慢性前列腺炎中医证型分布特征研究

【作者】 韩富强；

【导师】 李海松；

【作者基本信息】 北京中医药大学 ， 中医外科学， 2007， 硕士

【摘要】 慢性前列腺炎(Chronic Prostatitis,CP)是以排尿刺激症状和膀胱生殖区疼痛为主要表现的临床综合征,是成年男性的常见病,多发于20岁～50岁,青春期前很少患病。估计在全世界男性中的患病率为9%～14%。在我国,其病理发病率为24.3%。由于对CP的病因及发病机制缺乏深入的了解,治疗的效果不令人满意,以致CP对生活质量的影响远比前列腺增生或前列腺癌更为严重。因此,有必要对本病的诊断和治疗进行深入研究。慢性前列腺炎属于中医“精浊”的范畴,其病位在精室、精窍,与肾和膀胱相关,同时与肝、肺、脾、心、三焦等也有密切关系。其病机特点是:肾虚为本,湿、热、瘀、毒为标。中医药治疗慢性前列腺炎有一定的优势,尤其以中医药为主的综合疗法,能够较好地改善临床症状,取得了满意的临床疗效,已被广泛应用。通过对近年来大量文献分析,发现存在以下问题:①病名及病因病机的认识尚不统一,辨证分型不规范;②诊断及疗效判定标准不统一;③临床研究方案设计不严谨,很少遵循随机、对照、双盲法的原则,很少描述随访及不良反应等。中医药治疗的特点和优势在于辨证论治,目前关于CP的中医辨证分型各家报道不一,很少专题流行病学调查。本研究运用临床流行病学的方法,统计CP中医证型的分布频率及生物学特征指标在各证型中的出现频率,分析中医证型的分布规律,探讨生物学特征指标与中医证型之间的内在联系。此次调查共收集病例918例,统计结果表明,CP以气滞血瘀证(89.76%)、湿热下注证(74.07%)为主,且二证多合并出现(68.41%),一部分患者可夹杂肾阳虚证(7.95%)或肝肾阴虚证(10.24%)。肝肾阴虚证较为少见,且以夹杂证出现。随着年龄增加,肾阳虚证的出现频率有升高趋势。经Logistic逐步回归分析发现前列腺触诊情况与四种证型的关系均有统计学意义。其中与肾阳虚关联性最高。再次经逐步回归分析发现肾阳虚与前列腺变小高度相关(OR=15.422),因此可以认为前列腺变小对诊断肾阳虚有高度提示意义。湿热下注证与前列腺饱满相关性强,其标准回归系数大于0,优势比值大于10。同时发现EPS中WBC计数,与湿热下注型的标准回归系数为0.189241,OR值为2.619,相关性最高,即随着EPS中WBC的增多,患者为湿热下注型的可能性,较其他证型越来越大;EPS中卵磷脂小体计数,与肾阳虚型的标准回归系数为0.184462,OR值为1.725,相关性最高,即随着卵磷脂小题的减少,肾阳虚的可能性,较其他证型越来越大;EPS中WBC计数,与气滞血瘀型、肝肾阴虚型、肾阳虚型呈负相关,且其OR值均<1;EPS中卵磷脂小体计数,与湿热下注型负相关,与气滞血瘀型间的关联无统计学意义。但总体而言,特异性不高。说明中医证类与生物学特征指标之间存在函数关系,但生物学指标对于证类的诊断是弱特异性的,只能作为中医证类判别手段的补充或延伸。通过对CP流行病学调查,证实了肾虚为本、湿热瘀血为标的中医病机基本认识,对临床治疗CP提供了理论依据。通过对生物学指标判别分析,揭示了生物学特征指标与中医证型的联系,对中医证候的诊断研究有重要的参考价值。更多还原

【Abstract】 Chronic prostatitis (CP), a commonly encountered disease of male adult, is a clinical syndromes with the main effect of dysuric symptom and bladder genital area pain. It seldom comes before adolescence but easily occurs between 20 and 50 years old. It is estimated that the incidence rate of CP among the adults in the world is 9%-14%. In china, the pathological incidence rate of CP is 24.3%.the influence of CP to the quality of life is further more severe than that of benign prostatic hyperplasia or prostate cancer due to the lack of deep research on the pathogeny and the mechanism of the disease, and the lack of efficient treatment. Therefore, it is necessary to make deeper research on the diagnosis and treatment of this disease.CP belongs to the scope of“jingzhuo”in the field of TCM. It locates in the jingshi and jingqiao, which is related to the kidney and bladder as well as to the liver, lung, spleen, heart and sanjiao. It’s mechanism has: the deficiency of kidney as the fundamental cause, the dampness, heat, stagnated blood and qi, poison as the incidental complications. There are some definite advantages in treating CP with TCM or combined therapy, which are utilised popularly..They can improve the syndromes and get satisfactory effects. Through analysing the recent years’ literature: the following problems are found:1, the name of this, it’s causes and it’s mechanisms has not been unified, neither the different dialectical types; 2, the standards of diagnosis and effectiveness are not unified. 3, the clinical research are not precisely designed , few of them follow the principles of randomization, comparison and double-blind , and few of them describes the follow up and adverse reaction.Clinical epidemiology investigation. This project is trying to analyse the distributing discipline of the CP’s symptoms, physical sign and patterns in TCM. Then,with statistic and clinical epidemiological methods,we discuss the relationship between the physical sign and types in TCM, and the relationship between the biological parameter and types in TCM.. The result of this project will enrich the content of TCM analysing and differentiating pathological conditions and provide the scientific and objective index to clinical analysing and differentiating pathological conditions.更多还原