基于抑郁、焦虑、躯体形式障碍的郁证特质研究
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摘要
目的通过对抑郁、焦虑、躯体形式障碍患者的临床调查,探讨中医郁证的症状、证候、脏腑病位等临床特征。方法将符合纳入标准的患者分为抑郁障碍(MDD)、焦虑障碍(AD)和躯体形式障碍(SFD)3组,分别进行抑郁自评量表(SDS)、焦虑自评量表(SAS)、复合自主神经症状量表(COMPASS-31)评分,采集3组患者临床信息评估中医证候、中医病症,运用频数统计法、卡方检验法、Wilcoxon秩和检验以及Spearman相关分析等方法进行统计,分析郁证患者的中医特质。结果①共观察291例,MDD124例、AD92例、SFD75例,3组均以女性和脑力劳动者偏多(P>0.05);②3组患者平均症状数为(5.98±3.03)个,在MDD、AD组,病情越重症状数量越多(P<0.05);③各组及3组合并的COMPASS-31评分与症状数量均呈正相关(P<0.05);④仅有精神心理症状或躯体症状者分别为1.37%、38.49%,兼有二类症状者占60.14%;⑤3组患者临床表现以脾胃病系为最多,其次为气血津液系、心病系;证候以复证多于单证;脏腑病位以心系为最多(44.67%),其次为肝、脾、肾、胃、胆、肺;COMPASS-31评分值以肾病系最高;病名以心病系为最多,其次为气血津液病系、肝病系、脾胃病系、肾病系。结论中医郁证临床表现多以躯体症状形式出现,证候属性离散度较大,脏腑病位以心、肝、脾为主,可涉及多种病名。
Objective To discuss the symptoms, pattern manifestations and disease locations related to zang-fu organs of depression pattern of traditional Chinese medicine(TCM) through the clinical survey on patients with depression, anxiety and somatoform disorders. Methods The patients in accordance with internalized standard were divided into group of major depressive disorder(MDD group), group of anxiety disorder(AD group) and group of somatoform disorders(SFD group). All groups were given scoring by using Self-rating Depression Scale(SDS), Self-rating Anxiety Scale(SAS) and Composite Autonomic Symptom Scale(COMPASS-31). The clinical information was collected from 3 groups for reviewing TCM pattern manifestations and TCM diseases. The TCM characteristics in patients with depression pattern were analyzed by using methods of frequency statistics, chi-square test, Wilcoxon rank sum test and Spearman correlation analysis. Results ①There were totally 291 cases observed, and 124 in MDD group, 92 in AD group and 75 in SFD group. There were more women and mental workers in 3 groups(P>0.05). ②The average numbers of symptoms were(5.98±3.03) in 3 groups, and the more severe the condition, the more the symptoms in MDD group and AD group(P<0.05). ③The scores of COMPASS-31 were positively correlated to symptom numbers in different groups and in combined 3 groups(P<0.05). ④The patients with only psychosomatic symptoms or somatic symptoms accounted for 1.37% and 38.49%, and those with two of them accounted for 60.14%. ⑤The most common clinical manifestations were in spleen-stomach disease system, and secondly in qi-blood-fluid-humor disease system and heart disease system. Compound pattern manifestations were more than simple pattern manifestations. The disease locations related to zang-fu organs were mostly in heart system(44.67%), and secondly in systems of liver, spleen, kidney, stomach, gallbladder and lung. The scores of COMPASS-31 were the highest in kidney disease system. The disease names were the most in heart disease system and secondly in qi-blood-fluid-humor disease system, liver disease system, spleen-stomach disease system and kidney disease system. Conclusion The clinical manifestations of TCM depression pattern appear mostly in the form of somatic symptoms with higher dispersion in pattern properties. The disease locations related to zang-fu organs are mainly heart, liver and spleen involving many disease names.
Objective To discuss the symptoms, pattern manifestations and disease locations related to zang-fu organs of depression pattern of traditional Chinese medicine(TCM) through the clinical survey on patients with depression, anxiety and somatoform disorders. Methods The patients in accordance with internalized standard were divided into group of major depressive disorder(MDD group), group of anxiety disorder(AD group) and group of somatoform disorders(SFD group). All groups were given scoring by using Self-rating Depression Scale(SDS), Self-rating Anxiety Scale(SAS) and Composite Autonomic Symptom Scale(COMPASS-31). The clinical information was collected from 3 groups for reviewing TCM pattern manifestations and TCM diseases. The TCM characteristics in patients with depression pattern were analyzed by using methods of frequency statistics, chi-square test, Wilcoxon rank sum test and Spearman correlation analysis. Results ①There were totally 291 cases observed, and 124 in MDD group, 92 in AD group and 75 in SFD group. There were more women and mental workers in 3 groups(P>0.05). ②The average numbers of symptoms were(5.98±3.03) in 3 groups, and the more severe the condition, the more the symptoms in MDD group and AD group(P<0.05). ③The scores of COMPASS-31 were positively correlated to symptom numbers in different groups and in combined 3 groups(P<0.05). ④The patients with only psychosomatic symptoms or somatic symptoms accounted for 1.37% and 38.49%, and those with two of them accounted for 60.14%. ⑤The most common clinical manifestations were in spleen-stomach disease system, and secondly in qi-blood-fluid-humor disease system and heart disease system. Compound pattern manifestations were more than simple pattern manifestations. The disease locations related to zang-fu organs were mostly in heart system(44.67%), and secondly in systems of liver, spleen, kidney, stomach, gallbladder and lung. The scores of COMPASS-31 were the highest in kidney disease system. The disease names were the most in heart disease system and secondly in qi-blood-fluid-humor disease system, liver disease system, spleen-stomach disease system and kidney disease system. Conclusion The clinical manifestations of TCM depression pattern appear mostly in the form of somatic symptoms with higher dispersion in pattern properties. The disease locations related to zang-fu organs are mainly heart, liver and spleen involving many disease names.
引文
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[13] 岳振松,潘战宇,于春泉,等. 以单证为基础兼及复合证候和证候要素的证候命名分类新系统[J]. 辽宁中医杂志,2015,42(4):694-696. Yue ZS, Pan ZY, Yu CQ, et al. New naming and classifying system of syndromes based on single syndrome combined with complex syndromes and elements[J]. Liaoning Journal of Traditional Chinese Medicine, 2015, 42(4): 694-696.
[14] Kroenke K. The interface between physical and psychological symptoms[J]. Primary Care Companion J Clin Psychiatry, 2003, 5(7): 11-18.
[15] Boven K, Lucassen P, Ravesteijn H, et al. Do unexplained symptoms predict anxiety or depression? Ten-year data from a practice-based research network[J]. Br J Gen Pract, 2011, 61(587): e316-325.
[16] 曾庆枝,何燕玲,刘哲宁,等. 综合医院抑郁焦虑障碍患者躯体症状与躯体疾病诊断分布研究[J]. 中国全科医学,2012,15(8):2656-2661. Zeng QZ, He YL, Liu ZN, el al. Distribution of physical symptoms and diagnoses in patients with depression or anxiety disorders in general hospitals[J]. Chinese General Practice, 2012, 15(8): 2656-2661.
[17] 蒋健. 郁证发微(一)—郁证形态论[J]. 上海中医药杂志,2015,49(8):4-7. Jiang J. The morphology of depression syndrome(I)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(8): 4-7.
[18] 蒋健. 郁证发微(二)—郁证诊断论[J]. 上海中医药杂志,2015,49(9):3-6. Jiang J. The diagnostics of depression syndrome (II)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(9): 3-6.
[19] 蒋健. 郁证发微(四)—隐性郁证论[J]. 上海中医药杂志,2015,49(11):4-7. Jiang J. Masked depression syndrome(IV)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(11): 4-7.
[20] Levenson JL. 心身医学[M]. 吕秋云,译. 北京:北京大学医学出版社,2010:233-251.Levenson JL. Textbook of Psychosomatic Medicine[M]. Lyu QY,trans. Beijing: Peking University Medical Press, 2010: 233-251.
[21] Kooy KG, Hout HPJ, Marwijk HWJ, et al. Differences in heart rate variability between depressed and non-depressed elderly[J]. Int J Geriatr Psychiatry, 2006, 21(2): 147-150.
[22] 姜春华,沈自尹. 肾的研究[M]. 2版.上海:上海科学技术出版社,1984:213-223. Jiang CH, Shen ZY. Research on Kidney [M]. Second Edition.Shanghai: Shanghai Scientific and Technical Publishers, 1984: 213-223.
[23] 沈自尹. 肾阳虚证的定位研究[J]. 中国中西医结合杂志, 1997, 17(1): 50-52. Shen ZY. Positioning study on kidney-yang deficiency pattern[J]. Chinese Journal of Integrated Traditional and Western Medicine, 1997, 17(1): 50-52.
[2] Sletten DM, Suarez GA, Low PA, et al. COMPASS 31: a refined and abbreviated composite autonomic symptom score[J]. Mayo Clinic Proceedings, 2012, 87(12): 1196-1201.
[3] Low PA, Benrud-Larson LM, Sletten DM, et al. Autonomic symptoms and diabetic neuropathy: a population-based study[J]. Diabetes Care, 2004, 27(12): 2942-2947.
[4] 林志坚,季晓林,周瑞玲. 2型糖尿病患者皮肤交感反应与心血管自主功能检查的相关性[J]. 临床神经电生理学杂志,2008,17(5):264-267. Lin ZJ, Ji XL, Zhou RL. Correlation of sympathetic skin response and cardiovascular autonomic function tests in patients with Type 2 diabetes mellitus[J]. Journal of Clinical Electroneurophysiology(China), 2008, 17(5): 264-267.
[5] Michael G, Paul H, Philip C. 牛津精神病学教科书[M]. 5版. 刘协和,李涛,译.成都:四川大学出版社,2010:4-22. Michael G, Paul H, Philip C. Shorter Oxford Textbook of Psychiatry[M]. Fifth Edition. Liu XH, Li T eds. Chengdu: Sichuan University Publishing House, 2010: 4-22.
[6] 朱文峰. 中医诊断学[M]. 北京:中国中医药出版社,2002:14-125. Zhu WF. Diagnostics of Traditional Chinese Medicine[M]. Beijing:China Press of Traditional Chinese Medicine,2002:14-125.
[7] 王永炎,严世芸. 实用中医内科学[M].2版. 上海:上海科学技术出版社,2009:458-469. Wang YY, Yan SY. Practical Chinese Internal Medicin[M]. Second Edition. Shanghai: Shanghai Science and Technology Publishing House, 2009: 458-469.
[8] 中华中医药学会中医诊断分会. 中医常见证诊断标准(上)[J]. 湖南中医药大学学报,2008,28(5):3-20. Diagnostic Subcommittee of China Association of Traditional Chinese Medicine. Diagnosis standards for common patterns in traditional Chinese medicine(I)[J]. Journal of TCM Univ. of Hunan, 2008, 28(5): 3-20.
[9] 中华中医药学会中医诊断分会. 中医常见证诊断标准(下)[J]. 湖南中医药大学学报,2008,28(6):3-10. Diagnostic Subcommittee of China Association of Traditional Chinese Medicine. Diagnosis standards for common patterns in traditional Chinese medicine(II)[J]. Journal of TCM Univ. of Hunan, 2008, 28(6): 3-10.
[10] 侯凤刚,赵刚,贺佳. 文献中原发性肝癌中医单证辨证专家观点分析[J]. 成都中医药大学学报,2003,26(2):56-57. Hou FG, Zhao G, He J. Analysis on expert’s views on single pattern differentiation of traditional Chinese medicine for primary liver cancer in literature[J]. Journal of Chengdu University of TCM, 2003, 26(2): 56-57.
[11] 方肇勤. 中医辨证标准制定的若干关键问题[J]. 上海中医药杂志,2006,40(1):11-13. Fang ZQ. Some crucial problems in establishing chinese medical syndrome differentiation standards[J]. Shanghai Journal of Traditional Chinese Medicine, 2006, 40(1): 11-13.
[12] 赵晖,吴崇胜,陈家旭. 中医证候诊断标准研究的方法学探讨[J]. 上海中医药大学学报,2008,22(4):47-50. Zhao H, Wu CS, Chen JX. Discussion on methodology of diagnostic criterion for pattern identification[J]. Journal of Shanghai University of Traditional Chinese Medicine, 2008, 22(4): 47-50.
[13] 岳振松,潘战宇,于春泉,等. 以单证为基础兼及复合证候和证候要素的证候命名分类新系统[J]. 辽宁中医杂志,2015,42(4):694-696. Yue ZS, Pan ZY, Yu CQ, et al. New naming and classifying system of syndromes based on single syndrome combined with complex syndromes and elements[J]. Liaoning Journal of Traditional Chinese Medicine, 2015, 42(4): 694-696.
[14] Kroenke K. The interface between physical and psychological symptoms[J]. Primary Care Companion J Clin Psychiatry, 2003, 5(7): 11-18.
[15] Boven K, Lucassen P, Ravesteijn H, et al. Do unexplained symptoms predict anxiety or depression? Ten-year data from a practice-based research network[J]. Br J Gen Pract, 2011, 61(587): e316-325.
[16] 曾庆枝,何燕玲,刘哲宁,等. 综合医院抑郁焦虑障碍患者躯体症状与躯体疾病诊断分布研究[J]. 中国全科医学,2012,15(8):2656-2661. Zeng QZ, He YL, Liu ZN, el al. Distribution of physical symptoms and diagnoses in patients with depression or anxiety disorders in general hospitals[J]. Chinese General Practice, 2012, 15(8): 2656-2661.
[17] 蒋健. 郁证发微(一)—郁证形态论[J]. 上海中医药杂志,2015,49(8):4-7. Jiang J. The morphology of depression syndrome(I)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(8): 4-7.
[18] 蒋健. 郁证发微(二)—郁证诊断论[J]. 上海中医药杂志,2015,49(9):3-6. Jiang J. The diagnostics of depression syndrome (II)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(9): 3-6.
[19] 蒋健. 郁证发微(四)—隐性郁证论[J]. 上海中医药杂志,2015,49(11):4-7. Jiang J. Masked depression syndrome(IV)[J]. Shanghai Journal of Traditional Chinese Medicine, 2015, 49(11): 4-7.
[20] Levenson JL. 心身医学[M]. 吕秋云,译. 北京:北京大学医学出版社,2010:233-251.Levenson JL. Textbook of Psychosomatic Medicine[M]. Lyu QY,trans. Beijing: Peking University Medical Press, 2010: 233-251.
[21] Kooy KG, Hout HPJ, Marwijk HWJ, et al. Differences in heart rate variability between depressed and non-depressed elderly[J]. Int J Geriatr Psychiatry, 2006, 21(2): 147-150.
[22] 姜春华,沈自尹. 肾的研究[M]. 2版.上海:上海科学技术出版社,1984:213-223. Jiang CH, Shen ZY. Research on Kidney [M]. Second Edition.Shanghai: Shanghai Scientific and Technical Publishers, 1984: 213-223.
[23] 沈自尹. 肾阳虚证的定位研究[J]. 中国中西医结合杂志, 1997, 17(1): 50-52. Shen ZY. Positioning study on kidney-yang deficiency pattern[J]. Chinese Journal of Integrated Traditional and Western Medicine, 1997, 17(1): 50-52.