缅甸不同途径感染艾滋病中医证候的研究
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摘要
目的
     通过理论研究,分析、总结艾滋病与中医病证的相关性,探讨艾滋病的病因病机,了解目前缅甸艾滋病中医证候的研究现状和存在的问题。通过临床研究,采集静脉吸毒感染艾滋病和血行感染艾滋病两种患者群的中医临床流行病学资料,对这些患者进行症状、体征、证候的统计研究。通过比较和分析,以及不同人群的差异,为中医药治疗艾滋病提供一定依据,加深对艾滋病的中医认识。
     方法
     1.理论研究:通过全面收集国内艾滋病中医文献,仔细阅读筛选文献,对文献进行分类和信息提取,了解艾滋病与中医病证的相关性、病因病机、证候三方面的研究现状。选择有代表性的文献,摘录各种观点,并进行客观地评价分析和总结。
     2.临床研究:
     (1)对170例缅甸因吸毒感染艾滋病患者的症状、体征(包括舌脉)、证候进行统计分析。
     (2)对160例缅甸血行感染艾滋病患者的症状、体征(包括舌脉)、证候进行统计分析。
     (3)缅甸170例因吸毒感染艾滋病患者与160例缅甸血行感染爱滋病患者症状、体征(包括舌脉)、证候进行比较统计分析。
     结果
     1.症状、体征的比较研究
     目前看到49项症状、体征的比较结果来看,静脉吸毒组有38项(62%)症状、体征的出现频率均高于血行感染组,频率相差最大的是头晕(相差31.11%)X2检验的结果显示,两组患者群有14项(32%)症状、体征的出现频率有显着(P<0.05)或极显着差异(P<0.01),有统计学意义。
     2.证候的比较研究
     (1)证候出现频率的排序
     静脉吸毒感染艾滋病患者群出现的单证多达37种。其中,证候出现频率较高者(10%以上)依次为:痰热蕴肺(27.65%)、气虚证(25.88%)、脾胃气虚(25.29%)、痰湿蕴肺(23.52%)、肾阴虚(22.93%)、肝郁气滞(22.34%)、心阴虚(17.65%)、肾精亏虚(17.06%)、肝阴虚(16.47%)、肾阴阳两虚(15.29%)、肺阴虚、肾阳虚、湿浊困阻(11.76%)。
     血行感染艾滋病出现单证证候频率由高到低为:脾胃气虚(60.64%)、肝郁气滞(50.7%)、肾阴阳两虚(48.66%)、痰湿蕴肺(48.32%)、心气阴两虚(38.9%)、肝郁脾虚(37.56%)、痰热蕴肺(34.91%)、肝胃不和(30.12%)、肾阳虚(28.21%)、心气血两虚(26.4%)、肺阴虚(24.72%)、肾阴虚(20.02%)、心气虚肝阴虚(16.66%)、心血虚(12.58%)、阳虚证(11.22%)、气虚证(10.54%)、外感风寒(3.4%)、胃热(3.06%)、心阳虚(1.36%)、阴虚证气血两虚(1.01%)、胃阳虚(1.01%)、肠燥津亏(0.67%)。
     (2)两组的比较
     从上述17种常见证候的出现频率比较结果来看,血行感染组10种证候(占62.96%)的出现频率均高于吸毒感染组,相差最多的是脾胃气虚(相差33.63%),相差最少的是气血两虚(相差1.38%);吸毒感染组有4种证候(占37.04%)的出现频率高于血行感染组,相差最多的是气虚(相差15.34%),相差最少的是气血两虚证(相差1.38%)。X2检验结果显示:两组常见证候的比较,14证候的出现频率为差异显极显着,有统计学意义。
     两组比较,气虚、痰湿蕴肺、肝郁气滞、肾阴阳两虚、肺阴虚、肾阳虚、湿浊困阻、肝胃不和、肠燥津亏、心气阴两虚、心气虚、心气血两虚、胃脘气滞、痰热蕴肺血虚、阳虚证、肝郁脾虚、血虚证等证候出现频率有极显着差异(P<0.01)
     血行感染组的脾胃气虚、痰湿蕴肺、肝郁气滞、心阴虚、肾阴阳两虚、肺阴虚、肾阳虚、湿浊困阻、肝胃不和、心气阴两虚、胃脘气滞、心气虚、心气血两虚、心血虚、阳虚证、肝郁脾虚、血虚证等证候的出现频率均高于吸毒感染组。吸毒感染组的气虚、肠燥津亏、气血两虚等证候的出现频率高于血行感染组。
     结论
     (1)在全面、系统检索国内数据库全文对艾滋病和中医病证的相关性、病因病机和证候进行初步的研究和总结。艾滋病不等同于任何中医病证,但艾滋病的辨证论治可以参考和借鉴相关的中医病证治疗经验。目前国内艾滋病的证候研究存在证候名称不规范、内涵模糊、辨证机械、研究方案不合理等诸多问题,证候研究的质量有待于提高。
     (2)对因静脉吸毒感染艾滋病的人群进行症状、证候分布的统计学研究,总结了因吸毒感染艾滋病人群的症状及证候特点。
     (3)对因血行感染艾滋病人群进行症状、证候分布的统计学研究,总结了因血行感染艾滋病人群的症状及证候特点。
     (4)对两类人群,即因血行感染艾滋病人群、因吸毒感染艾滋病人群进行了证候比较。
     通过对症状证候整体分析我们认为,艾滋病证候表现为虚实夹杂,虚证的分布从多到少依次为气虚、脾虚、肾虚、肺虚、阴虚、血虚、肝虚、心虚,实证的分布依次为痰湿、血瘀、湿热、热毒。其病毒性质属热毒湿浊,热可成瘀,湿浊化热而成湿热。而不同人群由于病程和其他因素的影响而证候分布略有不同,病程越长,虚证的表现越为突出,研究中因血行感染艾滋病人群总体病程最长,症状表现也最为严重,以虚证为主;因吸毒感染艾滋病人群感染时间虽难以明确,但从其吸毒年限来推测,病程整体较因血行人群短,与因有血行人群相比,此人群证候虚实兼见,实证方面仍以痰湿、热毒、湿热等为特点,虚证与因血行感染人群的分布也相似,只是由于毒品的影响而个别证候在两者中的分布排序有所不同。综上所述,通过我们对血行感染艾滋病与吸毒感染艾滋病人群的分析,我们认为两者的证候特点在本质上是相似的,但由于病程及其他因素干扰(如毒品),其症状、证候的分布又有所区别,体现在临床上,其治则治法是相同的,而扶正祛邪的比例又有不同,用药可有所偏重。
Objective
     The paper analyze and summarize the link between AIDS and the syndrome of Chinese Medicine through the study of theory in order to discuss in TCM. It shows the current research of Chinese Medicine syndrome of AIDS and question. There are two groups of patients in Myanmar. One get infected by paid blood transfusion, the other get infected by intraveneous drug. We get the TCM clinic epidemic data through clinical research and do the statistic research of the morbility mode of the symptoms, objective sign,so as to provide some evidences for the treatment of TCM and know more information of AIDS.
     Methods
     1.Theoretical study:The author read and screened the overall collected domestic AIDS TCM literature, then classified the documents and extract the current useful information about the link between the AIDS and the TCM syndrome and the TCM etiopathogenisis of AIDS and the syndrome of the AIDS. The author chose the representative literature depleting the repeating contents, and extracted all kinds of viewpoint estimating and analyzing objectively. Sorting and comparing the occurrence frequency of the TCM syndrome in statistics.
     2.Clinical Research:
     (1) Analyzing the complaint, sign (included tongue appearance and pulse condition), syndrome and invasion of entrails of170pieces AIDS patients infected by intraveneous drug in Myanmar in statistics.Summarizing the syndrome rule and invasion of the entrails.
     (2) Analyzing the complaint, sign (included tongue appearance and pulse condition), syndrome and invasion of entrails of160pieces AIDS patients infected by paid blood-supply in Myanmar in statistics.Summarizing the syndrome rule and invasion of the entrails. Comparing study about the two groups of patients:complaint, sign (included tongue appearance and pulse condition), syndrome. Get the message of the disparity of the two groups.
     Results
     1.Comparing study of the complaint sign Comparing results of the49complaints and signs:occurrence frequency of38complains and the IV drug infection is higher than the blood-supply infection group. The most different frequency lies in dizzy (31.11%) It shows the severity of the pathogenetic condition of the the IV drug infection group is heavier than blood-supply group.
     The results of the chi-square criterion shows:there are13significant deviations or extremely significant deviations (occupied32%) in the occurrence frequency of the complaints and signs, and statistical significance exits.It is thus clear that two groups of the patients'pathogenetic condition are dixtinct.
     2.Comparing study of syndrome
     (1)Sorting syndromes'occurrence frequency The higher occurrence frequency in the IV drug group in order:pattern of spleen-stomach qi deficiency;pattern of qi deficiency, pattern of phlegm-heat congestion of lung;pattern of phlegm moist accumulation in the lung,kidney yin deficiency pattern;pattern of liver depression with qi tagnation; heart yin deficiency pattern; kidney essence insufficiency syndrome;liver yin deficiency; kidney yin and yang deficiency pattern; lung yin deficiency pattern; kidney yang deficiency pattern; pattern of damp-turbidity obstruction. The higher occurrence frequency in the blood-supply group in order:pattern of spleen-stomach qi deficiency,pattern of liver depression with qi stagnation;kidney yin and yang deficiency pattern;pattern of phlegm moist accumulation in the lung, heart qi and yin deficiency pattern; pattern of liver-stomach disharmony;pattern of phlegm-heat congestion of lung;kidney yan deficiency pattern;heart qi and blood deficiency syndrome;lung ying deficiency pattern;kidney ying deficiency deficiency;heart qi deficiency;liver ying deficiency pattern.
     (2)Comparison of common syndrome occurrence frequency12syndromes occurrence frequency of the blood-supply group are all higher than IV drug group, the most difference of the occurrence frequency is qi deficiency in spleen-stomach while the little difference of it is pattern of phlegm-heat congestion of lung; The results of the chi-square criterion showsthere are significant deviations or extremely significant deviations in the occurrence frequency of the complaints and signs, and statistical significance exits.
     (3)Comparison of two groups there are extremely significant deviation in pattern of spleen-stomach qi deficiency;pattern of qi deficiency,;pattern of phlegm moist accumulation in the lung,pattern of liver depression with qi stagnation;kidney yin and yang deficiency pattern;lung ying qi deficiency,kidney yang qi deficiency, pattern;pattern of phlegm moist accumulation in the lung,heart qi ying both qi deficiency,heart blood deficiency pattern;yang deficiency pattern of P value below0.001.The syndromes'frequency of blood-supply group is higher of drug group:qi deficiency of spleen-stomach, liver depression with qi stagnation, kidney yin and yang deficiency, disharmony and liver and stomach, pattern of damp-turbidity obstruction, heart qi and yin deficiency, stomach qi stagnation, heart qi deficiency, heart qi and blood deficiency, liver depression with spleen qi deficiency. The occurring frequency of qi deficiency, qi and blood deficiency, insufficiency of large intestinal fluidsyndromes in IV drug group are higher than in blood-supply group.
     Conclusions
     (1) Overall and systemic searching the domestic data-base a, do the primary research and summarize the link of the AIDS and Chinese medical science disease and syndromes, etiological factor, syndromes. AIDS is not equal to any kind of Chinese medicine disease and syndromes. However, AIDS'determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs can refer to correlative Chinese disease experience. The current domestic AIDS syndrom research has the following question: nonstandard names, blurry connotation, pedestrian differentiation of symptoms and signs, unreasonable program, and the illegal quality of the syndrome research.
     (2) Analyzing the complaint, sign syndrome and invasion of entrails of170pieces AIDS patients infected by intraveneous drug in Myanmar in statistics.Summarizing the syndrome rule and invasion of the entrails.
     (3) Analyzing the complaint, sign, syndrome and invasion of entrails of160pieces AIDS patients infected by paid blood-supply in Myanmar in statistics.Summarizing the syndrome rule and invasion of the entrails. Comparing study about the two groups of patients:complaint, sign (included tongue appearance and pulse condition), syndrome.Get the message of the disparity of the two groups.
     We can see AIDS shows deficiency pattern from high to low is qi deficiency pattern, spleen deficiency, kidney deficiency, lung deficiency、ying deficiency、blood deficiency liver and heart deficiency,andthe empirical distribution of phlegm dampness, blood stasis, hot and humid, hot poison. The virus nature belongs to toxic heat, dampness heat into stasis, wet soft hot and humid,While different people due to the course of the disease and syndrome distribution is slightly different from the effects of other factors, the longer the duration, deficiency syndrome performance is outstanding,Due to the line of blood infected with HIV/AIDS population in the study of the overall course of the longest, symptoms are the most serious, mainly deficiency syndrome;HIV infection time that people from taking drugs is difficult to clear, but from the drug use fixed number of year to speculate that the overall course of the disease than with the blood line is short, and compared with the blood line, the crowd syndrome deficiency.empirical aspect still with phlegm dampness, toxic heat, hot and humid as the characteristics of deficiency syndrome and because infected blood type distribution was similar,Just because of the influence of drugs and individual syndrome distribution in both ordering is different. To sum up, through our line of blood infected with AIDS and drug HIV population analysis, we think the two syndromes characteristic in essence is similar, but because of interference duration and other factors (such as drugs), its distribution and different of symptoms, syndrome, reflected in clinic, its therapy and therapeutic principle is the same, and foster the proportion is different, medication can be used in different way.
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