子宫内膜异位症中医证候及相关因素初探

【作者】 刘敏；

【导师】 王阿丽；

【作者基本信息】 北京中医药大学 ， 中医妇科学， 2009， 硕士

【摘要】 子宫内膜异位症的中医辨证没有统一的标准和依据,证候分型种类繁多,缺乏规范的分型论治,而证候是临床立法处方的根本依据,辩证准确与否直接关系到临床疗效,目前有关内异症证候研究的文献报道较少,在CNKI(中国全文期刊数据库)查找近30年的文献报道,仅有1篇文章从文献分析的角度去探寻子宫内膜异位症的证候分布规律,因此,对子宫内膜异位症进行证候学研究,掌握病变人群的证候特点及分布规律,有助于我们更好的把握疾病的本质,提高临床疗效,并为以后分型论治规范化研究奠定基础。方法:以证候学研究为核心,采用临床流行病学的设计方法,制定统一的调查表对患者一般情况、部分相关危险因素以及中医辨证所需的四诊资料进行证候调查,将所有信息资料输机进行统计分析。结果:1.相关因素:本次调查患者年龄在20～51岁之间,发病年龄有年轻化的趋势;患者主要以脑力劳动者居多;68.3%的患者感到不同程度生活压力;80.6%的患者情志变化比较明显;嗜食辛辣者所占比例较高占4 1.8%;57.1%的患者表示几乎不怎么运动;9.2%的人体重指数低于正常低限,15.3%的体重指数高于正常高限;初潮年龄≤12y者占25.5%,初潮年龄≥15y者占28.6%;86例非子宫切除患者中经期延长占3.5%,月经量多者占16.3%,周期延长者占8.2%,痛经者占68.4%,不孕者占17.4%;有流产史者占有性生活妇女的52.3%,宫内节育器者占20.5%,合并子宫畸形占2.0%,合并其他系统疾病史者占14.3%,合并有腺肌症者占33.7%;82例手术患者有1次以上巧囊手术史者占11.2%,附件合并有其他病理改变者占14.6%。2.证候特点:以畏寒肢冷、经行腹痛、气短乏力、急躁易怒、腰酸、经前乳胀、血块量多、小腹坠胀出现频次较高,均在40次以上。辨证分型主要分为以下5型:寒凝血瘀型(54.0%)、痰瘀互结型(25.5%),气滞血瘀(12.4%)、肾虚血瘀(6.1%),湿瘀化热型(2.0%)。结论:子宫内膜异位症的病位主要在冲任胞脉,涉及肝、脾、肾,血瘀为本病的基本病机,亦有夹湿、夹郁、夹痰、夹虚的特点,病性以虚实夹杂多见;中医辨证以复合证型多见,以兼寒湿、气滞、气虚为多,分型主要以寒凝血瘀型最多见,其次为痰瘀互结型;痰瘀互结型多见于年龄≥40岁以上者;重度痛经者主要集中在寒凝血瘀组及痰瘀互结组;形体过于肥胖、不良情绪、劳逸失节可能是本病的危险因素。更多还原

【Abstract】 Objective:To study the syndrome of endometriosis and master lesion syndrome characteristics and distribution of EMs patients,will help us better grasp the nature of the disease and improve clinical efficacy,and lay a basis for the standardization of endometriosis syndrome differentiation.Methods:Unified questionnaires with normal information,and some related risk factors,as well as TCM four diagnostic information necessary were made to conduct the investigation Syndrome,then input the information for statistical analysis.Results:1.Relevant factors:In this survey patients aged from 20 to 51 years old, showing a tendency to younger age;patients mainly mental workers;68.3% patients felt the pressure of life;80.6%of patients with obvious emotional changes; 57.1%patients seldom do exercise;9.2%with low body index,15.3%with high body index;menarche age≤12y accounted for 25.5%,menarche age≥15y accounted for 28.6%;Of the 86 non-hysterectomy patients,3.5%patients have extend period, 16.3%with more menstrual quantity,68.4%have dysmenorrhea;Of 98 patients, 17.4%sterility,52.3%have history of abortion,IUD accounted for 20.5%,2.0% patients with uterine malformation,the history of other diseases accounted for 14.3%,33.7%patients with adenomyosis;patients with more than 1 surgeries accounted for 11.2%,with other pathological changes accounted for 14.6%.2.Syndrome characteristic:The limbs chill,abdominal pain,shortness of breath,irritability,lumbar acid,premenstral distension of breast,blood clots,abdomen distension,which all occur more than 40 times;Syndrome differentiations are as follows:blood stasis due to cold(52.0%),phlegm and blood stasis(25.5%),blood stasis due to Qi stagnation(12.2%),blood stasis due to kidney deficiency(6.1%), blood stasis due to wet and heat(2.0%).Conclusion:Blood stasis in the disease as the main pathological change,but dampness,Qi stagnation and weakness also contribute to the development of this disease;Endometriosis syndrome differentiation based mainly to blood stasis due to cold,phlegm and blood stasis comes second;severe dysmenorrhea were mainly concentrated in the Blood stasis due to cold and Phlegm and blood stasis group; phlegm and blood stasis type was particularly prevalent in the age of more than 40-year-old.obesity and bad feelings,imbalance of work and rest,repeated obortion may be risks of this disease.更多还原