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西北燥证与心系疾病关联性研究
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摘要
目的:1)分析新疆地区心系疾病与西北燥证的罹患关系;2)分析新疆地区心系疾病病情、证情与西北燥证主兼证的相关性;3)分析新疆地区心系疾病患者与西北燥证罹患者素体状态的异同,从而揭示西北燥证对新疆地区心系疾病患者病证状态的影响。方法:运用文献学分析方法及临床流行病学方法,采用病例对照设计,共收集1314份调查问卷,其中病例组486例,对照组828例,对2组西北燥证罹患率、西北燥证证情、气血阴阳及五脏虚证罹患率进行比较。对病例组中燥证组非燥证组病情、临床证候证情、西北燥证证情、虚证证情进行比较。资料全部收回后采取EPIDATA3.0录入,然后导出数据。由SPSS16.0统计软件完成统计分析。病例组与对照组均进行人口学资料均衡性分析。计数资料采用卡方检验,计量资料采用t检验、方差分析。方差不齐者采用t’检验和Kruskal-Wallis秩和检验。所有的统计检验均采用双侧检验,P值小于或等于0.05将被认为所检验的差别有统计意义。计数资料多组间两两比较时,检验水准α' = 2α/k(k-1)。结果:1)心系疾病病例组西北燥证罹患率为37.86%,对照组为18.47%,病例组高于对照组(χ~2=60.329,P<0.01)。各病种病例组西北燥证罹患率均高于对照组(均有P<0.05)。各病种西北燥证罹患率排序从高到低依次为神经衰弱(62.65%)、皮肤瘙痒症(49.35%)、冠心病(31.48%)、高血压(31.37%)、痤疮(24.13%);2)心系疾病组西北燥证总积分高于对照组(P<0.01)。各证候除肺心脾风火燥证两组无差异外,其余主兼证西北燥证积分二者均有显著差异,病例组均高于对照组(P<0.01)。各证候均数差值以心肾阴虚证及肺卫孔窍皮肤燥证最高;3)除高血压外,各病种病例组外燥证均高于对照组(均有P<0.05),尤以皮肤瘙痒症、痤疮明显。高血压、冠心病、神经衰弱三病种内燥证均高于外燥证(均有P<0.05)。皮肤瘙痒症、痤疮内燥证与外燥证积分比较未显示出差异(P>0.05);4)高血压与神经衰弱燥证组病情积分均高于非燥证组(均见P<0.01)。皮肤瘙痒症与痤疮燥证组与非燥证组病情积分未显示出差异(P>0.05);5)高血压阴阳两虚证与燥证总证情相关性最强(r=0.864,P<0.01);典型相关分析提示,西北燥证主兼证与高血压各证有很强关联性,其中因变量组阴阳两虚证、痰湿壅盛证与自变量组脾胃蕴湿证、肝肾精血不足证相关性最强。神经衰弱气郁化火证与西北燥证总证情相关性最强(r=0.692,P<0.01);典型相关分析提示,西北燥证主兼证与神经衰弱各证有很强关联性,其中因变量组肝阴亏虚证、气郁化火证与自变量组肝肾精血不足证、心肾阴虚证相关性最强。皮肤瘙痒症血虚风燥证与西北燥证总证情相关性最强(r=0.517,P<0.01);典型相关分析提示,西北燥证主兼证与皮肤瘙痒症各证有很强关联性,其中因变量组血虚风燥证、湿热壅盛证与自变量组肺心脾风火燥证、脾胃阴虚证相关性最强。痤疮湿热证与西北燥证总证情相关性最强(r=0.391,P<0.01);典型相关分析提示,西北燥证主兼证与痤疮各证有很强关联性,其中因变量组湿热证、风热证与自变量组肺心脾风火燥证、肺卫孔窍皮肤燥证相关性最强;6)高血压病情与西北燥证证情有较强关联度(f_i=0.51)。类证中与肝肾精血不足证(f_i=0.49)、肺心脾风燥证(f_i=0.38)、心肾阴虚证(f_i=0.38)关联度也较强(P<0.01)。神经衰弱病情与西北燥证证情病证切合指数=0.31(P<0.01),提示神经衰弱病情与西北燥证证情有较强关联度。与各类兼证病证切合指数均有P<0.01,尤以肝肾精血不足证病证切合指数(f_i=0.40)最大,其次是脾胃蕴湿证(f_i=0.37)、心肾阴虚证(f_i=0.32)、脾胃阴虚证(f_i=0.32),与肺心脾风火燥证关联度最小(f_i=0.29)。皮肤瘙痒症病情除与肺心脾风火燥证(f_i=0.30,P<0.01)有较强关联度外,其余各证f_i均无统计学意义(P>0.05)。痤疮病情积分与西北燥证病证切合指数经检验均无统计学意义(P>0.05);7)心系疾病病例组气虚证、阳虚证、心虚证、肝虚证罹患率均高于对照组(P<0.05),其他虚证罹患二者无统计学差异(P>0.05)。冠心病组阳虚证、心虚证、肺虚证、肝虚证罹患率高于对照组(均有P<0.01)。高血压组心虚证、肝虚证罹患率高于对照组(P<0.05)。神经衰弱组气虚证、心虚证、肝虚证罹患率高于对照组(P<0.01),其他虚证罹患率与对照组比较无统计学差异(P>0.05)。皮肤瘙痒症组气虚证、阴虚证、阳虚证罹患率均高于对照组(P<0.05),尤以气虚证、阳虚证明显(P<0.01)。痤疮组各类虚证罹患情况与对照组无差异(P>0.05);8)冠心病燥证组气血阴阳虚证及五脏罹患率均高于非燥证组(P<0.01)。高血压燥证组气血阴阳及五脏虚证罹患率均高于非燥证组(P<0.01)。神经衰弱燥证组气虚证、阴虚证、心虚证、肺虚证、肝虚证罹患率高于非燥证组(P<0.01)。血虚证、阳虚证、脾虚证、肾虚证罹患率2组无差异(P>0.05)。皮肤瘙痒症燥证组阴虚证、阳虚证、心虚证、肝虚证、肾虚证罹患率高于非燥证组(P<0.05)。气虚证、血虚证、肺虚证、脾虚证、胃虚证罹患率2组无差异(P>0.05)。痤疮燥证组气虚证、血虚证、阴虚证、肝虚证高于非燥证组(P<0.05)。其他虚证罹患率2组无差异(P>0.05);9)病证组、唯病组、唯证组、非病证组4组虚证比较:既罹患心系疾病又罹患西北燥证的人群体质最差,各类虚证均较明显。其次为西北燥证罹患者,再次为仅患有心系疾病者,而以既无疾病又无西北燥证罹患的人群体质状态最佳。结论:1)西北燥证是新疆地区心系疾病的
     危险因素。西北燥证是新疆地区心系疾病的共同临床伴随证候,并以心肾阴虚证为突出表现;2)新疆地区心系疾病病情和证情与西北燥证主兼各证均有较强相关性,随各病种特点,与西北燥证主兼证相关性亲疏不等;3)新疆地区心系疾病组虚证证情较对照组严重,突出表现为气虚、阳虚、心虚和肝虚证重而且多;4)冠心病组以阳虚为主,其次为气虚。五脏虚证中以心虚、肺虚、肝虚较为突出。其中肺虚证是新疆地区冠心病患者特殊素体状态。高血压组以心虚、肝虚为主,亦有气虚表现。这是新疆地区高血压患者有别于内地的体质特点。神经衰弱组气虚、心虚、肝虚较为突出。皮肤瘙痒症组气虚、阴虚、阳虚较为突出。痤疮组因年龄较轻,整体体质状况较好,但亦有肾虚表现。肾虚可能是新疆地区痤疮患者的潜在病理状态;5)西北燥证加重新疆地区心系疾病虚证证情。西北燥证是新疆民众亚健康状态的主要表现形式,防治西北燥证有助于提高新疆地区民众的健康水平。
Objectives: 1) to analyze the relationship of attack rate between the Northwest Dryness Syndrome and heart system diseases in Xinjiang Autonomous Region. 2) to analyze the correlation between the state of illness and syndrome of heart system diseases and NDS in Xinjiang. 3) to analyze the similarities and differences of the physique between the patients of NDS and heart system diseases and to reveal the impact of NDS on the patients’status of heart system diseases. Methods: By applying methods of philology analysis and clinical epidemiology, 1314 questionnaires were designed and collected. On the basis of case-control, disease group (486 cases) and control group (828 cases) are set up to compare the attack rate of northwest dryness syndrome (NDS), NDS integration, deficiency syndrome of Qi, blood, Yin and yang; to compare the state of illness, general syndrome differentiation in traditional Chinese medicine, integrations of NDS and deficiency syndrome of NDS group and non-NDS group in the disease group. After the collection of all questionnaires, all data were put into EPIDATA 3.0 and derived into SPSS 16.0 for statistic analysis. Equilibrium Analysis of demographic data is adopted in both disease group and control group. Enumeration data is analyzed by chi-square. Masurement data is analyzed by T-Test and analysis of variance. Heterogeneity of variance is analyzed with t’and Kruskal-Wallis testing method. Two-side test are applied in all statistic test. The tested difference will be considered to be Statistically Significant when P≤0.05. The significant level isα' = 2α/k(k-1) when the enumeration data is pairwise compared among groups. Results: 1) The attack rate of NDS in heart disease group (37.86%) is higher than control group (18.47%) (χ~2=60.329, P<0.01). The same situation exists in all other disease groups. The attack rate of NDS ranks in descending order as follows: neurasthenia (62.65%), prurituscutanea (49.35%), coronary heart disease (31.48%), hypertension (31.37%), acne (24.13%). 2) The total integration of NDS in heart disease group is higher than control group (P<0.01). There is obvious difference on the NDS integrations of main and accompanying syndromes between these two groups except the lung and heart wind-fire pathogen syndrome, i.e. Disease group is higher than control group. Among all standardized mean differences of syndromes, the highest ones are yin deficiencies of the heart and kidney syndrome and skin and opening of the body syndrome. 3) The outer dryness syndrome in all disease groups but group of hypertension is higher than control groups (P<0.05), especially prurituscutanea and acne. The integrations of inner dryness syndrome of coronary heart disease, hypertension and neurasthenia are higher than that of outer dryness syndrome (P<0.05). The comparison between the integrations of inner dryness syndrome of prurituscutanea and acne shows no difference (P>0.05). 4) The illness integration in groups of hypertension and neurasthenia are higher than those of non-dryness syndrome groups (P<0.01). The comparison between the integrations of dryness syndrome groups of prurituscutanea and acne shows no difference with those of non-dryness syndrome groups (P<0.05). 5) The deficiency of both Ying and Yang in group of hypertension and dryness are the most related with total NDS integration (r=0.864, P<0.01); The canonical correlation coefficient showed that the NDS main and the accompanied symptoms with hypertension has a strong correlation, in which the dependent variable set of deficiency of both yin and yang, phlegm wet obstruct the lung from the independent variable group of spleen-stomach damp syndrome, the deficiencies syndrome of essence and blood of the liver and the kidney are the most relevant. The syndrome of depressed qi transforming into fire of neurasthenia is the most related with total NDS integration (r=0.692, P<0.01); The canonical correlation coefficient showed that the NDS main and the accompanied symptoms with hypertension has a strong correlation, in which the dependent variable set of yin deficiencies of the liver syndrome, the syndrome of qi depression transforming into fire from the independent variable group of the deficiencies syndrome of essence and blood of the liver and the kidney, yin deficiencies of the heart and kidney syndrome are the most relevant. The blood deficiency and wind dryness syndrome in group of prurituscutanea is the most related with total NDS integration (r=0.517, P<0.01); The canonical correlation coefficient showed that the NDS main and the accompanied symptoms with prurituscutanea has a strong correlation, in which the dependent variable set of the blood deficiency and wind dryness syndrome, damp-heat filled syndrome from the independent variable group of the lung and heart wind-fire pathogen syndrome, yin deficiencies of the spleen and stomach syndrome are the most relevant.The damp-heat syndrome of acne is the most related with total NDS integration (r=0.391, P<0.01); The canonical correlation coefficient showed that the NDS main and
     the accompanied symptoms with acne has a strong correlation, in which the dependent variable set of damp-heat syndrome, wind-heat syndrome from the independent variable group of the lung and heart wind-fire pathogen syndrome, Lung health skin pore opening dry permit are the most relevant.6) There is a strong correlation between the illness status of hypertension and syndromic state of NDS (f_i=0.51). The illness status of hypertension is also correlated with some accompanying syndromes (P<0.01), eg. deficiencies of essence and blood of the liver and the kidney syndrome (f_i=0.49); the lung and heart wind-fire pathogen syndrome (f_i=0.38), yin deficiencies of the heart and kidney syndrome (f_i=0.38). The corresponding index 0.31 (P<0.01) between the illness status of neurasthenia and syndromic state of NDS shows that there is a strong correlation between them. The corresponding index between the former and other accompanying syndromes are descending sorted as follows: deficiencies of essence and blood of the liver and the kidney syndrome (f_i=0.40), endogenous dampness syndrome (f_i=0.37), yin deficiencies of the heart and kidney syndrome (f_i=0.32), yin deficiencies of the lien and stomach syndrome (f_i=0.32), the lung and heart wind-fire pathogen syndrome (f_i=0.29). the illness status of prurituscutanea is only correlated with the lung and heart wind pathogen syndrome (f_i=0.30, P<0.01) but has no statistic significant with other syndromes (P>0.05). The integration of acne and its corresponding index with NDS show no statistic significant after testing. 7) The attack rates of Qi, Yang, Heart and Liver deficiency in case group are higher than those in control group (P<0.05). There is no difference in statistics on other deficiency syndromes. The attack rates of Yang deficiency (20.95%), heart deficiency (46.67%), lung deficiency (25.71%) and liver deficiency (40.48%) in heart system disease on blood vessel are higher than control group (P<0.05), especially on heart and liver deficiency. The attack rates of Qi deficiency (68.87%), heart deficiency (53.01%) and liver deficiency (43.37%) in heart system disease on mind are higher than control group. The attack rate of Yang deficiency (15.54%) is the only one which is higher than the control group in heart system disease on skin. 8) The attack rates of Qi, Xue, Ying and Yang deficiency syndrome and five internal organs of syndrome groups of coronary disease are higher than the non-dryness groups (P<0.01). The attack rates of Qi, Xue, Ying and Yang deficiency syndrome and five internal organs of syndrome groups of hypertension are higher than the non-dryness groups (P<0.01). The attack rates of Qi, Ying deficiency syndrome and heart deficiency, lung deficiency and liver deficiency syndrome groups of neurasthenia are higher than the non-dryness groups (P<0.01). The attack rates of Ying and Yang deficiency syndrome and heart deficiency, liver deficiency
     and kidney deficiency syndrome in groups of prurituscutanea are higher than the non-dryness groups (P<0.01). The attack rates of Qi deficiency, Blood deficiency, Ying deficiency syndrome and liver deficiency syndrome in groups of acne are higher than the non-dryness groups (P<0.01). 9) To compare the disease and syndrome group, disease and the sole-illness group, the sole-syndrome group and the health group: The physical constitution of the disease and syndrome group are the poorest than other groups. The sole-syndrome group listed on the second and the sole-illness group on third. The physical constitution of the non-illness and syndrome group is the best. Conclusion: 1) The northwest dryness syndrome, with yin deficiencies of the heart and kidney syndrome as a prominent feature, is one of risk factors and common accompanying status for heart system disease in Xinjiang Region. 2) There is a strong correlation among the status of heart system diseases and its syndromes. The correlation with the main and accompanying syndromes of NDS varies with the different features of each disease. 3) The group of heart system disease in Xinjiang, asthenia syndrome condition is serious than the control group, which is mainly characterized as Qi deficiency, Yang deficiency, heart deficiency and liver deficiency. 4) Yang deficiency physique is most obvious in the group of coronary disease. The outstanding performance of the five internal organs is heart deficiency, lung deficiency and liver deficiency. Lung deficiency is the special physique for the patients of coronary disease in Xinjiang. The physique of heart deficiency and liver deficiency is evident in hypertension, Qi deficiency is also represented. This is a different physique feature of hypertension patients in Xinjiang and inland. The physique of Qi deficiency, heart deficiency and liver deficiency is evident in neurasthenia; the physique of Qi deficiency, Yin deficiency and Yang deficiency is evident in prurituscutanea. As a whole, the physique in the group of acne is better than other groups. Deficiency of the kidney may be the potential pathological status of the patients of acne in Xinjiang. 5) NDS accentuates the deficiency symptoms of heart system disease. The prophylaxis and treatment of NDS will contribute to improve people's health because it is the dominant manifestation of the sub-health status of people live in Xinjiang.
引文
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