摘要
目的：研究溃疡性结肠炎中医各证型与临床症状、临床类型、病情程度、病变范围、病程长短、肠镜黏膜象特点及组织学分级等方面的相关性,从而对本病的中医证型特点及证治规律进行总结,为今后临床诊疗提供一些线索及帮助。
方法：参照2009年制定的《溃疡性结肠炎中医诊疗共识意见》,设计临床调查表,将110例溃疡性结肠炎病例进行整理和数据统计,并采用SPSS17.0软件,采用确切概率法、spearman相关分析、独立样本方差分析等方法对数据进行分析,以期了解溃疡性结肠炎中医各证型在年龄、临床症状、肠镜黏膜象特点及组织学分级等方面的分布规律。
结论：本次研究的溃疡性结肠炎患者中,男女比率为1.12：1；平均年龄41.43±13.064岁。本次研究病例中,大肠湿热证所占比例最高,其后依次为脾虚湿蕴证、肝郁脾虚证、脾肾阳虚证、寒热错杂证及阴血亏虚证。病变范围以直肠、乙状结肠为主。各病变范围间以大肠湿热证较为常见。临床类型主要以初发型及慢性复发型为主,初发型、慢性复发型的患者主要以大肠湿热证、脾虚湿蕴证为主；慢性持续型则以脾肾阳虚证为主。病情程度上轻、中、重度患者均以大肠湿热证为多。病程小于五年的患者中,以大肠湿热证为主；病程在5-10年的患者中以脾虚湿蕴证多见；病程超过10年,则以脾肾阳虚证为多。溃疡性结肠炎常见镜下表现,从高到低依次为：粘膜充血水肿>粘膜血管纹理模糊>粘膜糜烂溃疡>脓性分泌物>息肉>粘膜脆性增加>粘膜颗粒样改变>管腔狭窄>肠管缩短>粘膜桥。粘膜充血水肿、血管纹理模糊、糜烂溃疡及脓性分泌物、粘膜脆性增加以大肠湿热证、脾虚湿蕴证常见；息肉以大肠湿热证、肝郁脾虚证常见；颗粒样改变则以肝郁脾虚证、大肠湿热证常见。各证型均有各自粘膜象特点。肠镜、病理组织学分级与各证型间均无显著关联性。肠镜、病理组织学分级均以II、III级为主。肠镜及组织学分级为III级的重度病变的患者以大肠湿热证及脾肾阳虚证为主。
Object:To study the relationship between traditional Chinese medicine (TCM) syndrome-typing of ulcerative colitis (UC) and some factors such as clinical symptoms, clinical classifications, severity of the disease, lesion range, stage, illness duration, characteristic of colorectal mucosa, and histological rank, thus to summarize the distinguishing feature of TCM syndrome-typing and the law of syndrome differentiation and treatment, and to make some clue for clinical diagnosis and treatment in future.
Methods:Referring to "the Common Understanding of UC of TCM Diagnosis and Treatment " in the2009,a clinical observation table is designed.The data of totally110patients with UC is collected,sorted out,and added up. With SPSS17.0, the data is analyzed to investigate the regularity in following aspects,such as: age,clinical symptoms, clinical classifications, severity of the disease, the affected sites, stage, illness duration, characteristic of colorectal mucosa, and histological rank.
Results:In this research, the proportion of male and female is1.12:1, and the average age is41.43±13.064.
Large intestine damp-heat syndrome is especially common in UC, Spleen deficiency and damp accumulation, Liver depression and spleen deficiency, spleen-kidney Yang deficiency, cold-heat complicated, Yin-blood deficiency syndrome thereafter.
Patients with lesion range in rectum and sigmoid colon are in the majority. Large intestine damp-heat syndrome occurs frequently in almost all the syndromes.
In UC cases, initial type and chronic recurrent type are more common than chronic persistent type. And it also can be seen that damp-heat syndrome and spleen deficiency and damp accumulation syndrome are more common in initial and chronic recurrent types, and spleen-kidney Yang deficiency syndrome more common in chronic persistent type.
In the aspect of disease severity, mild cases mainly express Large intestine damp-heat syndrome, Liver depression and spleen deficiency syndrome and Spleen deficiency and damp accumulation syndrome; moderate cases mainly express Large intestine damp-heat syndrome and Spleen deficiency and damp accumulation syndrome:severe cases mainly express Large intestine damp-heat syndrome and spleen-kidney Yang deficiency syndrome.
It can be found that Large intestine damp-heat syndrome, Spleen deficiency and damp accumulation syndrome are more common in the group in which the illness course is less than5years; Spleen deficiency and damp accumulation syndrome is more common in the group in which the illness course is from5to10years; and spleen-kidney Yang deficiency syndrome is more common in the group in which the illness course is more than10years.
The common manifestation of colorectal mucosa under endoscope is as follows: congestion and edema, vascular texture disorder, erosion and ulcer, secretion with pus, polyps, brittle texture, granulation, luminal stenosis, luminal shortening, and mucosal bridge.
Congestion and edema, vascular texture disorder, erosion and ulcer, secretion with pus, and brittle texture are frequently found in Large intestine damp-heat syndrome and Spleen deficiency and damp accumulation syndrome; polyps in Large intestine damp-heat syndrome and Liver depression and spleen deficiency syndrome; and granulation however in Liver depression and spleen deficiency syndrome and Large intestine damp-heat syndrome. Each syndrome has its own manifestation of colorectal mucosa.
There is no obvious relationship between TCM syndromes and mucosal and histological ranks. Rank II and Rank III are dominant in both mucosal rank and histological rank.
Large intestine damp-heat syndrome and spleen-kidney Yang deficiency syndrome are more common in Rank III in both mucosal rank and histological rank.
引文
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