalf of the Guangzhou area of irritable bowel syndrome syndrome characteristics, there is a strong guiding significance for the treatment of IBS.更多还原