结核性胸膜炎中医证候规律探讨性研究
|
摘要
目的通过文献研究、临床回顾性病例调查研究,总结分析广州中医药大学第一附属医院结核性胸膜炎住院患者的常见证型及征候分布特点,探索建立其中医证候规律,为临床更好的对结核性胸膜炎进行辨证论治提供理论依据和指导意义。
方法对收集到的330例符合纳入标准的结核性胸膜炎病人进行生活资料、入院时临床症状等信息的调查,进行症型统计。使用SPSS 11.5统计处理,通过聚类分析,初步探讨相关中医证候的分布规律.
结果通过聚类分析,归为四类,分别为：饮停胸胁证、邪犯胸肺证、气滞络痹证、阴虚内热证。饮停胸胁证所占总病例数为47.6%,主要临床表现为胸闷,胸胁胀满,呼吸气短,胸胁疼痛,不可平卧,纳差,舌淡,苔白,脉沉弦；邪犯胸肺证占32.7%,主要临床表现为胸胁疼痛,胸闷,恶寒发热,咽干口苦,咳嗽,咯黄白粘痰,纳差,舌淡红,苔腻,脉弦；气滞络痹证占12.1%,主要临床表现为胸胁疼痛,胸闷,唇甲青紫,纳差,舌紫暗、瘀点瘀斑,苔薄白,脉沉弦；阴虚内热证占7.6%,主要临床表现为胸胁疼痛,口干欲饮,五心烦热,小便短赤,大便秘结,咽干,舌红苔黄少,脉数。
结论：上述四种证型所包括的临床症状均可反映悬饮病阳虚阴盛,输布失调,因虚致实,虚实夹杂,水饮停积,水瘀互结为患的病理性质,由于大多数患者就诊时多为发作期,故证型分布以标实为主。临床辨证证型分布及聚类分析证型分布整体符合率为49.7%。两种辩证分型的一致性较低,分析原因,可能与临床中医证候标准不统一,导致临床医生对中医证型的判定不一致,以及回顾性资料研究中重要信息不全有关。
Objective To explore the distribute regulation of TCM symptom-sign in tuberculous pleurisy, and the regulation of syndrome differentiation of and the regulation of syndrome differentiation of symptom-sign which match TCM clinical practice. And provide references to Improve the prevention and treatment of the disease TCM effect.
Methods Collected 330 cases met the inclusion criteria for patients with the diminished ovarian reserve. Surveyed detailed history, means of living and the four diagnostic information. To analyze the relative factors. Use SPSS 11.5 for statistics, By clustering analysis, then decide the pattern of syndrome of every cluster category combining theory of TCM.
Results Cluster analysis classified into four categories, namely:the Yin stopped Xiong Xie syndrome, the evil committed chest syndrome, Qi stagnation Luo arthralgia, yin deficiency heat syndrome. Yin stopped to the total number of cases was 47.6%, the main clinical manifestations of chest tightness, fullness Xiong Xie, breathing shortness of breath, Xiong Xie pain, not supine, anorexia, pale tongue, white coating, pulse string; evil 32.7% committed Chest cards, the main clinical manifestations of Xiong Xie pain, chest tightness, chills, fever, throat, mouth pain, cough, slightly yellow phlegm, anorexia, pale tongue, greasy moss, pulse string; Qi stagnation Luo arthralgia 12.1%, main clinical manifestations Xiong Xie pain, chest tightness, a purple lips, anorexia, dark purple tongue, petechiae petechiae, thin white fur, the pulse string; yin deficiency heat syndrome accounted for 7.6%, the main clinical Xiong Xie showed pain, dry mouth, want to drink, five upset hot, scanty dark urine, constipation, dry throat, red tongue yellow little pulse. Conclusion The four syndromes included in the clinical symptoms may reflect the yin yang hang drinking disease, transmission distribution imbalance, deficiency caused by Actuality mixed, stop drinking the water volume, water, suffering from the pathological stasis became the nature of each other, as the majority of treatment when patients are mostly attack, so the card type distribution in real standard-based. Clinical syndrome syndrome syndrome distribution and cluster analysis of the overall compliance rate was 49.7% distribution. Both the consistency of the dialectical lower type, analyze the causes and clinical syndromes may be non-uniform standards, the clinician's decision on TCM lack of consistency, retrospective study of important data on incomplete information.
方法对收集到的330例符合纳入标准的结核性胸膜炎病人进行生活资料、入院时临床症状等信息的调查,进行症型统计。使用SPSS 11.5统计处理,通过聚类分析,初步探讨相关中医证候的分布规律.
结果通过聚类分析,归为四类,分别为：饮停胸胁证、邪犯胸肺证、气滞络痹证、阴虚内热证。饮停胸胁证所占总病例数为47.6%,主要临床表现为胸闷,胸胁胀满,呼吸气短,胸胁疼痛,不可平卧,纳差,舌淡,苔白,脉沉弦；邪犯胸肺证占32.7%,主要临床表现为胸胁疼痛,胸闷,恶寒发热,咽干口苦,咳嗽,咯黄白粘痰,纳差,舌淡红,苔腻,脉弦；气滞络痹证占12.1%,主要临床表现为胸胁疼痛,胸闷,唇甲青紫,纳差,舌紫暗、瘀点瘀斑,苔薄白,脉沉弦；阴虚内热证占7.6%,主要临床表现为胸胁疼痛,口干欲饮,五心烦热,小便短赤,大便秘结,咽干,舌红苔黄少,脉数。
结论：上述四种证型所包括的临床症状均可反映悬饮病阳虚阴盛,输布失调,因虚致实,虚实夹杂,水饮停积,水瘀互结为患的病理性质,由于大多数患者就诊时多为发作期,故证型分布以标实为主。临床辨证证型分布及聚类分析证型分布整体符合率为49.7%。两种辩证分型的一致性较低,分析原因,可能与临床中医证候标准不统一,导致临床医生对中医证型的判定不一致,以及回顾性资料研究中重要信息不全有关。
Objective To explore the distribute regulation of TCM symptom-sign in tuberculous pleurisy, and the regulation of syndrome differentiation of and the regulation of syndrome differentiation of symptom-sign which match TCM clinical practice. And provide references to Improve the prevention and treatment of the disease TCM effect.
Methods Collected 330 cases met the inclusion criteria for patients with the diminished ovarian reserve. Surveyed detailed history, means of living and the four diagnostic information. To analyze the relative factors. Use SPSS 11.5 for statistics, By clustering analysis, then decide the pattern of syndrome of every cluster category combining theory of TCM.
Results Cluster analysis classified into four categories, namely:the Yin stopped Xiong Xie syndrome, the evil committed chest syndrome, Qi stagnation Luo arthralgia, yin deficiency heat syndrome. Yin stopped to the total number of cases was 47.6%, the main clinical manifestations of chest tightness, fullness Xiong Xie, breathing shortness of breath, Xiong Xie pain, not supine, anorexia, pale tongue, white coating, pulse string; evil 32.7% committed Chest cards, the main clinical manifestations of Xiong Xie pain, chest tightness, chills, fever, throat, mouth pain, cough, slightly yellow phlegm, anorexia, pale tongue, greasy moss, pulse string; Qi stagnation Luo arthralgia 12.1%, main clinical manifestations Xiong Xie pain, chest tightness, a purple lips, anorexia, dark purple tongue, petechiae petechiae, thin white fur, the pulse string; yin deficiency heat syndrome accounted for 7.6%, the main clinical Xiong Xie showed pain, dry mouth, want to drink, five upset hot, scanty dark urine, constipation, dry throat, red tongue yellow little pulse. Conclusion The four syndromes included in the clinical symptoms may reflect the yin yang hang drinking disease, transmission distribution imbalance, deficiency caused by Actuality mixed, stop drinking the water volume, water, suffering from the pathological stasis became the nature of each other, as the majority of treatment when patients are mostly attack, so the card type distribution in real standard-based. Clinical syndrome syndrome syndrome distribution and cluster analysis of the overall compliance rate was 49.7% distribution. Both the consistency of the dialectical lower type, analyze the causes and clinical syndromes may be non-uniform standards, the clinician's decision on TCM lack of consistency, retrospective study of important data on incomplete information.
引文
[1]陈文彬.胸腔积液诊断的思堆程序与步骤[J].实用肺科杂志,1996,3(2)：5
[2]施毅.陈正堂现代呼吸病治疗学[M].北京：人民军医出版社,2002,496.
[3]李嫣红,谢灿茂.结核性胸膜炎的发病机制研究进展[J].国外医学内科学分册,2002：9(29)9：373
[4]王吉耀,廖二元,胡品津等.内科学[M],北京：人民卫生出版社,2005,8(1)：100
[5]金周德,于关成,曹洪顺.耐药结核病产生原因的探讨[J].吉林医学,2008；1(29)1：72-73
[6]王撷秀.耐多药结核病的预防[J].中华结核和呼吸杂志,2006；39(8)：511-513.
[7]国家中医药管理局医政司.中医病证诊断疗效标准.南京：南京大学出版社,1994：4
[8]张敦熔.肺结核的诊断与治疗[M].北京：人民军医出版社,2004；161-163
[9]苗倩.活血化瘀法对结核性胸膜炎胸膜增厚的影响及对胸水中TGF-β1的干预作用.广州中医药大学硕士学位论文,2009；5：17
[10]Light RW. Pleural Disease.3rd, Baltimore:WⅢia/N8&Wilkins,1995; 154-166
[11]Bouros D. Schiza S, Patsourakis G, et al. lmrapleural streptokinase versas urokenase in the treatment of complicated parapneumonic effasion. AH1 J Respir Crit care Med.1997; 155:294-295
[12]陈新谦,金有豫等.新编药物学[M].北京：人民卫生出版社,第14版：422-423
[13]阴智敏,田正良.浅述结核性胸膜炎的辨证论治[J].陕西中医,2005；26(11)：56
[14]林永乐,张华,悬饮证治[J],福建中医药,1998,10(30)：5[15]李义群,王涛.渗出性胸膜炎中医临床证型的X线分析[J].职业与腱康,1999,12(15)：12
[16]刘红霞,梁定,等.渗出性胸膜炎中医辨证现代化研究[J].中国中西医结合杂志,2008,2(6)：1
[17]陆礼然.葶苈大枣泻肺汤加味治疗渗出性胸膜炎的临床观察[J].贵阳中医学院学报,1988；(3)：30-31
[18]彭治安.小柴胡汤治疗悬饮一附42例临床观察[J].湖南中医杂志,1987；3(2)：12-13
[19]关深涛.复元活血汤治愈悬饮1例[J].陕西中医,1987； (1)10：23
[20]侯天印.饮瘀同治包裹性胸水[J].中级医刊,1988；23(8)：491
[21]罗永兵,王俊峰.浅谈中西医对结核性渗出性胸膜炎发生胸膜增厚的防治[J].国医论坛,2006；21(4)：20-21
[22]谢灿茂.胸膜疾病的流行概况[J].中华结核和呼吸杂志,2001；24(1)12：213s
[23]中华医学会结核病学分会.中国结核病分类法.中华结核和呼吸杂志,1998；21：716-717
[24]谢惠安.现代结核病学[M],北京：人民卫生出版社,2000,326-327
[25]田德禄.中医内科学.1版[M].北京：人民卫生出版社,2007,04：105-107
[26]陈小燕.支气管扩张中医证候规律研究.广州中医药大学硕士学位论文.2007；4：40
[2]施毅.陈正堂现代呼吸病治疗学[M].北京：人民军医出版社,2002,496.
[3]李嫣红,谢灿茂.结核性胸膜炎的发病机制研究进展[J].国外医学内科学分册,2002：9(29)9：373
[4]王吉耀,廖二元,胡品津等.内科学[M],北京：人民卫生出版社,2005,8(1)：100
[5]金周德,于关成,曹洪顺.耐药结核病产生原因的探讨[J].吉林医学,2008；1(29)1：72-73
[6]王撷秀.耐多药结核病的预防[J].中华结核和呼吸杂志,2006；39(8)：511-513.
[7]国家中医药管理局医政司.中医病证诊断疗效标准.南京：南京大学出版社,1994：4
[8]张敦熔.肺结核的诊断与治疗[M].北京：人民军医出版社,2004；161-163
[9]苗倩.活血化瘀法对结核性胸膜炎胸膜增厚的影响及对胸水中TGF-β1的干预作用.广州中医药大学硕士学位论文,2009；5：17
[10]Light RW. Pleural Disease.3rd, Baltimore:WⅢia/N8&Wilkins,1995; 154-166
[11]Bouros D. Schiza S, Patsourakis G, et al. lmrapleural streptokinase versas urokenase in the treatment of complicated parapneumonic effasion. AH1 J Respir Crit care Med.1997; 155:294-295
[12]陈新谦,金有豫等.新编药物学[M].北京：人民卫生出版社,第14版：422-423
[13]阴智敏,田正良.浅述结核性胸膜炎的辨证论治[J].陕西中医,2005；26(11)：56
[14]林永乐,张华,悬饮证治[J],福建中医药,1998,10(30)：5[15]李义群,王涛.渗出性胸膜炎中医临床证型的X线分析[J].职业与腱康,1999,12(15)：12
[16]刘红霞,梁定,等.渗出性胸膜炎中医辨证现代化研究[J].中国中西医结合杂志,2008,2(6)：1
[17]陆礼然.葶苈大枣泻肺汤加味治疗渗出性胸膜炎的临床观察[J].贵阳中医学院学报,1988；(3)：30-31
[18]彭治安.小柴胡汤治疗悬饮一附42例临床观察[J].湖南中医杂志,1987；3(2)：12-13
[19]关深涛.复元活血汤治愈悬饮1例[J].陕西中医,1987； (1)10：23
[20]侯天印.饮瘀同治包裹性胸水[J].中级医刊,1988；23(8)：491
[21]罗永兵,王俊峰.浅谈中西医对结核性渗出性胸膜炎发生胸膜增厚的防治[J].国医论坛,2006；21(4)：20-21
[22]谢灿茂.胸膜疾病的流行概况[J].中华结核和呼吸杂志,2001；24(1)12：213s
[23]中华医学会结核病学分会.中国结核病分类法.中华结核和呼吸杂志,1998；21：716-717
[24]谢惠安.现代结核病学[M],北京：人民卫生出版社,2000,326-327
[25]田德禄.中医内科学.1版[M].北京：人民卫生出版社,2007,04：105-107
[26]陈小燕.支气管扩张中医证候规律研究.广州中医药大学硕士学位论文.2007；4：40