本文關(guān)鍵詞： 遺忘型輕度認(rèn)知損害 證型 證候要素 癥狀　出處：《北京中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的：探討分析遺忘型輕度認(rèn)知損害的中醫(yī)證候分布特征,旨在為遺忘型輕度認(rèn)知損害的臨床辨證提供理論依據(jù)。方法：(1)采用meta分析的理念,確立文獻(xiàn)檢索策略,在中國學(xué)術(shù)文獻(xiàn)網(wǎng)絡(luò)出版總庫、中文科技期刊數(shù)據(jù)庫與萬方知識(shí)服務(wù)平臺(tái)進(jìn)行檢索,檢索出報(bào)告遺忘型輕度認(rèn)知損害患者證候分型及各型病例數(shù)或臨床表現(xiàn)病例數(shù)的文獻(xiàn),共納入文獻(xiàn)25篇,提取癥狀、證型與證候要素,規(guī)范名詞術(shù)語,并進(jìn)行證候要素與癥狀關(guān)系研究,采用描述性統(tǒng)計(jì)的方法分析癥狀、證型、證候要素出現(xiàn)頻次,證候要素與癥狀關(guān)系研究采用系統(tǒng)聚類分析法。(2)利用描述性統(tǒng)計(jì)方法對(duì)臨床病例的人口學(xué)資料進(jìn)行統(tǒng)計(jì),采用頻數(shù)優(yōu)勢(shì)法篩選四診條目,采用析因分析、聚類分析提取證候要素,利用描述性統(tǒng)計(jì)的方法報(bào)告證候要素的分布特征。(3)利用描述性統(tǒng)計(jì)方法、非參數(shù)檢驗(yàn)對(duì)臨床病例的人口學(xué)資料進(jìn)行統(tǒng)計(jì),采用二分類Logistic回歸分析疾病與癥狀關(guān)系、疾病與證候要素關(guān)系以及證候要素與癥狀的關(guān)系。結(jié)果：現(xiàn)代文獻(xiàn)研究：(1)頻次5的主觀感覺類癥狀包括健忘、善忘、神昏、神疲、嗜臥、倦怠、不寐、疲乏、多夢(mèng)、少氣、頭暈、頭痛、頭重、耳鳴、耳聾、腰膝無力、四肢不溫、心悸、胸悶、食欲不振、腹?jié)M、大便秘結(jié)。頻次5的客觀體征類癥狀包括口唇青紫、面色萎黃、便溏、苔白、舌紅、苔膩、舌淡紅、舌生瘀斑、舌胖大、苔黃、苔薄、脈細(xì)、脈弦、脈數(shù)、脈沉、脈滑、脈弱、脈澀。(2)共提取24個(gè)證型,百分比大于1%的證型依次是腎精虧虛證(10.5%)、痰濁蒙竅證(10.5%)、氣血兩虛證(10.5%)與熱毒內(nèi)盛證(10.5%),其他的依次為：腑滯濁留證(8.9%)、瘀阻腦絡(luò)證(8.9%)、肝陽上亢證(6.5%)、陰虛陽亢證(4.85%)、痰濁證(4.03%)。(3)總共提取15個(gè)證候要素,其中,病位類證候要素5個(gè),按百分比由高到低依次是腎(29.89%)、腦(27.59%)、肝(13.79%)、脾(9.2%)、心(6.9%)；病性類證候要素9個(gè),按百分比由高到低依次是氣虛(16.44%),其他的依次為痰濁(11.84%)、血瘀(11.84%)、血虛(11.18%)、陽亢(9.21%)、精虧(8.55%)、熱毒(8.55%)、陰虛(7.89%)、腑實(shí)(7.24%)、濁邪(7.24%)。(4)確定證候要素—癥狀關(guān)系如下：腎：耳聾、耳鳴、腰膝無力、脈沉；腦：健忘、善忘、神昏、頭暈、頭痛；心：心悸、胸悶、多夢(mèng)；肝：頭暈、頭痛、脈弦、耳鳴；脾：神疲、乏力、四肢不溫、面色萎黃、舌體胖大、倦怠、食欲不振、便溏；氣虛：少氣、神疲、乏力、脈弱、倦怠、苔薄、舌體胖大；血虛：面色萎黃、心悸、頭暈、脈細(xì)；精虧：耳聾、腰膝無力、耳鳴；陰虛：耳鳴、脈細(xì)；陽虛：四肢不溫、便溏、苔白；痰濁：嗜臥、苔膩、脈滑、舌體胖大、頭重、頭暈；腑實(shí)：腹?jié)M、苔膩、食欲不振；血瘀：口唇青紫、舌生瘀斑、脈澀；陽亢：頭暈、耳鳴、頭痛、脈弦；熱毒：苔黃、脈數(shù)、舌紅。臨床調(diào)查：(1)證候要素分布特征：病位類證候要素出現(xiàn)頻次總計(jì)714次,按頻次排序,由高到低分別是：腦165次,占總頻次百分比為23.1%；腎165次,占總頻次百分比為23.1%；脾152次,占總頻次百分比為21.3；心126次,占總頻次百分比為17.6%；肝106次,占總頻次百分比為14.8%。病因、病性類證候要素出現(xiàn)頻次總計(jì)1342次,按頻次排序,由高到低分別是：痰濁166次,占總頻百分比為12.4%；血虛160次,占總頻次百分比為11.9%；精虧158次,占總頻次百分比為11.8%；血瘀155次,占總頻次百分比為11.5次；熱毒145次,占總頻次百分比為10.8%；陰虛137次,占總頻次百分比為10.2%；陽虛127,占總頻次百分比為9.5%；氣虛123次,占總頻次百分比為9.2%；腑實(shí)109次,占總頻次百分比為8.1%；氣郁62次,占總頻次百分比為4.6%。(2)證候要素的病-證-癥關(guān)系：中醫(yī)四診條目共154條,與遺忘型輕度認(rèn)知損害相關(guān)的主觀感覺類癥狀包括：畏寒、氣短、憂慮、易怒、耳鳴如蟬、目眩、下肢酸重。客觀體征類癥狀包括：痰多、痰色白、口唇色淡、口臭、眼瞼紫暗、面色不華、肢體攣急、筋惕肉跳、肢體震顫、指甲蒼白、舌紫、苔白、脈沉、脈遲、脈數(shù)、脈滑、脈虛、脈弦。確定15組證候要素—癥狀關(guān)系。與腎相關(guān)的癥狀：牙齒脫落、腰痛、腰酸；與腦相關(guān)的癥狀：頭暈、頭昏、頭痛；與肝相關(guān)的癥狀：易怒、憂慮、口苦、耳鳴如蟬、脈弦；與脾相關(guān)的癥狀：神疲、乏力、四肢不溫、舌淡、舌體胖大；與心相關(guān)的癥狀：心煩、失眠、心悸；與氣虛相關(guān)的癥狀：乏力、氣短；與血虛相關(guān)的癥狀：目昏花、面色不華、脈細(xì)；與精虧相關(guān)的癥狀：耳鳴如蟬、牙齒脫落；與陽虛相關(guān)的癥狀：畏寒、四肢不溫、大便溏、喜熱飲；與陰虛相關(guān)的癥狀：口干、咽干、耳鳴如蟬、目干澀、目昏花；與痰濁相關(guān)的癥狀：咯痰、苔厚、苔膩、反應(yīng)遲鈍,舌邊齒痕、脈滑；與血瘀相關(guān)的癥狀：瘀斑瘀點(diǎn)、口唇紫暗、舌暗；與熱毒相關(guān)的癥狀：苔灰黃、口干、口臭；與腑實(shí)相關(guān)的癥狀：口干、口臭、腹脹；與陽亢相關(guān)的癥狀：頭暈、頭痛、頭昏；與氣滯相關(guān)的癥狀：憂慮、情緒低落、表情淡漠。與遺忘型輕度認(rèn)知損害相關(guān)的證候要素包括腎(P=0.028)、痰濁(P=0.010)與陰虛(P=0.004)。結(jié)論：遺忘型輕度認(rèn)知損害的證型以腎精虧虛證、痰濁蒙竅證、氣血兩虛證為主,病位類證候要素以腦和腎為主,病因、病性類證候要素以痰濁、血虛、血瘀、精虧、陰虛為主,證候要素的證-癥的量化關(guān)系還有待進(jìn)一步研究。
[Abstract]:Objective: To investigate amnestic mild cognitive impairment and the TCM syndrome distribution characteristics, in order to provide theoretical basis for clinical diagnosis of amnestic mild cognitive impairment. Methods: (1) using meta analysis concept, establish the strategy of literature retrieval, in the academic literature China Network Publishing Database, Chinese journal database and Wanfang knowledge service platform for retrieval, retrieval report amnestic mild cognitive impairment syndromes and the number of cases or cases of clinical manifestations of literature, 25 articles were included, the extraction of symptoms, syndromes and syndrome elements, the term specification noun, and study the relationship between syndrome factors and symptoms, methodsdescriptive statistical analysis of symptoms, syndromes and syndrome elements of frequency, study the relationship between syndrome factors and symptoms using clustering analysis. (2) by using the method of descriptive statistics on demographic data in clinical cases For statistics, the frequency method for screening four entries by factorial analysis, cluster analysis to extract the syndromes distribution characteristics by using descriptive statistical methods to report the syndrome elements. (3) by using descriptive statistics, nonparametric test data on demographic clinical material statistics, using two Logistic regression analysis of disease the relationship between syndromes and symptoms, disease and syndrome and syndrome elements and symptoms. Results: the modern literature research: (1) the frequency of the 5 subjective symptoms including amnesia, forgetfulness, coma, lassitude, addicted to lying, burnout, fatigue, insomnia, dreaminess, dizziness, headache, shortness of breath, also, tinnitus, deafness, waist weakness, limb temperature, heart palpitations, chest tightness, loss of appetite, abdominal distention, constipation. 5 the frequency of objective signs symptoms including purple lips, pale complexion, loose stools, white fur, red tongue, greasy moss, pale tongue, ecchymosis on tongue, big fat tongue, 鑻旈粍,鑻旇杽,鑴夌粏,鑴夊雞,鑴夋暟,鑴夋矇,鑴夋粦,鑴夊急,鑴夋訂.(2)鍏辨彁鍙，

本文編號(hào)：1446823