小儿抽动障碍的中医证候分布规律研究

【作者】 周蕾；

【导师】 韩斐；

【作者基本信息】 北京中医药大学 ， 中医儿科学， 2009， 硕士

【摘要】 研究目的本研究从性别、年龄、病程长短、西医分型、是否服用西药等不同的角度,以中医辨证分型为方法,了解抽动障碍患儿病情的发展变化,体质的变化,中医证候的变化,归纳总结中医证型的分布规律,以指导临床治疗和疾病的康复。研究方法与内容临床观察病例均来源于2008年3月至2009年4月广安门医院儿科门诊。采用回顾性研究的方法,以1994年美国《精神疾病诊断统计手册》第四版(DSM-Ⅳ)中抽动障碍的诊断标准作为纳入标准,根据中医辨证论治的原则,观察、总结160例临床病例,将其主要分为心肝火旺、肝肾阴虚、脾气不足及脾肾阳虚四型,进一步探讨不同性别、年龄、病程长短、是否服用西药、西医分型及是否合并其他心理行为障碍等不同情况下的中医证型分布规律。研究结果①中医证型分布主要集中在心肝火旺证;②抽动障碍发病率男性高于女性,为3.10:1,脾肾阳虚证的男性患儿所占比例比女性患儿大;③随着年龄的增大,心肝火旺证所占比例逐渐减小,脾肾阳虚证所占比例逐渐增大,肝肾阴虚证所占比例也有所增大;④随着病程发展,肝火亢旺证所占比例逐渐减小,脾肾阳虚证所占比例逐渐增大;⑤服用西药组患儿脾肾阳虚证所占比例较未服用西药组大;⑥慢性抽动障碍(CTD)组及多发性抽动(MT)组,脾肾阳虚证及肝肾阴虚证所占比例皆较短暂性抽动障碍(TTD)组大;⑦合并注意缺陷多动障碍(ADHD)脾肾阳虚证所占比例较大。研究结论1.抽动障碍最常见的中医证型为心肝火旺证。2.男性大龄患儿在病程长或服用西药、或病情复杂转变为CTD、MT或合并ADHD等情况下出现脾肾阳虚证型的可能性增大。3.大龄患儿在病程长或病情复杂转变为CTD或MT等情况下肝肾阴虚证可能性也有所增大。更多还原

【Abstract】 ObjectivesAccording to the basic theory of Traditional Chinese Medicine(TCM) and the theory of differentiation of syndrome,observe the clinic patients of tics disorders(TD) and discuss how the disease develops,the constitution changes and the TCM types distributes from different angle, such as different gender,age,courses of disease,types of western medicine,having taken western medicine or not.Summary the distribution of TCM types,so that it can be the clinic guide to the treatment.MethodClinical observation cases originate from the March of 2008 to the April of 2009 the Guang’ an Gate hospital department of pediatrics outpatient. Using the method of retrospective study,taking the Diagnostic and statistical manual of mental disorders.Fouthed(DSM-Ⅳ) as the standard to choose the cases,observe and summary them.Accordingto the TCM theory of differentiation of syndrome,divide the cases into four types, hyperactivity of heart-and-liver fire type,deficiency of liver-and-kidney-yin type,deficiency of spleen-qi type,deficiency of spleen-and-kidney-yang type.Discuss the differences of the cases in these four types,when in different conditions,such as in different gender,age groups,courses of the disease,whether not taking western medicine,etc.Result①The TCM syndromes distribute mainly in the type of hyperactivity of heart-and-liver fire.②Boys have an obvious higher occurrence rate than girls in TD,the male-female ratio is 3.10:1.In deficiency of spleen-and-kidney-yang type,the percentage of boys’ is higher than girls’ ③As age grows,the percentage of type hyperactivity of heart-and-liver fire goes down gradually,and the percentage of type of deficiency of spleen-and-kidney-yang goes up,so does the type of deficiency of liver-and-kidney-yin.④As disease develops,the percentage of type the percentage of type hyperactivity of heart-and-liver fire goes down gradually,and the percentage of type of deficiency of spleen-and-kidney-yang goes up gradually.⑤The percentage of deficiency of spleen-and-kidney-yang type is higher in the group of taken western medicine than en the group of not taken western medicine.⑥The percentages of deficiency of spleen-and-kidney-yang type and deficiency of liver-and-kidney-yin type in chronic tic disorders (CTD) group and multiple tics(MT) group are both higher than in transient tic disorders(TTD) group.⑦The percentage of deficiency of spleen-and-kidney-yang type in group in which patients combine with both TD and Attention-deficit/hyperactivity disorder(ADHD) is higher than in group that not combined.Conclusion①The most common TCM type is hyperactivity of heart-and-liver fire.②Elder boy patients become deficiency of spleen-and-kidney-yang more probably when have long course of disease,or have taken western medicine,or turn to CTD or MT,or combine with ADHD③Elder patients may be deficiency of liver-and-kidney-yin when have long course of disease,or turn to CTD or MT.更多还原