体检人群中子宫肌瘤患者的脉象图与脉波图的研究

【作者】 苌丽静；

【导师】 梁嵘； 王召平；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2010， 硕士

【摘要】 1目的理论研究：比较脉象仪和脉波仪分析脉搏波的方法,发现两者的异同。临床研究：对子宫肌瘤组与非子宫肌瘤组的脉象、脉形、脉象图参数、脉波图参数、以及中医体质分布情况进行研究,探讨子宫肌瘤患者的脉象、脉形、脉象图参数、脉波图参数的特征,以及上述指标与体质的相关性,并为子宫肌瘤患者的体质调理提供脉诊依据。2方法研究对象为健康体检人群中的子宫肌瘤患者,采用病例对照的原则收集样本。以《中医体质问卷》的调查结果为依据,确定研究对象的体质类型。采集研究对象的脉象图和脉波图；分析脉象仪自动诊断的脉象；运用统计软件对所获得的脉象图、脉波图参数进行数据分析。3结果3.1理论研究通过对脉象仪和脉波仪的工作原理、分析方法和特征参数等进行分析比较,发现两者的异同。脉象仪是在中医脉象诊断的基础上,主要根据脉象的位、数、形、势确定所分析的参数,并在此基础上评价参数的意义,脉象的分析结果用于反映全身的整体状态。脉波仪是建立在西医物理学、解剖学的基础上,从心血管功能的角度来确定分析参数和评价参数的意义,脉搏波的分析结果主要用来评估循环系统的功能状态。3.2临床研究一子宫肌瘤患者的脉象图与脉波图的参数分析3.2.1子宫肌瘤患者的脉象分布特点根据脉象仪自动进行的脉名诊断,子宫肌瘤组与非子宫肌瘤组的脉象分布没有统计学差异,弦脉类脉象均占70%以上。弦脉无力是子宫肌瘤组各类复合脉中出现率最高的脉象。子宫肌瘤组的平弦脉和滑脉类脉象的出现率高于非子宫肌瘤组；子宫肌瘤组的弦缓脉、伏脉出现率低于非子宫肌瘤组。3.2.2子宫肌瘤患者脉象的脉形分布特征子宫肌瘤组与非子宫肌瘤组的脉形分布有统计学差异,表现为子宫肌瘤组abc脉形的出现率高于非子宫肌瘤组。3.2.3子宫肌瘤患者的脉象图参数与脉波图参数的特征子宫肌瘤组与非子宫肌瘤组的脉象图、脉波图参数比较有统计学差异。表现为子宫肌瘤组的h4、Ad、最佳压力、h4/h1、rAI、rAP的均值小于非子宫肌瘤组；h5、h5/h1的均值大于非子宫肌瘤组。3.3临床研究二不同体质的子宫肌瘤患者的脉象图与脉波图的参数分析3.3.1子宫肌瘤组与非子官肌瘤组的体质及脉象分布特征子宫肌瘤组与非子宫肌瘤组的体质分布有统计学差异。实性体质、特别是痰湿质在子宫肌瘤组中的出现率明显高于非子宫肌瘤组。子宫肌瘤组与非子宫肌瘤组的不同体质者的脉象分布无统计学差异。3.3.2不同体质的脉象图参数与脉波图参数的特征子宫肌瘤组中9种不同体质组的脉象图参数与脉波图参数比较具有统计学差异。特禀质组的脉率均值最大,气郁质组的脉率均值最小；痰湿质组的SBP、CASP的均值最大、湿热质组的SBP、CASP的均值最小。子宫肌瘤组的平和质组、虚性体质组、实性体质组的脉象图参数与脉波图参数比较具有统计学差异。脉率均值从大到小的排列顺序为：虚性体质组>实性体质组>平和质组。t均值排列顺序则正好相反。DBP均值从大到小的排列顺序为平和质组>实性体质组>虚性体质组。PR均值从大到小的排列顺序为虚性体质组>平和质组>实性体质组；rAI和rAP的均值从大到小的排列顺序都为实性体质组>平和质组>虚性体质组。比较子宫肌瘤患者的平和质组和阳虚质组的脉象图参数、脉波图参数。平和质组的SBP、DBP、MAP1、MAP2、CASP的均值大于阳虚质组；h4、h5、h5/h1、A/t、PR均值小于阳虚质组。3.3.3同体质的子宫肌瘤组与非子宫肌瘤组的脉象图参数与脉波图参数比较对子宫肌瘤组与非子宫肌瘤组中属同一体质类型的受试者的脉象图参数与脉波图参数进行比较,提示平和质组、阳虚质组、阴虚质组、气虚质组、湿热质组和痰湿质组的脉象图参数或脉波图参数具有统计学差异。4结语(1)脉象图与脉波图分析的理论基础不同,但测量的主要参数具有相似性。以子宫肌瘤的病例对照研究为例,所获得的脉象图和脉波图参数多表现为相同的倾向。(2)子宫肌瘤组的脉象图参数h1均值和脉波图参数PP均值、脉象图参数h3/h1均值和脉波图参数rAI均值均小于非子宫肌瘤组,其中两组rAI均值的比较有统计学差异。子宫肌瘤组的脉象图参数脉率均值和脉波图参数PR均值大于非子宫肌瘤组。(3)脉形、脉象图参数、脉波图参数的比较结果表明：与非子宫肌瘤组比较,子宫肌瘤组的血管弹性、顺应性增加、血管外周阻力减小(4)实性体质者、特别是痰湿质者患子宫肌瘤的几率明显高于平和质者和其它体质者。(5)子宫肌瘤患者的特禀质组脉率增快；虚性体质组的脉率也增快,特别是阳虚质组的脉率。(6)“痰湿”可以导致子宫肌瘤患者的SBP、CASP升高。与平和质组、实性体质组相比,子宫肌瘤患者虚性体质组的心脏收缩功能减弱；血管顺应性升高。(7)比较同体质类型的子宫肌瘤组与非子宫肌瘤组的脉象图参数与脉波图参数,发现平和质、阳虚质、阴虚质、气虚质、痰湿质、湿热质的子宫肌瘤组与非子宫肌瘤组的脉象图参数或脉波图参数存在差异。更多还原

【Abstract】 1 ObjectiveTheoretical Study: To compare the analysis methods of pulse diagnosis analytical instrument and pulse wave analytical instrument, finding the similarities and differences between them. Clinic Research: To study the pulse manifestation, pulse shape, pulse manifestation graph parameters, pulse wave graph parameters, and TCM constitution of uterine fibroids group and non-uterine fibroids group. Getting the characteristics of them and the correlation between the pulse manifestation graph parameters、pulse wave graph parameters and TCM constitution, provide pulse diagnosis reference to TCM constitution conditions for uterine fibroids patients.2 MethodsThe subjects were healthy checking people, collecting samples using case-control principle. Accord to the result of "Questionnaire about constitution of TCM ", define the constitution type of the subjects. Collecting and analyzing the pulse manifestation graph and pulse wave graph, and obtaining the information of the parameters of them. Analyze the data using statistical software.3 Results3.1 Theoretical StudyTo comparing the work principle and analysis method of the two instruments, and finding out the similarities and differences between them. Pulse diagnosis analytical instrument is built on the basis of pulse manifestation, and the parameters related to "Position. Pulse rate. Shape and Situation". On this basis, we evaluate the significance of parameters. The analysis results of pulse manifestation can reflect the overall state of the whole body. Pulse wave analytical instrument is built on the basis of physics and anatomy, from the perspective of cardiovascular function, to determine the significance of analyzing and evaluating the parameters.The analysis results is mainly used to assess the functional status of the circulatory system.3.2 Clinic Research OneTo analyze the parameters’characteristics of pulse manifestation graph and pulse wave graph in uterine fibroids patients.3.2.1 The pulse manifestation distribution characteristics of the uterine fibroids patientsAccording to the name of pulse manifestation which the Pulse diagnosis analytical instrument gives automatically, and there isn’t statistically significant about pulse manifestation distribution between the uterine fibroids group and the non-uterine fibroids group, and all kinds of wiry pulse account for more than 70%. The occurrence of weak-wiry pulse in the uterine fibroids group is the highest. But the occurrence of moral wiry pulse and slippery pulse sorts in the uterine fibroids group is higher than in the non-uterine fibroids group; the occurrence of wiry-moderate pulse and hidden pulse in the uterine fibroids group is lower than in the non-uterine fibroids group.3.2.2 The pulse shape distribution characteristics of the uterine fibroids patientsThere is statistically pulse shape significant between the uterine fibroids group and the non-uterine fibroids group. The difference is caused by abc-pulse shape. The occurrence of abc-pulse shape is higher in the uterine fibroids group.3.2.3 The parameters’ characteristics of pulse manifestation graph and pulse wave graph in uterine fibroids patientsThere is statistically significant about the parameters of pulse manifestation graph and pulse wave graph between the uterine fibroids group and the non-uterine fibroids group. The mean of h4、Ad、“最佳压力”、h4/h1、rAI、rAP is lower in the uterine fibroids group; the mean of h5、h5/h1 is higher in the uterine fibroids group.3.3 Clinic Research twoResearch on the parameters’ characteristics of pulse manifestation graph and pulse wave graph in uterine fibroids patients who have the different constitution3.3.1 The constitution and pulse manifestation distribution characteristics of the uterine fibroids group and the non-uterine fibroids groupThere is statistically constitution significant between the uterine fibroids group and the non-uterine fibroids group. The occurrence of phlegm-dampness constitution and excess constitution is higher in the uterine fibroids group. There isn’t statistically significant in pulse manifestation distribution between the two groups.3.3.2 The parameters’ characteristics of pulse manifestation graph and pulse wave graph in people who have different constitutionThere is statistically significant in the parameters of pulse manifestation graph and pulse wave graph in 9 kinds of constitution. The mean of pulse rate is the highest in special diathesis constitution group, and the Qi depression constitution group’s is the lowest. The mean of SBP and CASP is the highest in phlegm-dampness constitution group, and dampness-heat constitution group’s is the lowest.There is statistically significant in the parameters’ characteristics of pulse manifestation graph and pulse wave graph in gentleness constitution group、deficiency constitution group and excess constitution group. The order of rate mean from the highest to the lowest is deficiency constitution group> excess constitution group> gentleness constitution group. The order of t mean is opposite. The order of DBP mean from the highest to the lowest is gentleness constitution group> excess constitution group> deficiency constitution group. The order of PR mean from the highest to the lowest is deficiency constitution group> gentleness constitution group> excess constitution group. The order of rAI mean and rAP mean from the highest to the lowest is excess constitution group> gentleness constitution group> deficiency constitution group.To compare the parameters of pulse manifestation graph and pulse wave graph in gentleness constitution group and Yang deficiency constitution group. The mean of SBP、DBP、MAP1、MAP2、CASP in gentleness constitution group is higher than in Yang deficiency constitution group. The mean of h4、h5、h5/h1、A/t、PR in gentleness constitution group is lower than in Yang deficiency constitution group.3.3.4 The parameters of pulse manifestation graph and pulse wave graph in people who have the same constitutionTo compare the parameters of pulse manifestation graph and pulse wave graph in people who have the same constitution, we find that there is statistically significant in the parameters’ characteristics of pulse manifestation graph or pulse wave graph in gentleness constitution group、Yin deficiency constitution group、Yang deficiency constitution group Qi deficiency constitution group、dampness-heat constitution group and phlegm-dampness constitution group.4 Conclusions(1) The theoretical basis of pulse manifestation graph and pulse wave graph is different, but the main parameters measured are similar. In the case-control study of uterine fibroids, the pulse manifestation graph parameters and pulse wave graph parameters show the same tendency.(2)The pulse manifestation graph parameters h1、h3/hland pulse wave graph parameters PP、rAI of the uterine fibroids patients are lower,and the mean of rAI has statistically significantm in the two groups. The pulse manifestation graph parameters"脉率"and pulse wave graph parameters PR of the uterine fibroids patients group are higher.(3)To compare the pulse shape、the parameters of pulse manifestation graph and pulse wave graph in people, the result shows that the artery flexibility and the artery compliance increased, and the artery peripheral resistance decreased.(4) The excess constitution group is susceptible to have uterine fibroids, especially phlegm-dampness constitution.(5) The mean of pulse rate is the highest in special diathesis constitution group, and deficiency constitution group’s pulse rate is faster, especially Qi deficiency.(6) Phlegm-dampness constitution cause SBP, CASP’s increase. The deficiency constitution group’systolic function reduce, and vascular compliance increased.(7) To compare the parameters of pulse manifestation graph and pulse wave graph in people who have the same constitution, and we find that the difference is caused by gentleness constitution、Yang deficiency constitution、Qi deficiency constitution、dampness-heat constitution and phlegm-dampness constitution.更多还原