子宫腺肌病发病相关因素及中医证候分布特点临床调查研究
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摘要
目的:本研究旨在了解子宫腺肌病发病相关因素,并对其中医证候分布特点进行探讨。方法:采用病例——对照的研究方法,对子宫腺肌病患者及健康女性的临床资料进行统计分析,找出本病发病的相关因素,同时对子宫腺肌病患者症状进行统计分析,探讨本病中医证候分布情况及辨证特点。结果:1.通过x~2检验和t检验,找出病例组与对照组中差异性比较有统计学意义的因素,再将上述因素进行Logistic回归分析,得出子宫腺肌病发病的危险因素为:年龄处于育龄期、长期从事脑力劳动、月经过多、经期延长或崩漏、原发性痛经史、妊娠次数多、采取宫内节育器避孕、多次宫腔操作史、子宫肌瘤病史及情志异常等,保护因素为月经后期或闭经。2.根据聚类分析结果,可将子宫腺肌病分为气滞血瘀、热蕴血瘀、痰瘀互结、肾虚血瘀、气虚血瘀、寒凝血瘀六大证型。结论:1.总结了子宫腺肌病的10种发病危险因素和1种保护性因素。2.运用聚类分析等统计方法对中医基本证型进行分类是有帮助的。3.当前开展子宫腺肌病发病相关因素及中医证候分布特点的流调工作对指导临床有一定实际意义。
Objective:To explorer the relevant factors of Adenomyosis patients and to summarize the syndromes distribution regularity and the characteristics of syndrome diferentiation. Method:Used case-control study methods,the patients and the healthy women were statistical analysis by clinical data in order to observe the relevant factors and the syndromes distribution regularity and the characteristics of syndrome diferentiation. Results: 1. The chi-square test suggests:the differences of some factorsh-ave statistically significant between the case group and the control group. Risk factors of Adenomyosis: logistic regression suggests: age,brainworker,the times of the operation in uterus, intrauterine device (IUD) contraception manner,pregnancy and delivery, menostaxis, menorrhagia,primary dysmenorrhea,emotional upsets,the medical history of hysteromyoma are the risk factors. Delayed menstrual cycle is the protectirefactors of Adenomyosis. 2. According to clustera nalysis, the symptoms of Adenomyosis patients could be divided into six nests, including qi stagnation and blood stasis type, blood stasis and heat accumulation type, kidney deficiency and blood stasis type, intermingled phlegm and blood stasis type, qi deficiency and blood stasis type and cold coagulation and blood stasis type.
Conclusion:1.Nine risk factors and a protectirefactors of Adenomyosis are generalized. 2.Cluster analysis is helpful to classification of elementary syndromes of TCM. 3.It is significant practically to carry out epidemiological study of syndromes of TCM of Adenomyosis.
Objective:To explorer the relevant factors of Adenomyosis patients and to summarize the syndromes distribution regularity and the characteristics of syndrome diferentiation. Method:Used case-control study methods,the patients and the healthy women were statistical analysis by clinical data in order to observe the relevant factors and the syndromes distribution regularity and the characteristics of syndrome diferentiation. Results: 1. The chi-square test suggests:the differences of some factorsh-ave statistically significant between the case group and the control group. Risk factors of Adenomyosis: logistic regression suggests: age,brainworker,the times of the operation in uterus, intrauterine device (IUD) contraception manner,pregnancy and delivery, menostaxis, menorrhagia,primary dysmenorrhea,emotional upsets,the medical history of hysteromyoma are the risk factors. Delayed menstrual cycle is the protectirefactors of Adenomyosis. 2. According to clustera nalysis, the symptoms of Adenomyosis patients could be divided into six nests, including qi stagnation and blood stasis type, blood stasis and heat accumulation type, kidney deficiency and blood stasis type, intermingled phlegm and blood stasis type, qi deficiency and blood stasis type and cold coagulation and blood stasis type.
Conclusion:1.Nine risk factors and a protectirefactors of Adenomyosis are generalized. 2.Cluster analysis is helpful to classification of elementary syndromes of TCM. 3.It is significant practically to carry out epidemiological study of syndromes of TCM of Adenomyosis.
引文
[1]彭超,周应芳.子宫腺肌病318例诊治分析.中国妇产科临床,2001;2:72-74.
[2]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;7(33):434.
[3]刘鑫磊.子宫腺肌症危险因素及VEGF和MVD在放置IUD的AM患者子宫内膜中的表达.长春:吉林大学,2006.
[4]Chrysostomou M,Akalesros G,Kallistros S,et al.lncidenos of adenomyosis uteri in a Greek population.Acta Obstet Gynecol Scand,1991:70:441.
[5]Shaikh H,Khan KS.Adenomyosis in Pakistani women:four year experience at the Aga Khan University Medical Center,Karachi.J Clin Pathol,1990;43:817.
[6]中华人民共和国卫生部.中药新药临床研究指导原则.北京:中国中医药出版社,1993,1:256-266.
[7]乐杰主编.妇产科学,第6版,北京:人民卫生出版社,2005,10:361.
[8]张玉珍主编.中医妇科学,北京:中国中医药出版社,2002,第1版.
[9]郑筱萸主编.中药新药临床研究指导原则,北京:中国医药出版社,2002,第1版:240-241.
[10]赵仲堂.流行病学研究方法与应用.北京:科技出版社,2000,第1版:76-79.
[11]潘凌亚.子宫内膜异位症发病高危因素的病例——对照研究.北京:北京协和医院.1993.
[12]许金晶.慢性盆腔炎发病相关因素及中医证候的研究.济南:山东中医药大学.2007.
[13]廖书杰.妊娠期糖尿病的发生及其危险因素的研究.昆明:昆明医学院.2005.
[14]Ezaki K,Motoyama H,Sasaki H.Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis.Obstet Gynecol,2001;98:815.
[15]郭志荣,张琚,郎景和等.子宫腺肌症患者在位子宫内膜雌激素效应相关因子的 时空变化,中华妇产科杂志,2004:39(4):246-249.
[16]周清平,汪锡耀,方英等.子宫腺肌病患病临床因素的相关性分析.中国妇幼保健,2005;20(3):296-297.
[17]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;33:434.
[18]李琼.宫内节育器的国内外研究进展.新医学 2003,34(6):396-397.
[19]周应芳,吴北生.盆腔子宫内膜异位症发病因素的调查.中华妇产科杂志,1995;30(6):356-359.
[20]李宝婷,钱丽娟.子宫腺肌症患者妊娠和节育手术史调查.中华计划生育学杂志,1999:45(1):26-28.
[21]Nesit V,et al.Adenomyosis as a social problem.GeskGynekol,1990,55:732.
[22]徐金陵.子宫腺肌病的病因与防范探讨.中华实用中西医杂志,2003;16(3):1611-1612.
[23]Mori T,et al.Animal model of uterine adenomyosis;isprolactin a potent inducer of Adenomyosis in mice? Am J Obstet Gynecol,1991;165:232.
[24]Mori T,Nagasava H,Mechanisms of development of prolactin-induced adenomyosis in mice.Acta Anat,1983;116:46.
[25]林佳静.痛经发病相关因素与中医证候学的调查与分析.北京:北京中医药大学.2007.
[26]周应芳,王贞娟.子宫腺肌症患者妊娠和计划生育手术史调查.北京医学,1996;18(2):78-81.
[27]Schulman H,et al.The uterine contractility index:a research and diagnostic tool in dysmenorrhea.Am J Obstet Gynecol 1983;145:1049.
[28]Muse KN.Cyelic Pelvic pain.Obstet Gyneeol Clin Morth Am 1990;14:427
[29]Dawood MY.Dysmenorrhea.Clin Obstet Gynecol 1990;33:168
[30]Ferenczy A.Pathophysiology of adenomyosis.Hum Reprod Update.1998;4(4):312.
[31]钟梅.岭南地区子宫内膜异位症的中医证候分析.广州,广州中医药大学,2007.
[32]白红,赵丽嫣.子宫腺肌病病因与发病机制研究进展.中国妇产科临床杂志,2003:4(6):460-461.
[33]赵淑清,刘惜时,张惜阴.子宫腺肌症生物学行为探讨.上海医学,2001;24(6):346-348.
[34]叶青,王红新.活血消癥化瘀止痛法分期治疗子宫腺肌病临床观察.山东中医杂志.2007:26(11):745-747.
[35]叶青.活血消癥胶囊与化瘀止痛胶囊分期治疗子宫腺肌病临床研究.中国中医急症.2008;17(2):179-180.
[36]叶青,高进军.中医药分期治疗对子宫腺肌病患者免疫调节作用的影响研究.山东中医药大学学报.2007;31(5):382-384.
[1]叶青,王红新.活血消癥化瘀止痛法分期治疗子宫腺肌病临床观察.山东中医杂志.2007;26(11):745-747.
[2]叶青.活血消癥胶囊与化瘀止痛胶囊分期治疗子宫腺肌病临床研究.中国中医急症.2008;17(2):179-180.
[3]乐杰主编.妇产科学,北京:人民卫生出版社,2004年,第6版:361.
[4]周应芳,麦永嫣,郑淑蓉.子宫腺肌症的发病原因和诊治研究进展.中华妇产科杂志,1995:30(8):502-505.
[5]Chrysostomou M,Akalesros G,Kallistros S,et al.Incidenos of adenomyosis uteri in a Greek population.Acta Obstet Gynecol Scand,1991;70:441.
[6]Shaikh H Khan KS.Adenomyosis in Pakistani women:four year experience at the Aga Khan University Medical Centre,Karachi.J Clin Pathol,1990;43:817.
[7]陈忠年,杜心谷,刘伯宁.妇产科病理学.上海:上海医科大学出版社,1996;135-138.
[8]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;33:434.
[9]Ezaki K,MotoyamaH,SasakiH.Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis.Obstet Gynecol,2001;98:815.
[10]周清平,汪锡耀,方英等.子宫腺肌病患病临床因素的相关性分析.中国妇幼保健,2005;20(3):296-297.
[11]徐金陵.子宫腺肌病的病因与防范探讨.中华实用中西医杂志,2003;16(3):1611-1612.
[12]赵淑清,刘惜时,张惜阴.子宫腺肌症生物学行为探讨.上海医学,2001;24(6):346-348.
[13]Ferenczy A.Pathophysiology of adenomyosis.Hum Reprod Update,1998;4(4):312.
[14]李琼.宫内节育器的国内外研究进展.新医学,2003;34(6):396-397.
[15]Kirshon B,Alfred N.A tidk factor for endometriosis.Obstet gynecol,1988;71:829.
[16]Nesit V,et al.Adenomyosis as a social problem.GeskGynekol,1990;55:732.
[17]Amold LL,Ascher SM,Simon JA,et al.Famillial adenomyosis:a case report.Feritl Steril,1994;61:1165-1167.
[18]宋利丽,潘德京,陈为民,等.HLA-DQA1、LA-DRB1等位基因与子宫内膜异位症和子宫腺肌症的比较性研究.中华医学遗传学杂志,2002;19(1):49-51.
[19]严勤华.朱南孙学术经验拾掇.中医文献杂志,1997:(2):27-28.
[20]刘海燕,张士表,王金凤,等.补肾祛瘀法在辨证论治子宫腺肌病中的体会.中国现代医生,2005;45(3):53.
[21]徐慧军,严建敏,邰国香.辨证论治子宫腺肌病.山东中医杂志,2006;25(8):564-565.
[22]经燕,王清.许润三治疗子宫内膜异位症、子宫腺肌病经验总结.中日友好医院学报,2004;18(2):104-105.
[23]袁亚敏,丁春桃.魏绍斌主任医师治疗子宫腺肌病经验.四川中医,2007;25(6):4-5.
[2]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;7(33):434.
[3]刘鑫磊.子宫腺肌症危险因素及VEGF和MVD在放置IUD的AM患者子宫内膜中的表达.长春:吉林大学,2006.
[4]Chrysostomou M,Akalesros G,Kallistros S,et al.lncidenos of adenomyosis uteri in a Greek population.Acta Obstet Gynecol Scand,1991:70:441.
[5]Shaikh H,Khan KS.Adenomyosis in Pakistani women:four year experience at the Aga Khan University Medical Center,Karachi.J Clin Pathol,1990;43:817.
[6]中华人民共和国卫生部.中药新药临床研究指导原则.北京:中国中医药出版社,1993,1:256-266.
[7]乐杰主编.妇产科学,第6版,北京:人民卫生出版社,2005,10:361.
[8]张玉珍主编.中医妇科学,北京:中国中医药出版社,2002,第1版.
[9]郑筱萸主编.中药新药临床研究指导原则,北京:中国医药出版社,2002,第1版:240-241.
[10]赵仲堂.流行病学研究方法与应用.北京:科技出版社,2000,第1版:76-79.
[11]潘凌亚.子宫内膜异位症发病高危因素的病例——对照研究.北京:北京协和医院.1993.
[12]许金晶.慢性盆腔炎发病相关因素及中医证候的研究.济南:山东中医药大学.2007.
[13]廖书杰.妊娠期糖尿病的发生及其危险因素的研究.昆明:昆明医学院.2005.
[14]Ezaki K,Motoyama H,Sasaki H.Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis.Obstet Gynecol,2001;98:815.
[15]郭志荣,张琚,郎景和等.子宫腺肌症患者在位子宫内膜雌激素效应相关因子的 时空变化,中华妇产科杂志,2004:39(4):246-249.
[16]周清平,汪锡耀,方英等.子宫腺肌病患病临床因素的相关性分析.中国妇幼保健,2005;20(3):296-297.
[17]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;33:434.
[18]李琼.宫内节育器的国内外研究进展.新医学 2003,34(6):396-397.
[19]周应芳,吴北生.盆腔子宫内膜异位症发病因素的调查.中华妇产科杂志,1995;30(6):356-359.
[20]李宝婷,钱丽娟.子宫腺肌症患者妊娠和节育手术史调查.中华计划生育学杂志,1999:45(1):26-28.
[21]Nesit V,et al.Adenomyosis as a social problem.GeskGynekol,1990,55:732.
[22]徐金陵.子宫腺肌病的病因与防范探讨.中华实用中西医杂志,2003;16(3):1611-1612.
[23]Mori T,et al.Animal model of uterine adenomyosis;isprolactin a potent inducer of Adenomyosis in mice? Am J Obstet Gynecol,1991;165:232.
[24]Mori T,Nagasava H,Mechanisms of development of prolactin-induced adenomyosis in mice.Acta Anat,1983;116:46.
[25]林佳静.痛经发病相关因素与中医证候学的调查与分析.北京:北京中医药大学.2007.
[26]周应芳,王贞娟.子宫腺肌症患者妊娠和计划生育手术史调查.北京医学,1996;18(2):78-81.
[27]Schulman H,et al.The uterine contractility index:a research and diagnostic tool in dysmenorrhea.Am J Obstet Gynecol 1983;145:1049.
[28]Muse KN.Cyelic Pelvic pain.Obstet Gyneeol Clin Morth Am 1990;14:427
[29]Dawood MY.Dysmenorrhea.Clin Obstet Gynecol 1990;33:168
[30]Ferenczy A.Pathophysiology of adenomyosis.Hum Reprod Update.1998;4(4):312.
[31]钟梅.岭南地区子宫内膜异位症的中医证候分析.广州,广州中医药大学,2007.
[32]白红,赵丽嫣.子宫腺肌病病因与发病机制研究进展.中国妇产科临床杂志,2003:4(6):460-461.
[33]赵淑清,刘惜时,张惜阴.子宫腺肌症生物学行为探讨.上海医学,2001;24(6):346-348.
[34]叶青,王红新.活血消癥化瘀止痛法分期治疗子宫腺肌病临床观察.山东中医杂志.2007:26(11):745-747.
[35]叶青.活血消癥胶囊与化瘀止痛胶囊分期治疗子宫腺肌病临床研究.中国中医急症.2008;17(2):179-180.
[36]叶青,高进军.中医药分期治疗对子宫腺肌病患者免疫调节作用的影响研究.山东中医药大学学报.2007;31(5):382-384.
[1]叶青,王红新.活血消癥化瘀止痛法分期治疗子宫腺肌病临床观察.山东中医杂志.2007;26(11):745-747.
[2]叶青.活血消癥胶囊与化瘀止痛胶囊分期治疗子宫腺肌病临床研究.中国中医急症.2008;17(2):179-180.
[3]乐杰主编.妇产科学,北京:人民卫生出版社,2004年,第6版:361.
[4]周应芳,麦永嫣,郑淑蓉.子宫腺肌症的发病原因和诊治研究进展.中华妇产科杂志,1995:30(8):502-505.
[5]Chrysostomou M,Akalesros G,Kallistros S,et al.Incidenos of adenomyosis uteri in a Greek population.Acta Obstet Gynecol Scand,1991;70:441.
[6]Shaikh H Khan KS.Adenomyosis in Pakistani women:four year experience at the Aga Khan University Medical Centre,Karachi.J Clin Pathol,1990;43:817.
[7]陈忠年,杜心谷,刘伯宁.妇产科病理学.上海:上海医科大学出版社,1996;135-138.
[8]张信美,石一复.子宫腺肌症206例临床分析.中华妇产科杂志,1998;33:434.
[9]Ezaki K,MotoyamaH,SasakiH.Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis.Obstet Gynecol,2001;98:815.
[10]周清平,汪锡耀,方英等.子宫腺肌病患病临床因素的相关性分析.中国妇幼保健,2005;20(3):296-297.
[11]徐金陵.子宫腺肌病的病因与防范探讨.中华实用中西医杂志,2003;16(3):1611-1612.
[12]赵淑清,刘惜时,张惜阴.子宫腺肌症生物学行为探讨.上海医学,2001;24(6):346-348.
[13]Ferenczy A.Pathophysiology of adenomyosis.Hum Reprod Update,1998;4(4):312.
[14]李琼.宫内节育器的国内外研究进展.新医学,2003;34(6):396-397.
[15]Kirshon B,Alfred N.A tidk factor for endometriosis.Obstet gynecol,1988;71:829.
[16]Nesit V,et al.Adenomyosis as a social problem.GeskGynekol,1990;55:732.
[17]Amold LL,Ascher SM,Simon JA,et al.Famillial adenomyosis:a case report.Feritl Steril,1994;61:1165-1167.
[18]宋利丽,潘德京,陈为民,等.HLA-DQA1、LA-DRB1等位基因与子宫内膜异位症和子宫腺肌症的比较性研究.中华医学遗传学杂志,2002;19(1):49-51.
[19]严勤华.朱南孙学术经验拾掇.中医文献杂志,1997:(2):27-28.
[20]刘海燕,张士表,王金凤,等.补肾祛瘀法在辨证论治子宫腺肌病中的体会.中国现代医生,2005;45(3):53.
[21]徐慧军,严建敏,邰国香.辨证论治子宫腺肌病.山东中医杂志,2006;25(8):564-565.
[22]经燕,王清.许润三治疗子宫内膜异位症、子宫腺肌病经验总结.中日友好医院学报,2004;18(2):104-105.
[23]袁亚敏,丁春桃.魏绍斌主任医师治疗子宫腺肌病经验.四川中医,2007;25(6):4-5.