【作者】 莫传伟；

【导师】 陈群；

【作者基本信息】 广州中医药大学 ， 中医诊断学， 2005， 博士

【摘要】 目的 目前中医界有关绝经后骨质疏松症(PMOP)的临床试验主要着眼于症状改善和实验室指标等方面,极少采用功能和生存质量层次的指标;而且缺少合适的中医证候疗效评定标准,不利于合理地判断以“辨证论治”为主的中医药治疗干预措施的有效性。本研究即是在上述指导思想下,尝试通过应用临床流行病学研究方法,以期更科学、更准确地反映中医药防治疾病所具有的真正效能。本课题采用横断面调查方法,对社区绝经后妇女的中医证候规律及生存质量进行了较为深入的研究。探讨了PMOP的中医病机、基本中医证候特征、生存质量及其评价,为临床应用提供具有重要实践价值的基础性研究,填补了国内空白,并对中医证型组合特点作了初步分析,尝试寻找绝经后骨质疏松症的中医证型分布及组合规律,为该病的辨证施治和优化中药复方组合提供理论依据。 方法 本课题共对227名广州市社区绝经后妇女进行腰椎(L1—L4)双能X线骨扫描测定骨密度,并完成中医征候调查表和SF—36生存质量调查表。用SPSS12.0,SAS9.0,STATA8.2,GraphPad Prism 4.03统计软件进行统计学分析处理与统计图制作。 结果 全组绝经后的社区妇女骨质疏松症的患病率为57.26%。与文献报道老年人群中该病的发病率为59.6%基本一致。中医证候的调查中发现,全组绝经后妇女中医辨证各证候的患病率(%)顺位按从高到低排列如下:肾虚证(92.5%)、心虚症(68.7%)、肝虚证(55.1%)、痹证(50.7%)、气虚证(26.0%)、阴虚证(23.8%)、血瘀证(18.1%)、阳虚证(15.9%)、肺虚证(14.1%)、脾虚证(7.9%)、痰证(7.9%)、更多还原

【Abstract】 ObjectivesThe clinic trials relating to women with postmenopausal osteoporosis (PMOP) in Traditional Chinese Medicine (TCM) fields in domestic mainly stressed on laboratory indexes and improvement of symptoms, while indexes of function and quality of life seldom used, and lacking of appropriate effectiveness assessment criteria of TCM syndrome, which went against the proper assessments of TCM inventions based on the theory of "Treating on Differentiation of TCM Syndrome". This study is directed under the above ideas and expected to construct a scientific system of outcome assessment indexes of PMOP with strictly approved validity and reliability including indexes of conventional clinical outcomes, assessments of TCM syndrome related indicators and quality of life(QOL), which was carried out through systematic evaluations of commonly used indexes under the constructions of principles of Clinical. This study made a deep research into both the Basic Traditional Chinese Medicine (TCM) syndromes of the PMOP patients and their QOL, by using cross-sectional study. This study tries to find out both the pathogenesis and characteristics of clinical TCM syndromes of the PMOP patients and their QOL, and hopes to provide important research foundations for clinical applications. The study was the first time to survey and evaluate both the Traditional Chinese Medicine (TCM) syndrome of the syndrome and QOL in women with PMOP and make up the domestic deficit. At the same time in the studythe syndrome was initial analysis. The aim is to try to search the law of distribution and constitution of the TCM syndrome of PMOP, while to provide a theoretical evidence of "diagnosis and treatment base on an overall analysis of the illness and the patient’s condition" and to optimize the composition of the compound of Chinese herbs.MethodsThe 227 postmenopausal women in resident were bone-scanned in lumber vertebra to measure the bone mineral density. They have finished TCM syndrome questionnaire and the Health Survey Questionnaire (Short form 36) QOL survey questionnaire. Making and analyzing statistically the datum is in virtue of the software about SPSS 12.0 , SAS9.0, STATA8.2, and GraphPad Prism 4.03.ResultsThe prevalence ofosteoporosis (OP) in these women is 57.26%. it is similar as the common people in documents. In the survey of TCM syndrome, the prevalence of distribution of the TCM syndrome is dealt with in a decreasing order. The results are listed here: the kidney deficiency(92. 5%), heart deficiency(68. 7%), liver deficiency(55. 1%), obstruction(50. 7%), qi deficiency(26. 0%), yin deficiency(23. 8%), blood stasis(18.1%), yang deficiency(15. 9%), lung deficiency(14. 1%), spleen deficiency(7. 9%), phlegm deficiency (7. 9%),accumulation of phlegm-dampness (7. 0%), stomach deficiency(6. 2%), stagnation of qi(4. 0%), blood deficiency(3. 5%).In the prevalence survey of distribution of the TCM syndrome of PMOP is dealt with in a decreasing order. The results are listed here : the kidney deficiency(94. 9%), heart deficiency(76. 3%), liver deficiency(61. 9%), obstruction(60. 2%), yin deficiency(28. 0%), qi deficiency(22. 0%), yang deficiency(20. 3%), lung deficiency(20. 3%), blood stasis(19. 5%), spleen deficiency(ll. 9%),accumulation of phlegm-dampness(9. 30%), stomach deficiency (8. 5%), phlegm deficiency(7. 6%), stagnation of qi(5.9%), blood deficiency(3. 4%).We also found the prevalence of kidney deficiency in the women is highest. The heartdeficiency, liver deficiency and obstruction were greater than 60.0% separately. The qi deficiency, yin deficiency, blood stasis, yang deficiency, lung deficiency were high too, the prevalence were greater than 10% separately. But spleen deficiency, phlegm deficiency, accumulation of phlegm-dampness, stomach deficiency, stagnation of qi, blood deficiency were relative low, the prevalence were below 10%. Besides the prevalence of every syndrome increased in PMOP patients. And they were complicated by heart deficiency and liver deficiency mostly.In the survey of basic combination of TCM syndrome, we try to search the law of distribution and constitution of the basic TCM syndromes PMOP, while to provide a theoretical evidence of "diagnosis and treatment base on an overall analysis of the illness and the patient’s condition" and to optimize the composition of the compound of Chinese herbs.The study dealt with the distributions of syndromes of Traditional Chinese Medicine (TCM) in 227 cases postmenopausal women in resident .According to the study results of basic combination of 16 kinds of syndromes TCM syndrome. Every TCM syndrome was recorded as 1 (have a syndrome) or 0( not have a syndrome). These contain 11 kinds of deficiency syndromes and five kinds of excess syndromes. The prevalence of combination law of the TCM syndromes of both whole group and PMOP is dealt with in a decreasing order . The results of whole group are listed here: the combination of four kinds of syndromes (19.4%X the combination of two kinds of syndromes (17.2%)> the combination of three kinds of syndromes (16.3%)> the combination of five kinds of syndromes (13.7%)> the combination of six kinds of syndromes (13.2%)> one kinds of syndrome (9.7%\ the combination of seven kinds of syndromes (5.7%)O the combination of four kinds of syndromes, the combination of two kinds of syndromes, the combination of three kinds of syndromes, the combination of five kinds of syndromes, the combination of six kinds of syndromes which had high frequency distributions were regarded as the basic syndromes in the postmenopausal women in resident.更多还原