本文選題：多系統(tǒng)萎縮 + 非運(yùn)動(dòng)癥狀��； 參考：《北京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：研究背景:多系統(tǒng)萎縮(Multiple System Atrophy,MSA)是累及多個(gè)系統(tǒng)的復(fù)雜神經(jīng)系統(tǒng)變性疾病,其廣泛存在的以自主神經(jīng)功能障礙為主的非運(yùn)動(dòng)癥狀(non-motor symptoms,NMS)是疾病的重要組成部分,嚴(yán)重影響著病情和患者生存質(zhì)量。但是現(xiàn)有量表多為評(píng)價(jià)MSA神經(jīng)功能缺損和肢體殘障,不能針對(duì)其包含的復(fù)雜非運(yùn)動(dòng)癥狀進(jìn)行測(cè)量,因而多系統(tǒng)萎縮非運(yùn)動(dòng)癥狀量表(Multiple System Atrophy Non-motor Symptoms Scale,MSA-NMSS)亟待研制,并可應(yīng)用于中醫(yī)藥治療MSA療效評(píng)價(jià)方面。MSA在世界范圍內(nèi)目前尚缺乏有效的治療方法,西藥干預(yù)多采用對(duì)癥治療,遠(yuǎn)期療效不明確,中藥治療MSA具有治病求本、靶點(diǎn)多的特點(diǎn),但現(xiàn)有中醫(yī)藥治療MSA文獻(xiàn)缺乏是否能夠延緩疾病進(jìn)展的相關(guān)論證及客觀指標(biāo)評(píng)價(jià);而中醫(yī)藥治療的核心是病因病機(jī)分析,分析MSA證候規(guī)律和演變可以指導(dǎo)中醫(yī)藥診治和明確預(yù)后,因此開(kāi)展大樣本量中藥治療MSA療效觀察及證候分析研究。研究方法:研究共分為三個(gè)部分:第一部分是MSA-NMSS的研制,參考國(guó)際患者報(bào)告結(jié)局量表研制方法,主要分為條目池構(gòu)成、預(yù)調(diào)查量表形成、臨床調(diào)查、條目篩選、性能考核五個(gè)步驟。①首先構(gòu)建量表概念框架,MSA-NMSS是用于測(cè)量MSA非運(yùn)動(dòng)癥狀嚴(yán)重程度,并以患者生存質(zhì)量為最后測(cè)量目的。并根據(jù)文獻(xiàn)MSA非運(yùn)動(dòng)癥狀初步構(gòu)想量表結(jié)構(gòu)13個(gè)方面。條目由以下三個(gè)方面獲取:理論模型即文獻(xiàn);參考統(tǒng)一多系統(tǒng)萎縮評(píng)估量表(UMSARS)和帕金森非運(yùn)動(dòng)癥狀量表(NMSS)等量表;應(yīng)用頭腦風(fēng)暴法以病人為中心提出條目,并統(tǒng)計(jì)既往收集MSA患者70例進(jìn)行整理分析。②以德?tīng)柗茖?zhuān)家咨詢法篩選條目池,即背對(duì)背分別發(fā)往全國(guó)多臨床中心MSA權(quán)威專(zhuān)家做出重要性評(píng)分、熟悉程度評(píng)分。進(jìn)行小范圍測(cè)試即語(yǔ)言調(diào)試和條目再改造,整理制成預(yù)調(diào)查量表。③臨床調(diào)查樣本量以最少條目數(shù)的5倍約200例MSA患者,同時(shí)發(fā)放UMSARS問(wèn)卷;并收集年齡、文化程度與MSA患者具有可比性的健康正常人;中藥治療后3個(gè)月對(duì)MSA患者進(jìn)行二次復(fù)測(cè)。④對(duì)預(yù)調(diào)查結(jié)果分別以離散趨勢(shì)法、逐步回歸分析進(jìn)行條目篩選,用探索性因子分析求出實(shí)際維度數(shù)目并命名,再綜合專(zhuān)家協(xié)商意見(jiàn)進(jìn)行條目篩選,最后以Pearson相關(guān)系數(shù)和克朗巴赫系數(shù)法(Cronbach's Alpha)再次篩選條目。⑤量表考核主要分為信度、效度和反應(yīng)度,信度檢測(cè)用Cronbach' s Alpha法,效度考核分為效標(biāo)效度即前述Pearson相關(guān)系數(shù)法,和區(qū)分效度即比較MSA和健康正常受試兩類(lèi)人群得分的差別。反應(yīng)度用秩和分析方法判斷中藥治療前后MSA患者的得分。第二部分是觀察溫腎健腦經(jīng)驗(yàn)方加減治療MSA前后的療效。收集MSA患者中藥治療前①UMSARS評(píng)分、UMSARS第四項(xiàng)整體失能等級(jí)、進(jìn)展程度(=評(píng)分/病程);②非運(yùn)動(dòng)癥狀尿失禁評(píng)分、夜尿次數(shù)、導(dǎo)尿次數(shù),直立性血壓數(shù)值。中藥治療后①半個(gè)月,1個(gè)月,3個(gè)月,6個(gè)月,12個(gè)月每一個(gè)時(shí)點(diǎn)UMSARS評(píng)分,UMSARS第四項(xiàng)整體失能等級(jí),進(jìn)展程度(=此時(shí)點(diǎn)評(píng)分/此時(shí)點(diǎn)每人病程年數(shù));②非運(yùn)動(dòng)癥狀包括治療后3個(gè)月、6個(gè)月、12個(gè)月尿失禁評(píng)分、夜尿次數(shù)、導(dǎo)尿次數(shù),直立性血壓數(shù)值;③患者主訴改善癥狀,改善人次,及改善率。隨訪記錄中藥治療后24個(gè)月,36個(gè)月,48個(gè)月UMSARS評(píng)分,UMSARS第四項(xiàng)整體失能等級(jí),進(jìn)展程度。第三部分是對(duì)MSA進(jìn)行證候特征分析。采用橫斷面分析方法,采集所有符合入組標(biāo)準(zhǔn)的MSA患者一般情況及證候分析所用的四診信息,提取證候要素,統(tǒng)計(jì)證候要素頻次,百分比,歸納證候要素組成分布;以類(lèi)型或平均值為界進(jìn)行證素的分組進(jìn)行比較,探討證候要素與病程、疾病嚴(yán)重程度、疾病分型的相關(guān)性,總結(jié)證候規(guī)律。研究結(jié)果:第一部分條目池形成共63個(gè)條目,13個(gè)維度,經(jīng)德?tīng)柗茖?zhuān)家咨詢法篩選條目池形成53個(gè)條目初稿,進(jìn)行小范圍測(cè)試和條目再改造,整理制成共37個(gè)條目的預(yù)調(diào)查量表。臨床調(diào)查收集入組MSA患者202例,男118例,女84例,平均年齡58.97±7.94歲,平均病程5.17±2.13年。其中C型96例,P型61例;C+P型和P+C型(無(wú)法確定優(yōu)勢(shì)分型,根據(jù)起病癥狀先后)45例。健康正常人202例,男82例,女120例,平均年齡61.96±7.86歲。調(diào)查后經(jīng)離散趨勢(shì)、逐步回歸分析、因子分析、專(zhuān)家協(xié)商意見(jiàn)進(jìn)行條目篩選形成了 12個(gè)維度、35個(gè)條目的量表。以Pearson相關(guān)系數(shù)、克朗巴赫系數(shù)法為主評(píng)價(jià)量表性能,結(jié)果顯示:①信度考核:量表的總alpha值=0.854,是可以接受的范圍。檢驗(yàn)每個(gè)條目對(duì)整體量表一致性的貢獻(xiàn)程度,心慌心悸條目得分低且臨床發(fā)生率低故予以刪除。②效度考核:MSA患者與健康正常人的量表總分秩均值差異大,且p=0.0000.05,兩組有顯著性差異,說(shuō)明量表總體區(qū)分效度良好。然而維度12消化功能方面,MSA患者與健康正常人差別不顯著(p=0.927)。③反應(yīng)度:量表總分二者差別p=0.6190.05,整體失能等級(jí)二者差別p=0.0050.01,說(shuō)明治療后3個(gè)月整體病情嚴(yán)重程度較治療前顯著加重,但非運(yùn)動(dòng)癥狀沒(méi)有顯著差異,具體表現(xiàn)在維度1全身癥狀、2認(rèn)知功能、12消化功能方面,治療后3個(gè)月明顯比治療前加重(p分別為0.044、0.000、0.001);在維度4睡眠癥狀、9排便功能方面,治療后3個(gè)月明顯比治療前減輕(p分別為0.000和0.000)。目前沒(méi)有相對(duì)應(yīng)MSA-NMSS的統(tǒng)一評(píng)價(jià)指標(biāo)可以用來(lái)判斷治療前后非運(yùn)動(dòng)癥狀是否真實(shí)發(fā)生了變化以驗(yàn)證反應(yīng)度,但文獻(xiàn)顯示中藥治療主要改善血壓、二便、頭暈癥狀,臨床研究前期基礎(chǔ)顯示失眠、便秘、RBD改善明顯,基本與MSA-NMSS改善睡眠癥狀、排便功能吻合,說(shuō)明MSA-NMSS具備較好的反應(yīng)度。第二部分收集入組MSA患者225例,平均病程5.20±2.15年,最長(zhǎng)者12年。C型99例,P型72例;C+P型和P+C型54例。堅(jiān)持服中藥MSA患者共130例。服藥時(shí)間最短半個(gè)月,最長(zhǎng)45個(gè)月。其中男性75例,女性55例,平均年齡59.10±8.08歲,平均病程4.61±2.18年,最短1年,最長(zhǎng)11年;C型58例,P型39例,C+P或P+C型混合型33例;很可能的MSA 112例,可能的MSA 18例。UMSARS評(píng)分最高者100分。130例堅(jiān)持服中藥MSA患者中,因從C型轉(zhuǎn)化為P型致病情惡化者14例;因骨折致病情惡化者1例;因停服中藥病情惡化者13例,最短1周,最長(zhǎng)1年,停服中藥病情惡化再服中藥病情好轉(zhuǎn)者3例。主要分為疾病進(jìn)展程度、患者主訴改善癥狀、非運(yùn)動(dòng)癥狀三個(gè)部分(由于數(shù)據(jù)缺失各部分病例數(shù)不同)。①病情進(jìn)展程度累計(jì)396人次(不同時(shí)點(diǎn)人次),在中藥治療半個(gè)月時(shí),平均病情進(jìn)展程度及平均整體失能等級(jí)進(jìn)展都達(dá)到頂峰,之后便開(kāi)始下降,在治療1個(gè)月時(shí),病情平均進(jìn)展程度略低于治療前水平。在中藥治療12個(gè)月時(shí),平均進(jìn)展程度約為治療前的4/5,平均整體失能等級(jí)進(jìn)展約為治療前的9/10,病程約是治療前平均病程(4.4年)的5/4。在中藥治療24個(gè)月、36個(gè)月及45個(gè)月時(shí)平均進(jìn)展程度和平均整體失能等級(jí)進(jìn)展仍呈現(xiàn)下降的趨勢(shì),分別約為治療前的4/5,3/5,2/5;以及9/10,7/10,2/5�？紤]95例缺失數(shù)據(jù)因素,中藥至少可以延緩57.8%(130/225)的MSA患者疾病進(jìn)展。②患者主訴改善癥狀結(jié)果顯示,MSA患者主訴改善癥狀前10位依次為直立性低血壓或暈厥、RBD、尿失禁、拍便困難、夜尿、尿不盡、精神狀態(tài)、乏力、失眠、言語(yǔ)含糊。其中直立性低血壓或暈厥的改善率44.6%,其次為二便癥狀,總計(jì)改善率約56.9%,另外由于精神體力睡眠改善共計(jì)18.7%,因語(yǔ)聲低微、雙腿乏力造成的言語(yǔ)及行走障礙也可以得到一定緩解。③非運(yùn)動(dòng)癥狀由于缺失數(shù)據(jù),4個(gè)時(shí)點(diǎn)數(shù)據(jù)完整者38人次,不完整者111人次。38人次統(tǒng)計(jì)結(jié)果顯示,溫腎健腦經(jīng)驗(yàn)方加減治療后3個(gè)月較治療前的平均尿失禁評(píng)分、平均夜尿次數(shù)有所減少(減幅分別為2%和6%),平均導(dǎo)尿次數(shù)(包括壓腹導(dǎo)尿)有所增加(增幅6%)。中藥治療6個(gè)月、12個(gè)月后三者均較治療前有所增加,12個(gè)月時(shí)增幅分別為42%、8%、59%。111人次統(tǒng)計(jì)結(jié)果增減趨勢(shì)與38人次基本相同。直立性血壓數(shù)值38人次結(jié)果顯示,治療前平均臥立位收縮壓差26.32mmHg,平均臥立位舒張壓差14.47 mmHg;整體治療后平均臥立位收縮壓差23.25mmHg,平均臥立位舒張壓差11.84mmHg。其中,經(jīng)正態(tài)分布檢驗(yàn)治療前與治療后6個(gè)月平均臥立位血壓差均呈正態(tài)分布,配對(duì)樣本t檢驗(yàn)顯示兩組收縮壓有較顯著差異(收縮壓差*P=0.0360.05)。111人次結(jié)果示12個(gè)月時(shí)數(shù)據(jù)有所反復(fù),但趨勢(shì)大致相同。第三部分收集MSA患者共194例,其中114例男性,80例女性,平均年齡59.03±9.13歲;160例很可能的MSA,34例可能的MSA;C型93例,P型59例,C+P或P+C混合型42例;平均病程4.38±2.09年,平均UMSARS評(píng)分42.64±16.11分。主要分為證素頻次分析,證素與疾病分型病程、疾病嚴(yán)重程度相關(guān)性,以及中藥治療前后證候變化三個(gè)部分。①證素頻次顯示共29種證候要素,從高到低前10位分別是血瘀、痰濕、腎(氣)虛、腎陽(yáng)虛、腎陰虛、痰熱、血虛、脾虛、內(nèi)熱、陰虛。虛證中以腎虛,包括腎陽(yáng)虛、腎陰虛為主,其次為血虛、脾虛、陰虛等,以肝病為主要病機(jī)的肝陰虛、肝血虛及肝風(fēng)內(nèi)動(dòng)所占比例不高。虛證所占比例高,前5位證素三虛兩實(shí)。②疾病分型辨證結(jié)果顯示,MSA總體病機(jī)虛多實(shí)少,寒多熱少;虛證以腎虛為主,氣虛其次;實(shí)證乃痰、濕多見(jiàn)。P型多見(jiàn)熱證、血虛,痰濕,和肝、心病;C型多見(jiàn)脾虛;C+P型多見(jiàn)寒證、氣虛,痰濕、血瘀,及腎虛、胃病,而氣陷只見(jiàn)于C+P型。病程分組辨證結(jié)果顯示,病程延長(zhǎng),虛證比例增加,實(shí)證有所減少但比率不高。隨病程延長(zhǎng)而熱證減少,氣虛證增多,甚至出現(xiàn)氣陷,寒證無(wú)顯著變化,與前述疾病分型辨證P型熱證多見(jiàn),而C+P型多在疾病后期出現(xiàn)可多見(jiàn)寒證結(jié)果吻合。隨病程延長(zhǎng),腎病、肝病、脾虛及肺虛證增加,心病及胃病減少。疾病嚴(yán)重程度分類(lèi)辨證結(jié)果顯示,疾病嚴(yán)重程度增加,虛證、實(shí)證都有所增加,具體表現(xiàn)在氣虛、血虛、氣陷增加,所有邪實(shí)之痰濕、血瘀、毒濁亦增加;疾病嚴(yán)重程度增加,熱證、寒證都增多,腎、肝、心、肺之病增加,脾病不變,胃病減少。③95例MSA患者(數(shù)據(jù)缺失)溫腎健腦經(jīng)驗(yàn)方加減治療3個(gè)月后證素頻次排序前5位依次為血瘀、腎陽(yáng)虛、腎虛、腎陰虛、痰濕,與前述證素頻次一致,較治療前相比痰濕減少,血瘀及腎虛無(wú)明顯變化。因血瘀、痰濕都是陽(yáng)氣虛無(wú)力推動(dòng)脈道、津液所致,可以推出MSA核心病機(jī)為腎陽(yáng)虛。溫腎健腦經(jīng)驗(yàn)方加減治療后3個(gè)月與治療前相對(duì)比,主要證素類(lèi)型無(wú)明顯變化,提示MSA短期證候類(lèi)型變化不大,中醫(yī)治療原則在于謹(jǐn)守基本病機(jī),即溫腎助陽(yáng),辨病論治為主,辨證其次。結(jié)論:MSA非運(yùn)動(dòng)癥狀量表具有良好的內(nèi)部信度、區(qū)分效度,和較好的反應(yīng)度,是臨床上可以應(yīng)用于MSA非運(yùn)動(dòng)癥狀評(píng)價(jià)的量表。溫腎健腦方加減能夠延緩至少58%MSA患者疾病進(jìn)展,主要體現(xiàn)在非運(yùn)動(dòng)癥狀上,其中直立位低血壓療效突出,因此可進(jìn)一步應(yīng)用MSA-NMSS進(jìn)行以后的中醫(yī)藥療效評(píng)價(jià);而MSA總體虛多實(shí)少,寒多熱少,核心病機(jī)為腎陽(yáng)虛,治法溫腎助陽(yáng),與溫腎健腦方的治療原則吻合。
[Abstract]:Background: Multiple System Atrophy (MSA) is a complex neurodegenerative disease involving multiple systems, and its widespread non motor symptoms (non-motor symptoms, NMS), which are mainly independent of autonomic dysfunction (NMS), are important parts of the disease, which seriously affect the condition and the quality of life of the patients. But the existing scale In order to evaluate MSA neural function defect and limb disability, it can not be used to measure the complex non motor symptoms it contains, so the Multiple System Atrophy Non-motor Symptoms Scale (MSA-NMSS) is urgent to be developed, and it can be used in the evaluation of the curative effect of traditional Chinese medicine in the field of MSA,.MSA in the world. There is still a lack of effective treatment methods. Western medicine intervention is mostly treated with symptomatic treatment, and the long-term effect is not clear. The traditional Chinese medicine treatment of MSA has the characteristics of treatment and target, but the existing traditional Chinese medicine MSA literature is short of whether it can delay the related argument and objective evaluation of the disease progress; and the core of the Chinese medicine treatment is the etiology and pathogenesis analysis, The analysis of the regularity and evolution of MSA syndrome can guide the diagnosis and treatment of traditional Chinese medicine and clear the prognosis. Therefore, the study of the curative effect and syndrome analysis of MSA with large sample volume of Chinese medicine is carried out. The research method is divided into three parts: the first part is the development of MSA-NMSS, referring to the development method of the international patient report knot local scale, which is mainly divided into the composition of the entry pool. Pre survey scale formation, clinical investigation, entry screening, performance assessment five steps. First, a scale concept framework was first constructed. MSA-NMSS was used to measure the severity of MSA non motor symptoms, and the final measurement of the patient's quality of life. And according to the document MSA non motion symptom initial conception scale structure 13 aspects. The entries were from the following three Aspect acquisition: the theoretical model is the literature; refer to the unified multi system atrophy assessment scale (UMSARS) and the Parkinson non motion symptom scale (NMSS) scale; use the brainstorming method to take the patient as the center, and collect 70 cases of the previous MSA patients to carry out the analysis. Second, the Delphy expert consultation method is used to screen the entry pool, that is the back to back score. Do not send to the national multi clinical center MSA authoritative expert to make the importance score, the familiarity degree score. Carry on the small range test namely the language debugging and the item reengineering, collate into the pre survey scale. (3) the clinical survey sample volume is about 200 cases of the 5 times of the minimum number of eyes and the UMSARS questionnaire, and collect the age, the education level and the MSA The patients with comparable health were healthy and normal people; 3 months after the treatment of Chinese medicine, the MSA patients were retested two times. (4) the results were selected by the discrete trend method, stepwise regression analysis, the number and name of the actual dimension were calculated with exploratory factor analysis, and then the expert consultation was used to select the items. Finally, the Pearson correlation was related. The coefficient and the Krone Bach coefficient method (Cronbach's Alpha) were used to screen the items again. The assessment of the scale was divided into reliability, validity and responsiveness. The reliability test was based on the Cronbach's Alpha method. The validity assessment was divided into the standard validity, namely the former Pearson correlation coefficient method, and the difference between the two groups of people who were compared to MSA and healthy subjects. The score of MSA patients before and after treatment of traditional Chinese medicine was judged by rank and analysis. The second part was to observe the curative effect of warm kidney and brain experience before and after MSA treatment. To collect the UMSARS scores before the treatment of the Chinese medicine of MSA, the level of the total UMSARS loss, the degree of progression (= score / disease course), the score of incontinence and the number of nocturia, The number of urinary catheterization, erect blood pressure value. After the treatment of Chinese medicine, one half month, 1 months, 3 months, 6 months, 12 months, each time point UMSARS score, UMSARS fourth overall disability grade, progress degree (= at this point score / time point per person course year); and non motor symptoms including 3 months after treatment, 6 months, 12 months incontinence score, nocturia Number, number of urinary catheterization, erect blood pressure value; (3) patients' complaint to improve symptoms, improve person times, and improve the rate. Follow up records of Chinese medicine 24 months, 36 months, 48 months UMSARS score, UMSARS fourth overall disability grade, progress degree. The third part is the analysis of the syndrome characteristics of MSA. Cross sectional analysis method, collect all conforms The general situation of the standard MSA patients and the four diagnosis information used in the syndrome analysis, the factor of syndrome, the frequency, the percentage, the distribution of the components of the syndromes, and the comparison between the groups of the syndromes with the type or the average value, and the correlation between the syndrome factors and the disease course, the severity of the disease, the classification of the disease, and the summary of the correlation between the syndrome factors and the classification of the disease. The first part of the entry pool formed a total of 63 items, 13 dimensions, the Delphy expert consultation method selected the entry pool to form the first draft of 53 entries, and carried out a small range test and remolding, and made up a total of 37 items of pre survey. 202 cases of MSA patients, 118 men and 84 women were collected in the clinical survey. Age 58.97 + 7.94 years, the average course of disease was 5.17 + 2.13 years, of which type C 96 cases, P type 61 cases, C+P type and P+C type (unable to determine the dominant classification, according to the onset of symptoms successively) 45 cases, healthy and normal people 202 cases, male 82 cases, 120 cases, average age 61.96 + 7.86 years. After the investigation, the discrete trend, stepwise regression analysis, factor analysis, expert consultation carry on entry 12 dimensions and 35 objective scales were formed. The performance of the scale was evaluated by the Pearson correlation coefficient and the Krone Bach coefficient method. The results showed that: (1) the reliability assessment: the total alpha value =0.854 of the scale was acceptable. The degree of contribution of each item to the overall scale of the scale was tested. The scores of palpitation and palpitation were low and clinical. There was a significant difference in the total score of the total score of MSA patients and healthy people, and p=0.0000.05, and the two groups had significant differences, which showed that the scale of the scale was good. However, there was no significant difference between the MSA patients and the healthy people (p=0.927) in the dimension of the digestive function (p=0.927). (3) the degree of reactivity: the difference of the total score of the scale of two was p =0.6190.05, the difference of overall disability grade two was p=0.0050.01, indicating that the overall severity of the disease was significantly worse 3 months after treatment, but there was no significant difference in non motor symptoms, specifically in dimension 1, 2 cognitive function and 12 digestive function, 3 months after treatment was significantly higher than that before treatment (P was 0.044,0.000,0.001, respectively. In dimension 4 sleep symptoms and 9 defecation, 3 months after treatment was significantly less than before treatment (P 0 and 0 respectively). There is no unified assessment of MSA-NMSS at present to determine whether non motor symptoms are true before and after treatment to verify the degree of reactivity, but the literature shows that traditional Chinese medicine treatment mainly improves blood pressure. Two stool, dizziness symptoms, early clinical research foundation showed insomnia, constipation, RBD improved obviously, basically with MSA-NMSS to improve sleep symptoms and defecation function, indicating that MSA-NMSS has a better degree of reactivity. Second part of the group of MSA patients were collected in 225 cases, the average course of disease was 5.20 + 2.15 years, the oldest was 99 cases of.C type, P type 72 cases, and C+P type and P+C type 54 cases. A total of 130 patients with Chinese traditional Chinese medicine (MSA) were taken for a shortest period of half a month and the longest period of 45 months, including 75 men and 55 women, with an average age of 59.10 + 8.08 years, with an average course of 4.61 + 2.18 years, the shortest 1 years, and the longest 11 years; C type 58, P 39, C+P or P+C mixed 33; the possible MSA 112, and possible MSA cases.UMSARS score the highest score.13 Of the 0 cases of Chinese traditional Chinese medicine MSA, 14 cases were transformed from type C to P type, 1 cases were exacerbated by fracture, 13 cases with deteriorating Chinese medicine, the shortest 1 weeks, the longest 1 years, 3 cases of Chinese traditional medicine deteriorated and then the improvement of Chinese medicine. The main complaint was to improve the symptoms and non motor symptoms three. The average progress degree and the average overall loss level of the disease were all reached the peak at the half month of Chinese medicine treatment. The average progress degree of the disease was slightly lower than that of the pre treatment water during the 1 month treatment. After 12 months of Chinese medicine treatment, the average progress was about 4/5 before treatment. The average overall loss of energy was about 9/10 before treatment. The course of the disease was about the average course of disease (4.4 years) before treatment (4.4 years) for 24 months, 36 months and 45 months. Not about 4/5,3/5,2/5 before treatment; and 9/10,7/10,2/5. considering 95 missing data factors, Chinese medicine can at least delay the disease progression of 57.8% (130/225) of MSA patients. Patients complained of improvement of the symptoms, and the first 10 patients complained of improving symptoms were orthostatic low blood pressure or syncope, RBD, urinary incontinence, bowel difficulty, nocturia, and urine. The improvement rate of erect hypotension or syncope was 44.6%, followed by two stool, the total improvement rate was about 56.9%, and the improvement of mental and physical sleep was 18.7%, and the speech and walking disorders caused by the weakness of the legs were also relieved. Missing data, 38 person times of 4 time point data and 111 person times of incomplete person, the average urine incontinence score after 3 months after treatment with warm kidney and brain experience was decreased (2% and 6% respectively), and the average number of urine conduction (including abdominal catheterization) increased (6%). Traditional Chinese Medicine (increase 6%). Traditional Chinese medicine (increase 6%). Chinese traditional medicine (6%). The average number of urinary incontinence (including abdominal catheterization) increased (6%). The average number of urinary incontinence was increased (6%). The average urine incontinence score was reduced (2% and 6%). Treatment for 6 months, 12 months after the three more than before the treatment, 12 months, the increase was 42%, 8%, the 59%.111 people's statistical results were basically the same as 38 people. The average vertical blood pressure value of 38 people showed that the mean horizontal position systolic pressure difference before treatment was 26.32mmHg, the mean horizontal position diastolic pressure difference was 14.47 mmHg; the overall treatment was flat. The contractile pressure difference was 23.25mmHg, and the mean horizontal position diastolic pressure difference was 11.84mmHg.. The mean blood pressure difference between the normal distribution test and the 6 months after treatment was positive. The paired sample t test showed that there was a significant difference between the two sets of systolic pressure (systolic pressure difference *P= 0.0360.05).111 times and the data were negative for 12 months. The third part collected 194 cases of MSA patients, including 114 cases of men and 80 women, with an average age of 59.03 + 9.13 years; 160 were likely to be MSA, 34 possible MSA; C type 93, P 59, C+P or P+C mixed, average course 4.38 + 2.09 years, average UMSARS score of 42.64 + divide. There were three parts of the course of the classification of the disease, the severity of the disease, and the change of the syndromes before and after the treatment of Chinese medicine. (1) the frequency of the syndrome showed a total of 29 syndromes, and the 10 were blood stasis, phlegm dampness, kidney (QI) deficiency, kidney yang deficiency, kidney yin deficiency, phlegm fever, blood deficiency, spleen deficiency, internal heat, yin deficiency. Mainly, the second is blood deficiency, spleen deficiency, yin deficiency, liver yin deficiency, liver deficiency and liver wind internal movement, the proportion of liver blood deficiency and liver wind internal movement is not high. The proportion of deficiency syndrome is high and the first 5 syndromes three deficiency two. See type.P multi see heat syndrome, blood deficiency, phlegm dampness, liver and heart disease, C type of spleen deficiency, type C+P mostly seen in cold syndrome, Qi deficiency, phlegm dampness, blood stasis, kidney deficiency, stomach disease, and stomach disease only in C+P type. There was no significant change in the syndrome of cold and cold syndrome, and P type heat syndrome was common with the syndrome differentiation and syndrome differentiation of the preceding diseases, but the occurrence of type C+P more in the later period of the disease was consistent with the result of cold syndrome. With the extension of the disease, kidney disease, liver disease, spleen deficiency and lung deficiency syndrome increased, heart disease and stomach disease decreased. The classification of disease severity showed that the severity of disease increased, deficiency syndrome, positive evidence All of them increased, manifested in Qi deficiency, blood deficiency, and increased air flow. All phlegm dampness, blood stasis and toxic turbidity increased, and the severity of the disease increased.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R277.7

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