摘要
目的
总结子宫内膜异位症患者的临床症状、体征及病史资料,探讨台湾地区子宫内膜异位症发病的病因病机和证候分布规律。并寻求证候分布规律与患者年龄,病程,既往流产次数,痛经程度的关系。
方法
本次课题对居住在台湾地区、生活条件近似的984名45岁以下罹患子宫内膜异位妇女进行了横断面调查。研究对象以台湾地区健保分区来区分,其中台北区187名,北区162名,中区212名,南区158名,高屏区220名,东区45名。采用传统的八纲和脏腑辨证系统,并根据本病的临床特点,结合国内虚证和血瘀证的辨证标准等制定了“子宫内膜异位症中医证型调查量表”；同时采用技术对受试者进行测定。.将所获得的临床症状、体征、检查结果的数据等,输入数据库,通过x2检验,描述性分析,聚类分析等统计学方法探讨子宫内膜异位症的中医证候特征及证候分布规律。
结果
本课题984例病人,证型分布中,气滞血瘀证202例(20.5%),寒凝血瘀证170例(17.3%),肾虚血瘀证139例(14.1%),瘀热互结证121例(12.3%),湿热血瘀证107例(10.9%),气虚血瘀证90例(9.1%),痰瘀互结证67例(6.8%),寒湿凝滞证58例(5.9%),另有其他证型分型31例(3.2%),包括血瘀瘤瘕证18例,阴虚血瘀证7例,阳虚血瘀证6例。所有证型均见血瘀证,其中气滞血瘀证和寒凝血瘀证是所有证型中比例最大的,其次是：肾虚血瘀、瘀热互结、湿热血瘀、气虚血瘀、痰瘀互结、寒湿凝滞证。
结论
1.子宫内膜异位症中医证候分布子宫内膜异位症的中医证型主要有气滞血瘀、寒凝血瘀、肾虚血瘀、瘀热互结、湿热血瘀、气虚血瘀、痰瘀互结、寒湿凝滞等8型。
2.证候与患者年龄、病程、流产次数以及痛经程度的相关性患者年龄、病程、既往流产次数与证候的虚实辨证密切相关。肾虚血瘀证和气虚血瘀证等虚实夹杂证以及寒湿凝滞证多分布在35～39岁和40-45岁组。
3.与发病相关的高危因素可能与发病相关的因素是：经常情志不畅(83.2%)、经期剧烈运动史(75.0%)、高工作生活压力史(45.9%),盆腔手术、负压吸引流产史和经期或产后受凉史亦为重要因素；提示子宫内膜异位症多因情志内伤、外邪侵袭、禀赋体质或手术损伤等,导致机体脏腑功能失调、冲任损伤、气血不和,不循常道,离经之瘀血积聚而发病。瘀血既是本病的病理产物,又是本病的致病因素,因此,瘀血是产生本病症状和体征的关键。
Objective
To summarize the clinical symptoms、physical signs and medical history of patients with endometriosis, study the etiopathogenisis、pathogenesis and syndrome pattern distribution regularity of the endometriosis in Taiwan, and find the relationship among the syndrome distribution regular patterns with patients'age、course、miscarriage and dysmenorrhea.
Methods
We made the cross-sectional study in 984 women with endometriosis under the age of 45, with approximate living condition in Taiwan. The patients were divided as the health-care territories in Taiwan, among which 187 came from Taipei area,162 from north area,21 from median area,158 from south area, 220 from Gaoping area, and 45 from east area. We used the systems of traditional eight principles (Ba Gang) and entrail differentiations of symptoms and signs, and according to the clinical characteristic of endometriosis, made "the investigation scale of syndrome patterns" combined with domestic diagnostic criteria of asthenia and stagnation of blood syndromes. We also tested the subjects with technology, and input all the data we got into the database.
The statistics were analyzed byχ2 describing decompose and cluster analysis in order to find the syndrome characteristic and the distribution regularity of endometriosis.
Results
Among 984 patients in the study, the syndrome distribution regularity is as follows:202 are qi-stagnancy and blood stasis (20.5%); 170 are cold coagulation and blood stasis (17.3%); 139 are renal deficiency and blood stasis (14.1%); 121 are combination of phlegm and heat (12.3%); 107 are humid heat and blood stasis (10.9%); 90 are deficiency of vital energy and blood stasis (9.1%); 67 are combination of phlegm and blood stasis (6.8%); 58 are cold hygrosis (5.9%); 31 are others (3.2%), including 18 blood stasis and oncosis、7 yin asthenia and blood stasis and 6 yang asthenia and blood stasis. All the syndrome patterns contain blood stasis, among which syndromes of qi-stagnancy and blood stasis、cold coagulation and blood stasis fill the maximal proportion. Renal deficiency and blood stasis、combination of phlegm and heat、humid heat and blood stasis、deficiency of vital energy and blood stasis combination of phlegm and blood stasis and cold hygrosis are followed one by one.
Conclusion
1. The syndrome patterns of endometriosis there are maily 8 patterns of endometriosis (qi-stagnancy and blood stasis、cold coagulation and blood stasis、renal deficiency and blood stasis、combination of phlegm and heat、humid heat and blood stasis、deficiency of vital energy and blood stasis combination of phlegm and blood stasis and cold hygrosis).
2. The correlation between patients'age、course、miscarrage、dysmenorrhear and the syndrome patterns there is close relationship in the asthenia and sthenia syndromes between and patients'age、course、miscarriages and the syndrome patterns、renal deficiency and blood stasis、deficiency of vital energy and blood stasis mostly distribute in groups age from35-39, and cold hygrosis mostly in groups age from 40-45.
3. High risks coherent with endometriosis possible factors that may cause endometriosis:depression(83.2%)、heavy exercises in menstruation(75.0%)、high pressure(45.9%); Pelvic surgery、vacuum aspiration operation、and catching cold in menstruation and after puerperium are important reasons. The results above show that exogenous evil、internal damage by sentiment、congenital constitution or operation injury may lead to dysfunction of the entrails、impairment of thoroughfare and conception vessel、disharmony between qi and blood、blood stasis outside the vessels, and reduce the disease. Stagnant blood is the patho-production, and the etiological factor, therefore, stagnant blood is the key point in causing the signs and symptoms.
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