本文選題：原發(fā)性干燥綜合征 + 中醫(yī)證候��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:臨床上常發(fā)現(xiàn)原發(fā)性干燥綜合征患者在臨床表現(xiàn)、中醫(yī)證候、病因病機(jī)及治療方面均與中醫(yī)肝生理病理密切相關(guān),現(xiàn)代醫(yī)學(xué)也發(fā)現(xiàn)該病患者具有抑郁、焦慮情緒或傾向,而抑郁、焦慮的表現(xiàn)往往與中醫(yī)"燥證"、"郁證"、"臟燥"等有相似之處。導(dǎo)師紀(jì)偉教授總結(jié)多年臨床經(jīng)驗(yàn),提出從肝論治理論,即治療本病時(shí),除單純滋陰外,重視疏肝、平肝、清肝、養(yǎng)肝。本課題旨在研究原發(fā)性干燥綜合征的中醫(yī)證候特點(diǎn)及其與西醫(yī)抑郁、焦慮的關(guān)系,進(jìn)一步探討該病與中醫(yī)肝生理病理的關(guān)系,為干燥綜合征從肝論治提供理論基礎(chǔ)。方法:本研究收集2015-2016年期間江蘇省中醫(yī)院風(fēng)濕科門(mén)診及病房的原發(fā)性干燥綜合征患者的臨床資料,抽取部分患者進(jìn)行抑郁、焦慮自評(píng)量表調(diào)查,并觀察全部患者的中醫(yī)證候表現(xiàn)及進(jìn)行中醫(yī)辨證分型。主要包括:一、采用自行編制的中醫(yī)證候調(diào)查表(編制依據(jù):通過(guò)文獻(xiàn)資料研究及臨床觀察,初步篩選出原發(fā)性干燥綜合征常見(jiàn)中醫(yī)癥狀),對(duì)每位與納入標(biāo)準(zhǔn)相符的患者進(jìn)行臨床資料收集整理,對(duì)其做出證候類(lèi)型判斷。本次研究共設(shè)肝腎陰虛、氣陰兩虛、陰虛血瘀及肺胃津傷證四個(gè)主要證型,及(肝郁)氣滯、濕熱、血瘀、熱毒四個(gè)兼證。二、協(xié)助其中任意50位患者及20位健康體檢者完成抑郁及焦慮自評(píng)量表。三、數(shù)據(jù)處理:應(yīng)用SPSS22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,其中計(jì)量資料統(tǒng)一用均數(shù)±標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料用卡方檢驗(yàn),獨(dú)立樣本用t檢驗(yàn)進(jìn)行分析比較。P0.05代表差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:一、一般資料:本次共調(diào)查原發(fā)性干燥綜合征病例132例,全為女性,平均年齡在51.75±11.61歲,并將患者分為青年段(20-40歲)、中年段(41-60歲)、老年段(≥61歲),我們發(fā)現(xiàn)發(fā)病年齡集中在41-60歲(61%)。二、臨床表現(xiàn):與臨床大部分研究結(jié)果相同,患者表現(xiàn)主要以口干、眼干多見(jiàn),分別為128例(96.97%)、97例(73.48%),同時(shí)關(guān)節(jié)痛、乏力、猖獗齒、反復(fù)口腔潰瘍、關(guān)節(jié)腫、發(fā)熱等也較為常見(jiàn),而舌脈表現(xiàn)主要以干、紅、瘦舌、及細(xì)、沉、弦脈等最普遍。不同年齡段的患者在全身表現(xiàn)上(發(fā)熱、乏力、關(guān)節(jié)痛、睡眠障礙)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);在局部外分泌腺表現(xiàn)上,老年段猖獗齒較青年段患者多見(jiàn),青年段腮腺腫較中年段患者多見(jiàn),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三、證型分布:(1)主要證型出現(xiàn)比例依次為肝腎陰虛證48例(36.36%)氣陰兩虛證40例(30.31%)陰虛血瘀證27例(20.45%)肺胃津傷證17例(12.88%)。四個(gè)證型中,肝腎陰虛證、氣陰兩虛證、陰虛血瘀證患者年齡顯著大于肺胃津傷證患者年齡,差異有統(tǒng)計(jì)學(xué)意義(P0.05);中、老年段肝腎陰虛證及氣陰兩虛證多見(jiàn),青年段肺胃津傷證比老年段多見(jiàn),差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同主證的患者在病程上無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(2)兼證出現(xiàn)頻次依次為(肝郁)氣滯證45例(34.09%)濕熱證20例(15.15%)血瘀證12例(9.09%)熱毒證11例(8.33%)。不同年齡段患者在兼證的分布上,青年段兼證以氣滯證多見(jiàn),老年段兼證以濕熱證多見(jiàn),差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同兼證患者的病程無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。四、抑郁及焦慮自評(píng)量表評(píng)分:50例患者的SDS、SAS標(biāo)準(zhǔn)分分別為42.20±8.49分、39.53±7.85分,9例(18%)患者存在抑郁癥狀,全部為輕度抑郁;存在焦慮癥狀的患者有10例(20%),其中中度焦慮患者1例(2%),輕度焦慮患者9例(18%),20例健康體檢者SDS、SAS標(biāo)準(zhǔn)分分別為30.81±4.48分、30.94±4.71分,與原發(fā)性干燥綜合征患者比較,均存在顯著性差異(P0.05)。各主要證型之間SDS標(biāo)準(zhǔn)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);各主要證型之間SAS標(biāo)準(zhǔn)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);氣滯證患者與全部患者的SDS標(biāo)準(zhǔn)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),與全部患者的SAS標(biāo)準(zhǔn)分差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同年齡段SDS標(biāo)準(zhǔn)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);不同年齡段SAS標(biāo)準(zhǔn)分差異統(tǒng)計(jì)學(xué)無(wú)意義(P0.05)。結(jié)論:pSS中醫(yī)證候分型目前尚無(wú)統(tǒng)一標(biāo)準(zhǔn),從本研究可發(fā)現(xiàn),(1)本病陰虛為本:以中老年女性多見(jiàn),四個(gè)主證(肝腎陰虛、氣陰兩虛、陰虛血瘀、肺胃津傷證)均與陰虛密切相關(guān),以前兩個(gè)主證最為常見(jiàn)。(2)肝郁氣滯是本病發(fā)病又一大主要因素:四個(gè)兼證中,(肝郁)氣滯證最常見(jiàn)(34.09%),其出現(xiàn)的頻次僅次于主證肝腎陰虛證(36.36%)。(3)現(xiàn)代醫(yī)學(xué)研究表明本病常見(jiàn)抑郁及焦慮狀態(tài),而抑郁、焦慮又與中醫(yī)"燥證"、"郁證"等相似,結(jié)合本課題抑郁及焦慮自評(píng)量表評(píng)分結(jié)果,不難發(fā)現(xiàn)本病與中醫(yī)肝生理病理密切相關(guān),肝郁氣滯是一大發(fā)病因素,貫穿疾病始終,影響著其他病理變化及疾病進(jìn)程。
[Abstract]:Objective: it is often found that the clinical manifestations, TCM syndromes, etiology, pathogenesis and treatment of primary Sjogren syndrome are closely related to the liver physiology and pathology of traditional Chinese medicine. Modern medicine also finds that the patients have depression, anxiety or tendency, and the depression and anxiety are often similar to "dryness syndrome", "stagnation" and "dirty dryness" in traditional Chinese medicine. Professor Ji Wei, a tutor, summed up many years of clinical experience, put forward the theory of liver theory, that is, in the treatment of this disease, in addition to simple nourishing Yin, pay attention to the liver, liver, liver and liver. This subject aims to study the characteristics of TCM syndrome of primary Sjogren syndrome and its relationship with western medicine depression and concern, and further explore the disease and liver physiology and pathology of traditional Chinese medicine. This study provides a theoretical basis for the treatment of Sjogren syndrome from the liver. Methods: This study collected the clinical data of the patients with primary Sjogren syndrome in the Department of rheumatism in the Department of rheumatism, Jiangsu Province Traditional Chinese Medicine Hospital during 2015-2016 years, and selected some patients to conduct depression, self rating Anxiety Scale, and observed the manifestations and progress of TCM syndromes in all patients. It mainly includes: first, using the self compiled TCM syndrome questionnaire (compilation basis: through the literature research and clinical observation, preliminary screening the common TCM symptoms of primary Sjogren syndrome), collect and collate the clinical data and make the type of syndrome. A total of four main syndromes of liver kidney yin deficiency, Qi Yin deficiency, yin deficiency and blood stasis and lung and stomach injury syndrome, and (liver depression) qi stagnation, damp heat, blood stasis and heat toxin four. Two, assist any 50 patients and 20 health examiners to complete the self rating depression and anxiety scale. Three, data processing: the application of SPSS22.0 statistical software for data analysis, among them measurement The data were unified with mean standard deviation, counting data were checked with chi square test, independent samples were analyzed by t test and compared with.P0.05 representative differences. Results: 1. General data: 132 cases of primary Sjogren syndrome were investigated, the average age was 51.75 + 11.61 years old, and the patients were divided into young patients (20-40 The age of age (41-60 years old), old age group (> 61 years old), we found that the age of onset was 41-60 years (61%). Two, the clinical manifestations were the same as most of the clinical findings. The patients showed mainly dry mouth and dry eye, 128 cases (96.97%), 97 cases (73.48%), joint pain, fatigue, rampant teeth, repeated oral ulcers, joint swollen, fever, etc. The most common manifestations of the tongue are dry, red, thin, and thin, heavy, and chord. There is no statistical difference between patients of different ages (fever, fatigue, joint pain, sleep disorders). In the local exocrine glands, there are more rampant teeth in the elderly than those in the young, and the parotidecs in the young are more than those in the middle age group. The difference was statistically significant (P0.05). (1) the distribution of syndrome type: (1) the proportion of main syndrome types in 48 cases (36.36%) Qi Yin two deficiency syndrome (30.31%) 27 cases of yin deficiency and blood stasis (20.45%) 17 cases (12.88%) of lung and stomach injury syndrome. Among the four syndrome types, the liver kidney yin deficiency syndrome, Qi Yin two deficiency syndrome, the age of yin deficiency and blood stasis syndrome were significantly greater than that of the lung and stomach. There were significant differences in the age of the patients with the syndrome of Tianjin injury (P0.05); in the elderly, the liver kidney yin deficiency syndrome and the Qi Yin two deficiency syndrome were more common, the lung and stomach injury syndrome in the young segment were more common than the elderly (P0.05); there was no statistical difference between the patients with different main syndromes (P0.05). (2) 45 cases (34.09) were (34.09) and 45 cases (34.09). %) 20 cases of damp heat syndrome (15.15%) blood stasis syndrome in 12 cases (9.09%) and 11 cases of heat toxin (8.33%). In the distribution of concurrent syndrome in different age groups, there were more syndrome in the youth segment and syndrome of qi stagnation. There was a significant difference between the elderly and the syndrome of damp heat (P0.05). There was no statistical difference in the course of disease in different cases (P0.05). Four, depression and anxiety self rating scale evaluation Score: 50 patients with SDS, SAS standard scores were 42.20 + 8.49, 39.53 + 7.85, 9 (18%) had depressive symptoms, and all were mild depression; there were 10 patients with anxiety symptoms (20%), 1 cases (2%) of moderate anxiety patients, 9 cases of mild anxiety (18%), and SAS standard score of SDS. .71 scores were significantly different from those with primary Sjogren syndrome (P0.05). There was no significant difference in SDS standard scores between the main syndromes (P0.05), and there was no statistical difference between the major syndromes (P0.05), and there was no statistical significance (P0.05) between the patients with qi stagnation and all patients with the SDS standard (P0.05). There were statistical significance (P0.05) in the standard difference of SAS standard in different age groups (P0.05), and there was no significant difference between the standard scores of SAS in different age groups (P0.05). Conclusion: there is no unified standard for the classification of SAS in different age groups (P0.05). From this study, there is no unified standard. (1) this study can be found, (1) the deficiency of this disease is the basis: the majority of the middle-aged and the elderly women are more common and four masters. Syndrome (liver, kidney yin deficiency, Qi Yin deficiency, yin deficiency and blood stasis, lung and stomach and Tianjin injury syndrome) are closely related to yin deficiency, and the previous two main syndromes are the most common. (2) stagnation of liver qi and qi stagnation is another major factor: the most common (34.09%) syndrome (liver qi stagnation) in four concurrent syndromes (34.09%) is second only to the main syndrome of liver and kidney yin deficiency syndrome (36.36%). (3) the modern medical research table The common depression and anxiety state of the disease, and depression and anxiety are similar to "dryness syndrome" and "depression" in traditional Chinese medicine. It is not difficult to find that this disease is closely related to the liver physiology and pathology of traditional Chinese medicine. The stagnation of liver depression is a major factor, which runs through the disease and affects the other pathological changes and the process of disease.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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