【作者】 姜德；

【导师】 周铭心；

【作者基本信息】 新疆医科大学 ， 药理学， 2011， 博士

【摘要】 西北燥证不是一种独立疾病,而是一组以口鼻、咽喉、肌肤干燥和干咳、烦躁等各种不适症状为特征的一组中医证候。西北燥证的证候包括1个主证和5个兼证。其主证是肺卫孔窍皮肤燥证,兼证为肝肾精血不足证、肺心脾风火燥证、心肾阴虚证、脾胃阴虚证、脾胃蕴湿证。孔窍类疾病是指在目、口、鼻、咽喉等部位发生病变的疾病,皮肤类疾病是指在面部皮肤、全身皮肤等部位发生病变的疾病。本文是探讨西北燥证与孔窍、皮肤类疾病相关性的研究。研究目的：探讨新疆和田、吐鲁番、哈密、乌鲁木齐等不同地区孔窍类、皮肤类疾病与西北燥证的罹患关系,分析二者之间病因病机和临床表现方面的相关性,以便为该两类疾病的异病同治防治提供理论依据。研究内容与方法：对2004年已经调查的和田地区2844例西北燥证流行病学资料进行挖掘分析。同时应用临床流行病学病例对照研究方法对新疆哈密地区3家医院、吐鲁番地区4家医院和乌鲁木齐地区3家医院的慢性鼻炎、慢性咽炎、慢性结膜炎等孔窍类疾病和慢性荨麻疹、皮肤瘙痒症等皮肤类疾病患者及作为对照的无相关疾病的城乡健康居民(在年龄、性别、民族等方面无显著性差别)的西北燥证罹患情况及西北燥证主兼证的证候情况进行问卷调查及评价,并探讨西北燥证对孔窍、皮肤类疾病的西医病情、中医证候的影响及燥证证情影响程度。调查资料数据的录入通过EPIDATA3.0完成,数据录入完毕,再随机抽取20%的问卷进行复核,同时利用相关统计软件检查录入的一致性,最终形成课题研究的分析数据库。在数据统计分析过程中使用SPSS16.0统计软件进行一般统计分析,如t检验、方差分析等,同时使用聚类分析等多元统计方法。本文使用了西医病情积分、西医病情指数、西北燥证主兼证燥证积分、燥证证情指数、中医证候证情贡献系数、证情积分、中医证候病情贡献系数、病情积分等诸多统计量指标。并运用传统的中医理论对西北燥证与孔窍、皮肤类疾病的关系加以合理的解释。结果：和田地区孔窍、皮肤类疾病西北燥证罹患率分别为56.07%和56.25%,均高于对照组的12.97%和12.50%(P<0.01)。西北燥证对慢性鼻炎、慢性咽炎、口腔溃疡、慢性荨麻疹、皮肤瘙痒症之相对危险度分析结果,OR值分别为3.18、2.63、4.23、3.51和3.48。将和田地区孔窍、皮肤类疾病的患者与对照组健康人群进行西北燥证主兼证燥证积分、燥证证情指数比较,结果显示,在临床证候表现上西北燥证主证和5个兼证均可见到。其中孔窍类疾病西北燥证主证与5个兼证的证情指数分别为0.31、0.28、0.22、0.33、0.23和0.15,均≥0.15且<0.35,为中度燥证；皮肤类疾病中脾胃蕴湿证的证情指数为0.14,<0.15,为轻度燥证,其余证候分别为0.30、0.29、0.26、0.33和0.22,均≥0.15且<0.35,为中度燥证。吐鲁番、哈密、乌鲁木齐3地区孔窍、皮肤类疾病西北燥证罹患率分别为62.97%和48.82%均高于对照组的14.69%和14.96%(P<0.01)。将它们之间进行西北燥证主兼证燥证积分、燥证证情指数比较,结果显示,孔窍类疾病临床证候以西北燥证主证和兼证肺心脾风火燥证为多见。其中西北燥证主证证情指数为0.31,>0.15,为中度燥证；肺心脾风火燥证的证情指数为0.12,<0.15,为轻度燥证。在孔窍类疾病患者中,西北燥证罹患者与非罹患者的西医病情积分和病情指数比较有显著差异(P<0.01)。皮肤类疾病临床证候以西北燥证主证、肺心脾风火燥证、心肾阴虚证、脾胃阴虚证和脾胃蕴湿证为多见,肝肾精血不足证则不常见。其中西北燥证主证和4个兼证证情指数分别为0.23、0.18、0.29、0.20和0.16,均>0.15,为中度燥证。皮肤类疾病燥证证情指数高于孔窍类疾病,说明前者西北燥证较后者严重。在皮肤类疾病患者中,西北燥证罹患者与非罹患者的西医病情积分和病情指数比较无显著差异(P>0.05)。三地区两类疾病所涉及各病的具体情况如下。慢性鼻炎患者西北燥证罹患率为47.50%高于对照组15.00%(P<0.01),西北燥证的临床证候以主证和兼证肺心脾风火燥证为多见。慢性鼻炎西北燥证罹患者与非罹患者西医病情积分、病情指数比较有显著性差异(P<0.01)。聚类分析,肺心脾风火燥证与慢性鼻炎证候关联性最强。慢性咽炎患者西北燥证罹患率为72.02%高于对照组15.69%(P<0.01),西北燥证的临床证候以主证为多见。西北燥证罹患者与非罹患者西医病情积分、病情指数比较有显著性差异(P<0.01)。聚类分析,西北燥证主证与慢性咽炎证候关联性最强。慢性结膜炎患者西北燥证罹患率为63.01%高于对照组18.70%(P<0.01),西北燥证的临床证候以主证、肝肾精血不足证和肺心脾风火燥证为多见。西北燥证罹患者与非罹患者西医病情积分、病情指数比较无显著性差异(P>0.05)。聚类分析,肝肾精血不足证与慢性结膜炎证候关联性最强,其次为西北燥证主证,再次为肺心脾风火燥证。慢性荨麻疹患者西北燥证罹患率为49.20%高于对照组16.34%(P<0.01),西北燥证临床证候以主证和5个兼证均可见到。西北燥证罹患者与非罹患者西医病情积分、病情指数比较无显著性差异(P>0.05)。聚类分析,西北燥证肺心脾风火燥证与慢性荨麻疹证候关联性最强。皮肤瘙痒症患者西北燥证罹患率为48.68%高于对照组23.03%(P<0.01),西北燥证的临床证候表现以主证和肺心脾风火燥证、心肾阴虚证、脾胃阴虚证为多见。西北燥证罹患者与非罹患者西医病情积分、病情指数比较无显著性差异(P>0.05)。聚类分析,西北燥证脾胃阴虚证、脾胃蕴湿证、肺心脾风火燥证与皮肤瘙痒症证候关联性强。结论：1.西北燥证罹患者之孔窍、皮肤类疾病的患病率高于非罹患者,西北燥证是孔窍、皮肤类疾病的重要危险因素。2.孔窍类与皮肤类疾病患者罹患西北燥证主证和兼证的证候结构各不相同,其中孔窍类疾病以西北燥证主证和肺心脾风火燥证为多见,其他兼证均不突出,皮肤类疾病则除上述两证外,心肾阴虚证、脾胃阴虚证和脾胃蕴湿证亦较多见,只有肝肾精血不足证少见。3.在孔窍类疾病病人中西北燥证罹患者的病情重于非罹患者,这种关系主要体现于慢性鼻炎和慢性咽炎患者之中；而在皮肤类疾病中,无论是慢性荨麻疹病人,或皮肤瘙痒症病人,其病情轻重在西北燥证罹患者与非罹患者之间无显著差异。4.西北燥证不但影响孔窍、皮肤类疾病的病情,更对两类疾病的中医证侯证情产生程度不同的影响。更多还原

【Abstract】 The Northwest Dryness Syndrome is not an independent entity, but a group of TCM syndrome characterized by dry oronasal, skin and throat, tussiculation and other uncomfortable symptoms. The Northwest Dryness Syndrome includes one main syndrome and five accompanying syndromes. The main symptom is Lung, skin and opening of the body dryness syndrome, accompanying syndromes are deficiencies of essence and blood of the liver and the kidney syndrome, the lung and heart wind-fire pathogen syndrome, yin deficienties of the heart and kidney syndrome, yin deficiencies of the lien and stomach syndrome and endogenous dampness syndrome. Opening of the body disease is pathological change in eye, mouth, nasal, throat, etc. Skin disease is pathological change in facial skin, whole skin, etc. This paper discusses correlation between the Northwest Dryness Syndrome and skin and opening of the body disease.Objective:Discuss attack rate correlation between the Northwest Dryness Syndrome and skin and opening of the body disease in Khotan, Turpan, Kami, Urumchi, Xinjiang. Analyse correlativity in etiology and pathogenesis and clinical manifestation between them. Provide theoretical basis for the prevention and cure of same treatment for different diseases of the two kinds of disease. Contents and Methods:Analyse epidemiology data based upon2844patients of the Northwest Dryness Syndrome that we have investigated in Khotan Region in2004. Applied clinical epidemiology Case-control study method, survey patients with opening of the body disease such as chronic rhinitis, chronic pharyngitis, chronic conjunctivitis etc. and skin disease such as chronic urticaria, cutaneous pruritus etc. by questionnaires about prevalence of the Northwest Dryness Syndrome and main syndrome and accompanying syndrome of the Northwest Dryness Syndrome in3hospitals in Kami Region,4hospitals in Turpan Region and3hospitals in Urumchi Region, and healthy urban and rural residents (no significant difference in age, sex, ethnic etc.) as control, then assess the date collected. Furthermore explore influence of disease condition and TCM syndrome, influence degree of dryness syndrome of skin and opening of the body disease to the Northwest Dryness Syndrome. The survey data was inputted through EPIDATA3.0, after that, another20%of the questionnaires were picked for random check, and checked the consistency of the data by relevant statistical software. Then, the final analysis research database was completely formed. In the process of statistical analysis, we used SPSS16.0statistical software for general statistical analysis such as t-test, ANOVA, while using of cluster analysis other multivariate statistical methods. In this paper, we used statistics indicator such as disease condition integral, disease condition index, main syndrome and accompanying syndrome of the Northwest Dryness Syndrome integral, dryness syndrome index, TCM syndrome contribution coefficient, TCM syndrome index. And applied TCM theory to give reasonable explanations about correlativity between the Northwest Dryness Syndrome and skin and opening of the body disease.Results:The Northwest Dryness Syndrome attack rates were56.07%and56.25%respectively in patients suffered opening of the body disease and skin disease in Khotan Region, both is higher than the control group with attack rates12.97%and12.50%(P<0.01). The relative risk (OR) of chronic rhinitis, chronic pharyngitis, oral ulcer, chronic urticaria, cutaneous pruritus caused by the Northwest Dryness Syndrome were3.18,2.63,4.23,3.51and3.48respectively. Compared main syndrome and accompanying syndrome of the Northwest Dryness Syndrome integral, dryness syndrome index of patients with skin and opening of the body disease with control group, the results showed that one main syndrome and five accompanying syndromes were encountered in clinical syndrome. Thereinto, dryness syndrome index of opening of the body disease with main syndrome and five accompanying syndromes of the Northwest Dryness Syndrome were0.31,0.28,0.22,0.33,0.23and0.15, all were greater than or equal to0.15, and less than0.35, they were moderate dryness syndrome; dryness syndrome index of skin disease with endogenous dampness syndrome was0.14, less than0.15, it’s slight dryness syndrome, the other dryness syndrome index of skin disease were0.30,0.29,0.26,0.33and0.22, all were over0.15, and less than0.35, they were moderate dryness syndromes.The Northwest Dryness Syndrome attack rates were62.97%and48.82%respectively in patients suffered opening of the body disease and skin disease in Turpan Region, Kami Region, Urumchi Region, both were higher than the control group with attack rates14.69%,14.96%(P<0.01). Compared main syndrome and accompanying syndrome of the Northwest Dryness Syndrome integral, dryness syndrome index with each other, the results showed that opening of the body disease with the main syndrome and the lung and heart wind-fire pathogen syndrome were frequent in clinical syndrome. Thereinto, main syndrome of the Northwest Dryness Syndrome index was0.31, over0.15, it’s moderate dryness syndrome; the lung and heart wind-fire pathogen syndrome index was0.15, less than0.15, it’s slight dryness syndrome. In patients of opening of the body disease, there were significant differences (P<0.01) on disease condition integral and disease condition index among patients with the Northwest Dryness Syndrome and control group. The main syndrome of the Northwest Dryness Syndrome, the lung and heart wind-fire pathogen syndrome, yin deficienties of the heart and kidney syndrome, yin deficiencies of the lien and stomach syndrome and endogenous dampness syndrome were frequent in clinical syndrome of skin disease, deficiencies of essence and blood of the liver and the kidney syndrome was infrequent. The main syndrome and four accompanying syndromes dryness syndrome index were0.23,0.18,0.29,0.20and0.16respectively, all were over0.15, they were moderate dryness syndromes. dryness syndrome index of skin disease was higher than that of opening of the body disease, the results show that the Northwest Dryness Syndrome of the former was more serious than latter. In patients of skin disease, there were no significant differences (P>0.05) on disease condition integral and disease condition index among patients with the Northwest Dryness Syndrome and control group.The concrete conditions of all syndromes involved by the two kinds of disease in the three regions as follows. The Northwest Dryness Syndrome attack rate was47.50%among patients of chronic rhinitis, it’s higher than control group with attack rate15%(P <0.01), the main syndrome and the lung and heart wind-fire pathogen syndrome were frequent in clinical syndrome among the Northwest Dryness Syndrome. There were significant differences (P<0.01) on disease condition integral and disease condition index among patients of chronic rhinitis with the Northwest Dryness Syndrome and control group. The lung and heart wind-fire pathogen syndrome correlated with chronic rhinitis most in cluster analysis. The Northwest Dryness Syndrome attack rate was72.02%among patients of chronic pharyngitis, it’s higher than control group with attack rate15.69%(P<0.01), the main syndrome was frequent in clinical syndrome among the Northwest Dryness Syndrome. There were significant differences (P<0.01) on disease condition integral and disease condition index among patients of chronic pharyngitis with the Northwest Dryness Syndrome and control group. The main syndrome correlated with chronic pharyngitis most in cluster analysis.The Northwest Dryness Syndrome attack rate was63.01%among patients of chronic conjunctivitis, it’s higher than control group with attack rate18.70%(P<0.01), the main syndrome were frequent in clinical syndrome among the Northwest Dryness Syndrome. There were no significant differences (P>0.05) on disease condition integral and disease condition index among patients of chronic conjunctivitis with the Northwest Dryness Syndrome and control group. Deficiencies of essence and blood of the liver and the kidney syndrome correlated with chronic conjunctivitis most in cluster analysis, secondly it’s main syndrome, and the next was lung and heart wind-fire pathogen syndrome.The Northwest Dryness Syndrome attack rate was49.20%among patients of chronic urticaria, it’s higher than control group with attack rate16.34%(P<0.01), the main syndrome and five accompanying syndromes were encountered in clinical syndrome among the Northwest Dryness Syndrome. There were no significant differences (P>0.05) on disease condition integral and disease condition index among patients of chronic urticaria with the Northwest Dryness Syndrome and control group. The lung and heart wind-fire pathogen syndrome correlated with chronic urticaria most in cluster analysis.The Northwest Dryness Syndrome attack rate was48.68%among patients of cutaneous pruritus, it’s higher than control group with attack rate23.03%(P<0.01), the main syndrome and the lung and heart wind-fire pathogen syndrome, yin deficienties of the heart and kidney syndrome and yin deficiencies of the lien and stomach syndrome were frequent in clinical syndrome among the Northwest Dryness Syndrome. There were no significant differences (P>0.05) on disease condition integral and disease condition index among patients of cutaneous pruritus with the Northwest Dryness Syndrome and control group. Yin deficiencies of the lien and stomach syndrome, endogenous dampness syndrome and the lung and heart wind-fire pathogen syndrome correlated with cutaneous pruritus strong in cluster analysis. Conclusion:1. Opening of the body disease and skin disease attack rates are higher in people with the Northwest Dryness Syndrome than control group, the Northwest Dryness Syndrome is important risk factor for skin and opening of the body disease.2. Main syndrome and accompanying syndromes of the Northwest Dryness Syndrome are different from each other in patients of opening of the body disease and skin disease. Thereinto, main syndrome and the lung and heart wind-fire pathogen syndrome are frequent in opening of the body disease, the other accompanying syndromes are not prominent; besides the above two syndromes, yin deficienties of the heart and kidney syndrome, yin deficiencies of the lien and stomach syndrome and endogenous dampness syndrome are also common in skin disease, only deficiencies of essence and blood of the liver and the kidney syndrome is infrequent.3. Disease condition with the Northwest Dryness Syndrome is more serious than non dryness syndrome among patients of opening of the body disease, this relationship is mainly embodied in chronic rhinitis and chronic pharyngitis; but there are no significant differences between disease condition with the Northwest Dryness Syndrome and non dryness syndrome among patients of skin disease either chronic urticaria or cutaneous pruritus.4. The Northwest Dryness Syndrome is not only influences disease condition of skin and opening of the body disease, but also impacts TCM syndrome of two kinds of disease in different degree.更多还原