【作者】 姚丹霓；

【导师】 卢传坚；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2009， 硕士

【摘要】 目的:探讨寻常型银屑病患者中医体质类型与其病情严重程度的相关性,为临床辨识寻常型银屑病患者体质类型,并为临床用药治疗、调护预防等提供参考。方法:对195例符合寻常型银屑病诊断标准,年龄18-65周岁,有一定的阅读理解能力,愿意合作的住院及门诊患者进行皮损PASI评分、VAS评分,并行一般流行病学资料、加重诱发因素等问卷调查;让患者自填SDS量表、SAS量表进行心理状态调查,并将原始分转化为SDS标准分、SAS标准分;用王琦中医体质量表对患者的中医体质类型进行调查。分别将主客观指标(PASI评分、SAS标准分、SDS标准分)划分为严重组与非严重组进行统计分析,统计学方法包括秩和检验、卡方检验、方差分析以及非条件逐步多元Logistic回归分析、相关分析。结果:1.本研究中寻常型银屑病患者最常见的中医体质类型为平和质(21%)、阳虚质(18%)、阴虚质(14%)、气虚质(12%),阴虚质患者男性较女性为多,阳虚质为女性患者多见。体质分类在各年龄段差异无统计学意义(P＞0.05)。2.9种体质类型患者PASI评分以阴虚质的平均分及平均秩和均最高,但各体质类型间差异无统计学意义(χ~2=3.97,P=0.860＞0.05)。各体质类型与皮损严重程度间的单因素分析差异无统计学意义(P＞0.05)。经非条件逐步多元Logistic回归,各体质类型与皮损面积严重程度间无相关和回归关系存在。(χ~2=22.749,P=0.04＜0.05)。3.9种体质类型患者SDS标准分(P=0.011＜0.05)、SAS标准分(P=0.004＜0.05)差异均有统计学意义。平和质与气虚质、阳虚质、阴虚质、痰湿质、气郁质间SDS标准分及SAS标准分差异均有统计学意义(P＜0.05)。经非条件逐步多元Logistic回归分析,气虚质、阴虚质、气郁质是抑郁严重程度的可能危险因素(χ~2=18.43,P=0.031＜0.05);气虚质出现抑郁为非气虚质的5.705倍;阴虚质出现抑郁为非阴虚质的5.634倍;气郁质出现抑郁状态是非气郁质的3.645倍;非平和质可能是出现焦虑状态的危险因素(χ~2=15.331,P=0.000＜0.05),非平和质出现焦虑为平和质的7.050倍。4.PASI评分与SDS标准分、VAS评分等主观指标均呈正相关关系(P＜0.01),与SAS标准分呈正相关关系(P＜0.05);VAS评分与SAS标准分呈正相关关系(P＜0.05),与SDS标准分无相关关系存在(P＞0.05);SDS标准分与SAS标准分间存在正相关关系,且相关系数为0.764(P＜0.01)。结论:1.平和质、气虚质、阳虚质、阴虚质为本次研究寻常型银屑病患者中最常见中医体质类型。2.阴虚质可能为发病皮损面积较重的危险因素;气虚质、阴虚质、气郁质可能为出现抑郁状态的危险因素;非平和质可能是出现焦虑状态的危险因素。3.皮损面积越重,瘙痒、抑郁、焦虑程度越重;抑郁程度越严重,焦虑程度也越严重。更多还原

【Abstract】 Objective:To explore the relativity of TCM constitution in patients with Psoriasis Vulgaris and the severity of the disease for identificating TCM constitution type of patients with the disease and for their TCM therapy,prevention,such as preventive nursing.Methods:The 195 inpatients and outpatients from 18 to 65 full years old whose symptoms comformed to the diagnostic criteria for psoriasis vulgaris with a certain degree of reading comprehension,willingness to cooperate were chosen.We kept a record of lesions of the patients with PASI scores,VAS scores and made a questionare about basic epidemiological data such as risk factors.The patients filled in the SDS scale and the SAS scale,and we turned their outcomes into SDS standard scores and SAS standard scores.And they also filled in the "TCM Constitution Scale" based on the TCM Constitution which created by Professor WangQi to diagnose pateints’ TCM Constitution type.We divided the subjective and objective indicators(PASI scores,,SDS standard scores,SAS standard scores) separately into serious and non-serious groups,and made statistical analysis.SPSS13.0 for windows Chi-square test, Rank sum test,ANOVA test and multiple logistic regression analysis,Bivariate Correlations were used in this research..Results:1.The most common types of TCM constitution in Psoriasis vulgaris patients in the research were Ping he zhi(21%),Yang xu zhi(18%),Yin xu zhi(14%)and Qi xu zhi(12%).There were more Yin xu zhi men than women,and more yang xu zhi women than men.The ratios of the nine TCM constitution in different age groups showed no statistical significance(P＞0.05). 2.Yin xu zhi had the highest median and the highest median rank sum of PASI scores in the nine TCM constitution types,but the differences between various types are no statistical significance(χ~2=3.97,P= 0.860＞0.05). In Case-control study,we used different TCM constitution types as single-factor and made single-factor analysis between them and the severity of psoriasis lesions.However,there was no statistical significance (P＞0.05).The type differences of the nine TCM constitution between the severity of lesions were not significant(χ~2 = 22.749,P = 0.04＜0.05) by multiple Logistic regression analysis.3.The type differences of the nine TCM constitution between both SDS standard scores(P=0.011＜0.05) and SAS standard scores(P=0.004＜0.05) were significant.The differences between Ping he zhi and other types such as Qi xu zhi,Yang xu zhi,Yin xu zhi,Tan shi zhi and Qi yu zhi in both SDS standard scores and SAS standard scores were statistically significant(P＜0.05).Qi xu zhi,Yin xu zhi and Qi yu zhi might be risk factors of the severity of depression(χ~2 =18.43,P=0.031＜0.05).The OR made by Logistic regression releaved that the risk of Qi xu zhi effecting the the severity of depression was 5.705 times than that of the non-Qi xu zhi doing;The OR made by Logistic regression,releaved that the risk of Yin xu zhi effecting the the severity of depression was 5.634 times than that of the non-Yin xu zhi doing;The OR made by Logistic regression,releaved that the risk of Qi yu zhi effecting the the severity of depression was 3.645 times than that of the non-Qi yu zhi doing.Non Ping he zhi might be a risk factor of the severity of anxiety(χ~2 =15.331,P=0.000＜0.05).The OR made by Logistic regression,releaved that the risk of non-Ping he zhi effecting the the severity of anxiety was 7.050 times than that of the Ping he zhi doing.4.PASI scores and subject indicators such as SDS standard scores and VAS scores were highly positively interrelated(P＜0.01 for each combination). Statistically significant correlations were also found between PASI scores and SAS standard scores(P＜0.05).VAS scores were positively correlated with SAS standard scores(P＜0.05),but it failed to reach a correlation with SDS standard scores(P＞0.05).There was a significant positive interrelated between SDS standard scores and SAS standard scores with a correlation coefficient of 0.764(P＜0.01).Conclusion:1.The most common types of TCM constitution in Psoriasis vulgaris patients in the research were Ping he zhi,Yang xu zhi,Yin xu zhi and Qi xu zhi.2.Yin xu zhi may tend to be a risk factor of the severity of lesions;Qi xu zhi,Yin xu zhi and Qi yu zhi may tend to be risk factors of the severity of depression;Non Ping he zhi tend to be risk factor of the severity of anxiety.3.The more serious the lesions were,the more serious itching,depression and anxiety it would be.The more serious degree of depression patients got,the more serious degree of anxiety they would suffer.更多还原