帕金森病排便障碍中医证候特征研究
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摘要
[目的]探讨帕金森病(PD)排便障碍的中医证候特征,为中医治疗PD排便障碍提供辨证论治依据。[方法]将纳入的102例PD患者,依据排便障碍诊断标准分为PD排便障碍组(44例)和非排便障碍组(58例)。应用PD证候量表(PD-PES-13)对两组受试者进行中医证候评分。分析PD排便障碍的中医证候特征及其与中医证候的相关性。[结果]证候积分方面,两组均以髓减积分数值为最高,排便障碍组(9.44±5.98)分,非排便障碍组(9.18±5.60)分。经卡方检验,PD排便障碍患者脾虚比例高于非排便障碍患者(P<0.01)。PD排便障碍患者中,髓减证与HOEHN&YAHR(H&Y)分级呈正相关(P<0.05);髓减证、肝风证与统一帕金森病评定量表(UPDRS)积分具有相关性(P<0.05或P<0.01)。[结论] PD可能以髓减证突出。脾虚对伴发排便障碍的PD患者可能存在影响。PD排便障碍患者H&Y分级越高髓减证越重。随着UPDRS积分升高,PD排便障碍患者髓减证和肝风证逐渐加重。
[Objective] To investigate the characteristics of traditional Chinese medicine(TCM) syndromes of Parkinson disease(PD) in defecation disorders and to provide evidence for the treatment of PD defecation disorders in Chinese medicine. [Methods] The 102 patients with PD who were included were classified into PD defecation disorder group(44 cases) and non-defecation disorder group(58 cases) according to the diagnostic criteria of defecation disorder. Patients with two groups were treated with the syndrome score of Parkinson’s disease(PD-PES-13). To analyze the features of TCM syndromes of PD defecation disorder and its correlation with TCM syndromes. [Results] In terms of syndrome scores, the scores for myelination were highest in both groups(9.44 ±5.98) for defecation disorder group and(9.18±5.60) for non-defecation disorder group. After chi-square test, the proportion of spleen-deficiency in PD patients was higher than that of patients without defecation(P<0.01). In patients with PD defecation disorder, there was a positive correlation between declining myelin levels and HOEHN&YAHR(H&Y) scores(P<0.05). And there was a linear relationship(P<0.01) among myelination syndrome, hepatic wind syndrome, and Parkinson’s disease rating scale(Unified Parkinson’s). The scores of Disease Rating Scale(UPDRS) were correlated(P<0.05 or P<0.01). [Conclusion] PD may be prominent with myeloid degeneration. Spleen deficiency may have effects on PD patients with defecation disorders. The higher the H&Y grade in patients with PD defecation disorder, the higher the marrow reduction certificate. With the increase of UPDRS scores, patients with PD defecation disorder have gradually increased their pith and hepatic wind syndrome.
[Objective] To investigate the characteristics of traditional Chinese medicine(TCM) syndromes of Parkinson disease(PD) in defecation disorders and to provide evidence for the treatment of PD defecation disorders in Chinese medicine. [Methods] The 102 patients with PD who were included were classified into PD defecation disorder group(44 cases) and non-defecation disorder group(58 cases) according to the diagnostic criteria of defecation disorder. Patients with two groups were treated with the syndrome score of Parkinson’s disease(PD-PES-13). To analyze the features of TCM syndromes of PD defecation disorder and its correlation with TCM syndromes. [Results] In terms of syndrome scores, the scores for myelination were highest in both groups(9.44 ±5.98) for defecation disorder group and(9.18±5.60) for non-defecation disorder group. After chi-square test, the proportion of spleen-deficiency in PD patients was higher than that of patients without defecation(P<0.01). In patients with PD defecation disorder, there was a positive correlation between declining myelin levels and HOEHN&YAHR(H&Y) scores(P<0.05). And there was a linear relationship(P<0.01) among myelination syndrome, hepatic wind syndrome, and Parkinson’s disease rating scale(Unified Parkinson’s). The scores of Disease Rating Scale(UPDRS) were correlated(P<0.05 or P<0.01). [Conclusion] PD may be prominent with myeloid degeneration. Spleen deficiency may have effects on PD patients with defecation disorders. The higher the H&Y grade in patients with PD defecation disorder, the higher the marrow reduction certificate. With the increase of UPDRS scores, patients with PD defecation disorder have gradually increased their pith and hepatic wind syndrome.
引文
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[15]李雨濛.帕金森病的证候特征及升清降浊方治疗的临床观察[D].北京:北京中医药大学,2018.
[16]赵国华,徐春波,曾慧敏.中医治疗帕金森病非运动症状的辨证思路[J].中医杂志,2008,49(8):747-748.
[17]牛磊,宫洪涛,马云枝.帕金森病肾病虚病机与治疗方向的思考[J].天津中医药,2010,27(4):133-134.
[2]Ashraf W,Pfeiffer RF,Park F,et al.Constipation in Parkinson’s disease:objective assessment and response to psyllium[J].Movement Disorders Official Journal of the Movement Disorder Society,1997,12(6):946-951.
[3]Palma JA,Kaufmann H.Autonomic disorders predicting Parkinson’s disease[J].Parkinsonism&Related Disorders,2014,20(1):S94-S98.
[4]Gage H,Kaye J,Kimber A,et al.Correlates of constipation in people with Parkinson’s[J].Parkinsonism&Related Disorders,2011,17(2):106-111.
[5]Bassotti G,Maggio D,Battaglia E,et al.Manometric investigation of anorectal function in early and late stage Parkinson’s disease[J].JNeurol Neurosurg Psychiatry,2000,68(6):768-770.
[6]Dip HE,Gage H,Kimber A,et al.Excess burden of constipation in Parkinson’s disease:a pilot study[J].Movement Disorders Official Journal of the Movement Disorder Society,2006,21(8):1270-1273.
[7]Cersosimo MG,Raina GB,Cristina P,et al.Gastrointestinal manifestations in Parkinson’s disease:prevalence and occurrence before motor symptoms[J].Journal of Neurology,2013,260(5):1332-1338.
[8]佚名.帕金森病Hoehn-Uajr(修正)分仪量表[J].中国微侵袭神经外科杂志,2008,13(2):51.
[9]Kamm MA.Constipation and its management[J].BMJ,2003,327(7413):459-460.
[10]靳昭辉.帕金森病中医证候分型诊断量表及中医证候特征研究[D].北京:北京中医药大学,2015.
[11]Kamm MA.Constipation and its management[J].BMJ,2003,327(7413):459-460.
[12]靳昭辉,田金洲,时晶,等.帕金森病中医证候特征研究[J].云南中医学院学报,2014,37(6):23-26.
[13]赵国华.老年颤证分期治疗3法[J].中医杂志,1997,47(5):294-295.
[14]赵国华.再论帕金森病的分期治疗3法[J].中医杂志,2005,55(7):541-543.
[15]李雨濛.帕金森病的证候特征及升清降浊方治疗的临床观察[D].北京:北京中医药大学,2018.
[16]赵国华,徐春波,曾慧敏.中医治疗帕金森病非运动症状的辨证思路[J].中医杂志,2008,49(8):747-748.
[17]牛磊,宫洪涛,马云枝.帕金森病肾病虚病机与治疗方向的思考[J].天津中医药,2010,27(4):133-134.