摘要
支原体和/或衣原体性盆腔炎(慢性)近年发病比例不断升高,严重影响广大妇女的身心健康。目前对于本病的中医研究多停留于慢性盆腔炎,对其进行系统的辨证分型研究未见报道,深入研究本病的中医证型分布规律及对本病的相关因素进行分析,具有重要临床意义和社会价值。
目的
探讨支原体和/或衣原体性盆腔炎(慢性)的中医证型分布规律,对其进行规范的辨证分型,并分析其病因病机,研究相关因素与证型分布之间的关系,为中医辨证治疗提供临床依据,并指导预防本病发生。
方法
收集广州中医药大学第一附属医院妇科门诊和住院部,2008年3月～2009年5月的支原体和/或衣原体性盆腔炎(慢性)病例,根据相关资料,参照中医证候诊断标准作出中医证型的判断,比较各证型的构成比,并分析支原体、衣原体、年龄、病程、孕产、流产等以及其它因素与中医证型的关系。
结果
共收到支原体和/或衣原体性盆腔炎(慢性)病例164例,其中UU感染159例,Mh感染14例,CT感染17例(均含上述病原体混合感染)。证型共有5种,病例数由多到少分别为脾虚瘀浊证,肾虚血瘀证,湿热瘀结证,气滞血瘀证,寒湿凝滞证。本病发病年龄以25—34岁之间,本病病程多在1月以上。
结论
1.支原体和/或衣原体性盆腔炎(慢性)临床上常见的证型由多到少依次为脾虚瘀浊、肾虚血瘀证、湿热瘀结证、气滞血瘀证、寒湿凝滞证等5种。这种证型分布主要针对广州及周边地区而言。本病兼夹证多,病性多虚实夹杂,病机复杂,治疗时须注意个体化,照顾兼夹证。根据证型分布及病机特点,活血化瘀、补肾健脾、清热祛湿以及疏肝行气是本病的常用治法。
2.CT感染的本病患者最易出现湿热瘀结证,次为为脾虚瘀浊证;且本病初起多表现为湿热瘀结证,又可兼见脾虚,故对此类患者应注意清热祛湿、健脾活血,使本病及早控制,以防病情迁延。
3.本病多发于生育年龄阶段,病程多在一月以上,病情进展多由湿热瘀结到脾虚瘀浊到肾虚血瘀,进展中兼见气滞血瘀、寒凝,且兼夹证较多,病情复杂,若不积极治疗,容易迁延难愈。本病与月经不调、不孕、阴道炎等关系密切,故须重视本病,及早积极治疗类似阴道炎的小病,避免小病酿大病,并对本病早期诊断、及时治疗。
4.过多产育、流产及宫腔操作是本病发生的诱因,所以避免过多产育、不当怀孕。并积极治疗原发病,减少宫外孕。手术操作要遵循无菌原则,恰当选择手术适应症。对上环者应注意阴道清洁度,有无湿热瘀结证候出现,针对治疗,并选择合适的避孕方式。
In recent years the mobidity of Mycoplasmal and or Chlamydial pelvic inflammation(short as "MPI" and/or "CPI" )(chronic) is higher and higher, which seriously effects the physical and mental health of wowen.At present, the study of traditional Chinese medicine of this disease stagnates in chronic pelvic inflammation,and there is no systematic differentiation of symptoms and signs of this disease.To intensively study the regular pattern in the distribution of TCM patterns of MPI and/or CPI(chronic) and analysize the correlated factor,are of important clinical significance and social value.
Objective:
To approach the regular pattern in the distribution of TCM patterns of MPI and/or CPI(chronic),carry out the standardized differentiations,analyze etiological factor and pathogenesis,study the relationship of the correlated factors and the distribution of the patterns,provide the clinical evidence of differentiation,and help to prevent this disease.
Methods:
To collect cases from inpatient and out patient departments of the first affiliated Hospital of Guangzhou University of TCM(March-2008,May-2009),make the diagnose according to the diagnostic criteria of traditional Chinese medicine,compare the constituent ratios of the patterns,analyze the relationship of the patterns and the correlated factors such as mycoplasma、chlamydia、age、course、gravidity and abortion.
Results:
We collect 164 qualification cases in all.There are 5 patterns,in which are splenic asthenia and blood stasis with hast,kidney asthenia and blood stasis,moist heat with blood stasis,qi-stagnancy and blood stasis,cold coagulation with moist stagnancy.In the study there are 159 cases UU(+),14 cases MH(+),and 17 cases CT(+)(all including mixed infection of pathogens above).The age of onset is between 25 and 34,and most of the course is more than one month.
Conclusions:
1.The patterns of MPI and/or CPI(chronic) by decreasing are the pattern of splenic asthenia and blood stasis with nast,kidney asthenia and blood stasis, moist heat with blood stasis,qi-stagnancy and blood stasis,cold coagulation with moist stagnancy.The distribution of the patterns is mainly for Guangzhou and the areas around.There are many accompanied patterns followed,and its nature is asthenia and sthenia included.The pathogenesis is complicated.The treatment of it should be individual,and pay attention to the accompanied patterns.According to the distribution of the patterns and the characteristic of the pathogenesis,the treating methods should be activating blood circulation to dissipate blood stasis、invigorating kidney and spleen、dissipating heat and dampness and dispersing the depressed liver-qi.
2.The easiest pattern which the patients with CT inflammation are going to be is moist heat with blood stasis,coming next is splenic asthenia and blood stasis with nast.The onset of the disease manifests the pattern of moist heat with blood stasis,accompanied by splenic asthenia,so these patients should be given dissipating heat and dampness、invigorating the spleen and activating blood to prevent the condition worse.
3.The disease occurs mostly in reproductive age,whose courses are more than one month.The state of the illness evolves from moist heat with blood stasis to splenic asthenia and blood stasis with nast,then kidney asthenia and blood stasis,in the progression accompanied by qi-stagnancy and blood stasis、cold coagulation,if not treat actively,the course may be longer and hard to recover.There is close relationship between MPI and/or CPI(chronic) and vaginitis、menstrual disorder、infertility,therefore,we should pay attention to it and treat disease as vaginitis as early as possible.
4.Excessive infanticultures、abortions、ectopic pregnancies and interuterine operations are remote factors of MPI and/or CPI(chronic).So in order to prevent MPI/CPI,we should advise patients avoid excessive infanticultures, unplanned pregnancies and ectopic pregnancies;also we should strictly follow sterilitas principles in operations,and choose indications.To patients with IUD,we should pay attention to the condition of vaginal purity;and notice if there is the appearance of the pattern of moist heat and blood stasis.Choose the suitable methods for contraception.
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