【摘要】：目的:通過(guò)了解緊張型頭痛與述情障礙的關(guān)系,在此基礎(chǔ)上進(jìn)一步探討緊張型頭痛中醫(yī)證型與述情障礙的相關(guān)性,為臨床上中醫(yī)藥治療緊張型頭痛提供一定的辨證客觀依據(jù),開(kāi)拓中醫(yī)藥在緊張型頭痛防治中的新思路。方法:依據(jù)2004年《國(guó)際頭痛分類(lèi)(第二版)》(ICHD-Ⅱ)的診斷標(biāo)準(zhǔn),納入2016例緊張型頭痛患者進(jìn)行本課題研究,并參照《中醫(yī)內(nèi)科學(xué)》中頭痛證候診斷標(biāo)準(zhǔn)進(jìn)行辨證分型,主要辨證為肝陽(yáng)頭痛、痰濁頭痛、腎虛頭痛、瘀血頭痛、血虛頭痛及導(dǎo)師的辨證經(jīng)驗(yàn)辨證為肝郁痰凝頭痛六種頭痛證型。入組的每例緊張型頭痛患者均給予多倫多述情障礙量表評(píng)分、漢密頓焦慮量表以及漢密頓抑郁量表評(píng)分。將患者的基本信息及量表評(píng)分等數(shù)據(jù)收集后選用spss18.0軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料選用x±s表示,計(jì)數(shù)資料選用百分?jǐn)?shù)表示,論文中出現(xiàn)的全部檢驗(yàn)為雙側(cè)檢驗(yàn),認(rèn)為p0.05有統(tǒng)計(jì)學(xué)意義。本文采用的統(tǒng)計(jì)方法有描述性統(tǒng)計(jì)、卡方檢驗(yàn)、Spearman相關(guān)分析(數(shù)據(jù)不服從正態(tài)分布)或皮爾森相關(guān)分析(數(shù)據(jù)服從正態(tài)分布)。結(jié)果:1一般人口學(xué)資料,患者平均病程為4.01年,緊張型頭痛患者性別分布在各年齡段無(wú)明顯的差異(p=0.1990.05),均以女性為多;腦力勞動(dòng)者發(fā)生述情障礙的比率較體力勞動(dòng)及混合型勞動(dòng)者高;文化程度越高,發(fā)生述情障礙的比率越高。2述情障礙的總發(fā)生率為64.8%,焦慮的總發(fā)生率為40.3%,抑郁的總發(fā)生率為70.4%。每種中醫(yī)證型中述情障礙的發(fā)生率如下:肝郁痰凝頭痛85.3%,血瘀頭痛74.3%,痰濁頭痛70%,腎虛頭痛40%,血虛頭46.3%,肝陽(yáng)頭痛36.8%,不同證型之間述情障礙的發(fā)生率,差異有統(tǒng)計(jì)學(xué)意義(p=0.0010.05)。3緊張型頭痛患者中醫(yī)證型與述情障礙總分之間存在相關(guān)性,r=-0.436,p=0.0010.05,有統(tǒng)計(jì)學(xué)意義。4緊張型頭痛患者述情障礙總分與焦慮總分之間無(wú)相關(guān)性,r=-0.026,p=0.7010.05,無(wú)統(tǒng)計(jì)學(xué)意義;緊張型頭痛患者述情障礙評(píng)分與抑郁評(píng)分之間存在正相關(guān)性,r=0.950,p=0.0010.05,有統(tǒng)計(jì)學(xué)意義。5頭痛各中醫(yī)證型述情障礙得分與焦慮得分經(jīng)相關(guān)性分析,其相關(guān)系數(shù)及p值分別如下:肝郁痰凝頭痛r=0.08,p=0.493;痰濁頭痛r=-0.233,p=0.274;血瘀頭痛r=-0.057,p=0.744;腎虛頭痛r=-0.254,p=0.280;血虛頭痛r=-0.007,p=0.953;肝陽(yáng)頭痛r=0.137,p=0.575;p值均大于0.05,表明各證型中述情障礙得分與焦慮得分之間無(wú)相關(guān)性;頭痛各中醫(yī)證型述情障礙得分與抑郁得分經(jīng)相關(guān)性分析,其相關(guān)系數(shù)及p值分別如下:肝郁痰凝頭痛r=0.906,p=0.001;痰濁頭痛r=0.986,p=0.001;血瘀頭痛r=0.973,p=0.001;腎虛頭痛r=0.962,p=0.0001;血虛頭痛r=0.917,p=0.001;肝陽(yáng)頭痛r=0.881,p=0.001;p值均小于0.05,相關(guān)性系數(shù)為正值,表明各證型中述情障礙得分與抑郁得分之間存在正相關(guān)性。結(jié)論:1緊張型頭痛的中醫(yī)證型與述情障礙總分之間存在相關(guān)性,證型按照肝陽(yáng)頭痛、腎虛頭痛、血虛頭痛、痰濁頭痛、血瘀頭痛、肝郁痰凝型頭痛的順序,述情障礙總分呈逐漸增高的趨勢(shì)。2述情障礙在緊張型頭痛各種中醫(yī)證型中的發(fā)生率存在顯著差異,其中以肝郁痰凝型頭痛述情障礙的發(fā)生率最高,其他證型的發(fā)生率依次為血瘀頭痛、痰濁頭痛、腎虛頭痛、血虛頭痛、肝陽(yáng)頭痛。因而可知,從病機(jī)方面可以得出郁與痰的相互交結(jié)、痰濁、瘀血在緊張型頭痛患者述情障礙發(fā)生的過(guò)程中起著重要的作用,在治療中可注重解郁化痰、化痰降濁、活血化瘀等治法的應(yīng)用。3緊張型頭痛患者述情障礙總分與抑郁量表總分存在正相關(guān)性,即緊張型頭痛患者隨著述情障礙量表總分的增高,其抑郁量表總分也隨之升高;而其與焦慮量表總分無(wú)相關(guān)性。在緊張型頭痛的中醫(yī)各種辨證分型中,患者述情障礙量表總分與焦慮量表總分仍無(wú)相關(guān)性。述情障礙量表總分與抑郁量表總分仍存在正相關(guān)性,即緊張型頭痛患者隨著述情障礙量表總分的增高,其抑郁量表總分也隨之增高。因此可知,心理精神因素,尤其是抑郁在述情障礙產(chǎn)生過(guò)程中起著重要的作用。4述情障礙在緊張性頭痛各種證型中的發(fā)生率及總分存在顯著差異,因此可將述情障礙作為緊張型頭痛中醫(yī)辨證的客觀指標(biāo),尤其為緊張型頭痛的中醫(yī)辨證分型提供了理論基礎(chǔ)。
[Abstract]:Objective: To explore the relationship between tension type headache and alexithymia, and to further explore the correlation between TCM syndrome type and alexithymia of tension type headache, to provide a certain objective basis for clinical traditional Chinese medicine to treat tension type headache, and to explore new ideas of TCM in the prevention and control of tension type headache. Method: according to 2004 < country. The diagnostic criteria for the classification of headaches (Second Edition) (ICHD- II) were included in the study of 2016 patients with tension type headache, and according to the diagnosis standard of the headache syndrome in the medicine of traditional Chinese medicine, the main syndrome differentiation was liver Yang headache, phlegm headache, kidney deficiency headache, blood stasis headache, blood asthenia headache and syndrome differentiation of tutor's syndrome differentiation for liver depression Six kinds of headache syndrome types of phlegm, headache and headache were given in each group. The Toronto Alexithymia Scale score, Hamilton Anxiety Scale and Hamilton Depression Scale score were given. The data of basic information and scale score of patients were collected and analyzed with SPSS18.0 software, and the measurement data were x + s and counted. The total test in this paper was a bilateral test. The statistical methods used in this paper were statistically significant. The statistical methods used in this paper were descriptive statistics, chi square test, Spearman correlation analysis (data disobeying normal distribution) or Pearson correlation analysis (the data were subject to normal distribution). Results: 1 General demographic data, patients were flat. The duration of the disease was 4.01 years. There was no significant difference in gender distribution in all age groups (p=0.1990.05). All of them were more women. The rate of alexithymia in mental workers was higher than that of manual labor and mixed type workers. The higher the cultural degree, the higher the rate of alexithymia, the total incidence of.2 alexithymia was 64.8%. The total incidence rate was 40.3%, the total incidence of depression was 70.4%., the incidence of alexithymia in each type of TCM syndrome was as follows: Liver Depression phlegm coagulating headache 85.3%, blood stasis headache 74.3%, phlegm headache 70%, kidney asthenia headache 40%, blood asthenia head 46.3%, liver Yang headache 36.8%, different syndrome types between different syndromes, the difference was statistically significant (p=0.0010.05).3 tight There was a correlation between the TCM syndrome type and the total score of alexithymia, r=-0.436, p=0.0010.05. There was no correlation between the total score of alexithymia and the total score of anxiety in.4 patients with tension type headache, r=-0.026, p=0.7010.05, no statistical significance; there was a positive correlation between the alexithymia score and the depression score of the patients with tension type head pain. The correlation coefficient and P value of the TCM syndrome type alexithymia score and anxiety score of different TCM Syndrome Types in.5 were statistically significant as follows: Liver Depression phlegm coagulation headache r=0.08, p=0.493, phlegm headache r=-0.233, p=0.274, blood stasis headache r=-0.057, p=0.744, kidney asthenia headache r=-0.254, p=0.280; blood asthenia headache, headache, respectively,.5 .953, liver Yang headache r=0.137, p=0.575 and P value were more than 0.05, indicating that there was no correlation between the scores of alexithymia and anxiety scores in each type of syndrome; the correlation coefficient and P value of the scores of the TCM syndrome type alexithymia and the depression score were as follows: Liver Depression phlegm coagulating headache r=0.906, p=0.001; phlegm headache r=0.986, p=0.001; blood stasis Headache r=0.973, p=0.001; kidney deficiency headache r=0.962, p=0.0001; blood asthenia headache r=0.917, p=0.001; Liver Yang headache r=0.881, p=0.001; P values are less than 0.05, correlation coefficient is positive value, indicating that there is a positive correlation between the scores of alexithymia and depression scores in each syndrome. Conclusion: there exists between the TCM syndrome type of 1 tension type headache and the total score of alexithymia. Correlation, in accordance with the liver Yang headache, kidney deficiency headache, blood asthenia headache, phlegm headache, blood stasis headache, liver depression and phlegm coagulating type headache, the total score of alexithymia is increasing gradually. The incidence of.2 alexithymia in various TCM syndrome types of tension type headache is significantly different, among which the incidence of headache and alexithymia of liver depression and phlegm type is the incidence of headache and alexithymia The occurrence rate of other syndrome types is blood stasis headache, phlegm headache, kidney deficiency headache, blood deficiency headache, liver Yang headache. Therefore, it can be found that the mutual connection between depression and phlegm, phlegm and blood stasis play an important role in the process of alexithymia in patients with tension type headache from the pathogenesis of the disease, and the treatment may pay attention to the solution of phlegm and phlegm in the treatment. The general score of alexithymia in patients with tension type headache was positively correlated with the total score of the depression scale, that is, with the increase of the total score of the alexithymia, the total score of the depression scale also increased with the increase of the total score of the depression scale in the patients with tension type headache, and there was no correlation between the total score of the depression scale and the total score of the anxiety scale. Various syndromes in the Chinese medicine of tension type headache were found in.3. There was no correlation between the total score of the patient's Alexithymia Scale and the total score of the anxiety scale. The total score of the alexithymia and the total score of the depression scale remained positive, that is, the total score of the tension type headache patients with the total score of the alexithymia was increased, and the total score of the depression scale was also increased. The incidence and total score of.4 alexithymia in the various syndromes of tension headache are significant differences. Therefore, alexithymia can be used as an objective index of TCM Syndrome Differentiation for tension type headache, especially for the TCM syndrome differentiation of tension type headache.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R277.7

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