【摘要】 目的探讨子宫内膜异位症(简称"内异症")证型分布规律及证候特点。方法采用多中心、大样本流行病学调查研究,纳入内异症患者1918例,设计"子宫内膜异位症中医证候临床流行病学调查表",包括一般资料、月经情况及中医临床症状体征、舌象,建立Excel数据库,运用SPSS 22.0软件进行频数统计分析。通过因子分析提炼内异症的中医证候要素(包括病性要素和病位要素);运用聚类方法总结内异症主要中医证型及分布规律。结果共纳入内异症患者四诊信息中有意义的条目85项,其中月经情况表现为经行血块量多或瘀阻不畅,月经时间延长且伴随经行腹痛,并易伴有经行或经前胸胁乳房胀痛,带下色白量多。排名前10位的症状和体征为神疲肢倦、腰膝酸软、急躁易怒、畏寒肢冷、少气懒言、喜热饮、多梦、少寐易醒、面色萎黄、口干。构成比>10%的舌象指标有10项,包括苔白、苔薄、舌淡红、舌红、舌淡暗、苔厚、舌无苔、舌暗红、苔黄、舌边有齿痕。对85项四诊信息进行因子分子可得病位证素为胞宫、肝、肾、脾、胃;病性证素为痰、饮、湿、热、火、寒、气滞、血瘀、阴虚、阳虚、血虚、气虚。聚类分析提示内异症可拟定为5种证型分别为寒凝气滞血瘀证(34.1%)、湿热血瘀证(20.0%)、肝郁肾虚血瘀证(19.0%)、痰湿血瘀证(16.4%)、气虚血瘀证(10.5%)。结论子宫内膜异位症病机复杂,多为虚实夹杂,主要证型为寒凝气滞血瘀证、湿热血瘀证、肝郁肾虚血瘀证、痰湿血瘀证及气虚血瘀证。更多还原

【Abstract】 Objective To clarify the distribution law and the characteristics of traditional Chinese medicine(TCM) syndromes of endometriosis.Methods A large sample multi-center epidemiological survey was conducted in 1918 endometriosis patients with a self-made "Clinical Epidemiological Survey Questionnaire of TCM Syndromes of Endometriosis".The collected data included general information,menstrual condition,TCM syndromes and symptoms and tongue manifestation,based on which an Excel database was conducted.The SPSS 22.0 software was used for frequency analysis;factor analysis was performed to extract the TCM syndrome elements of endometriosis including nature and location of disease;cluster analysis was used to summarize the main TCM syndrome types and distribution rules of endometriosis.Results A total of 85 meaningful items related to the four examinations of endometriosis were included;menstruation-related items were inhibited menstruation or large menstrual clots,prolonged menstruation with abdominal pain during menstruation,distending pain of the breasts during and before menstruation,and large amount of white leukorrhea.The top ten symptoms were mental and limbs fatigue,sore and weak loins and knees,impatience and irritability,fear of cold with cold limbs,weak breathing and want of speech,preferring hot drinks,profuse dreaming,less sleep and waking up easily,sallow yellow complexion,and dry mouth.The top ten(frequency>10%) tongue manifestations were white coating,thin coating,light red tongue,red tongue,pale dusky tongue,thick coating,mirror-like tongue,black red tongue,yellow coating and teeth-marked tongue.Factor analysis showed that the syndrome elements related to location of disease were uterus,liver,kidney,spleen,and stomach;syndrome elements related to nature of disease were phlegm,rheum,dampness,heat,fire,cold,qi stagnation,blood stasis,yin deficiency,yang deficiency,blood deficiency,and qi deficiency.Cluster analysis suggested that endometriosis can be divided into five syndrome types,namely,qi stagnation and blood stasis due to congealing cold syndrome(34.1%),damp-heat and blood stasis syndrome(20.0%),liver constraint,kidney deficiency and blood stasis syndrome(19.0%),phlegm,dampness and blood stasis syndrome(16.4%),qi deficiency and blood stasis syndrome(10.5%).Conclusion The pathogenesis of endometriosis is complicated,mostly with deficiency-excess complex.The main type include ⅰ) qi stagnation and blood stasis due to congealing cold syndrome,ⅱ) damp-heat and blood stasis syndrome,ⅲ) liver constraint,kidney deficiency and blood stasis syndrome,ⅳ) phlegm,dampness and blood stasis syndrome,and ⅴ) qi deficiency and blood stasis syndrome.更多还原