【摘要】 目的观察经前焦虑性障碍(premenstrual dysphoric disorder,PMDD)患者中医症状及肝失疏泄证候分布特点、相关神经内分泌水平的变化。方法应用临床流行病学现况调查法对3 541名18~45岁女性门诊患者进行面访调查,根据《精神疾病诊断和统计手册》第4版(DSM-Ⅳ)筛查,对PMDD患者进行中医证候判别,并对其主证及常见证的中医症状进行积分比较,检测其血清五羟色胺(5-hydroxytryptamine,5-HT)、促肾上腺皮质激素(adrenocor ticotropic hormone,ACTH)、血管紧张素Ⅱ(angiotensin-Ⅱ,Ang-Ⅱ)、糖皮质激素(glucocorticoid,GC)、同型半胱氨酸(homocysteine,Hcy)、褪黑素(melatonin,MLT)、一氧化氮(nitrogen monoxide,NO)、神经肽Y(neuropeptide Y,NPY)8种神经内分泌指标的含量。结果本次调查在3 541名18~45岁的女性共发现PMDD患者258例,其中PMDD主证与常见证为肝气逆证和肝气郁证,分别占40.3%(104/258)与34.9%(90/258)。其余5证候为肝郁脾虚、肝郁血瘀、肝郁化火、肝郁肾虚和脾肾阳虚,分别为7.8%(20/258)、7.4%(19/258)、6.2%(16/258)、3.1%(8/258)和0.4%(1/258)。与肝气逆证比较,肝气郁证的主症为情志抑郁和情绪低落,该两项症状得分升高(P<0.05);与肝气郁证比较,肝气逆证的主症为急躁易怒、心烦、小腹坠胀、焦虑、头晕、头痛、失眠、头胀、口苦和目昏共10项,该10项症状得分升高(P<0.05)。与肝气郁证比较,肝气逆证Hcy水平明显降低,差异有统计意义(P<0.05)。其余各项指标比较,差异均无统计学意义(P>0.05)。结论 PMDD与肝失疏泄密切相关,肝气逆、郁两证确有不同的科学内涵及生物学基础,"调肝"应为临床治疗首选之法。更多还原

【Abstract】 Objective To observe the changes of Chinese medicine( CM) symptoms,the distribution characteristics of CM syndromes,and related neuroendocrine levels in premenstrual dysphoric disorder( PMDD) patients.Methods Totally 3 5 4 1 female outpatients( 1 8- 4 5 years old) were interviewed by clinical epidemiological questionnaire. According to PMDD diagnostic criteria in DSM-Ⅳ,PMDD patients’ CM syndromes were identified.Their scores of main symptoms and CM symptoms of common CM syndromes were compared. Contents of 8 neuroendocrine indicators in serum were detected [5-hydroxytryptamine( 5-HT),adrenocorticotropic hormore( ACTH),angiotensin-Ⅱ( Ang-Ⅱ),glucocorticoid( GC),homocysteine( Hcy),melatonin( MLT),nitrogen monoxide( NO),neuropeptide Y( NPY) ]. Results Totally 258 PMDD were detected in 3 541 female outpatients( 18-4 5 years old). The main syndrome and common syndromes of PMDD patients were reversed invasion of Gan qi syndrome [4 0. 3 %( 1 0 4/2 5 8) ] and stagnation of Gan qi syndrome [3 4. 9 %( 9 0/2 5 8) ],followed by Gan stagnation Pi deficiency syndrome [7. 8 %( 2 0/2 5 8) ],Gan stagnation blood stasis syndrome [7. 4 %( 1 9/2 5 8) ],Gan stagnation induced fire hyperactivity syndrome [6. 2 %( 1 6/2 5 8) ], Gan stagnation Shen deficiency syndrome[3. 1 %( 8/258) ],and Pi-Shen yang deficiency syndrome [0. 4 %( 1/258) ]. Compared with reversed invasion of Gan qi syndrome,emotional depression and low spirits were main symptoms of stagnation of Gan qi syndrome.Scores for the two symptoms increased( P < 0. 0 5). Compared with stagnation of Gan qi syndrome,irritability,upset,abdominal distension,anxiety,headache,dizziness,insomnia,head distension,bitter mouth,unclear vision were main symptoms of reversed invasion of Gan qi syndrome. Scores for the 1 0 symptoms increased( P < 0. 0 5).Compared with stagnation of Gan qi syndrome,the Hcy level in serum obviously decreased in reversed invasion of Gan qi syndrome( P < 0. 0 5). There was no statistical difference in the rest indices( P > 0. 0 5). Conclusions PMDD is closely related to Gan failing to maintain normal flow of qi. Reversed invasion of Gan qi syndrome and stagnation of Gan qi syndrome have different scientific connotations and biological bases. So regulating Gan should be considered as the first choice.更多还原