肠易激综合征中医证候分布与神经内分泌机制的横断面临床研究  

Traditional Chinese medicine syndrome distribution and neuroendocrine mechanisms of irritable bowel syndrome: cross-sectional study

作　　者：侯政昆[1] 李梅[2] 谢地[3,4] 刘凤斌[1] 

机构地区：[1]广州中医药大学第一附属医院脾胃病科,广东广州510405 [2]重庆市中医院肝病科,重庆400021 [3]广州中医药大学研究生院,广东广州510006 [4]北京和睦家医院医疗培训中心,北京100015

出　　处：《中国中药杂志》2016年第7期1325-1337,共13页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金面上项目(81373786);国家自然科学基金青年项目(81303148);国家重点基础研究发展计划(973)项目(2011CB505103);中央财政支持地方高校发展专项(粤财教[2014]276号);广东省高水平大学重点建设高校和重点学科建设项目(粤办函[2015]325号);广东省中医药局建设中医药强省专项(粤中医函[2015]19号)

摘　　要：为明确肠易激综合征的中医证候分布和发病规律,该研究采用横断面设计,纳入广州中医药大学第一附属医院的本病就诊患者,收集其社会学资料(12个变量)、疾病影响因素(13个变量)、症状和体征(9个方面84个变量)和神经内分泌指标(19个变量),统计方法采用单向方差分析、卡方检验、非参数检验分析各组间差别,用二分类Logistic回归分析疾病亚型和证型与临床症状间关系,并将中医证型进行证素分解以分析神经内分泌指标在各证型和证素间的差别。结果共收集383例患者,其中泄泻型、便秘型、混合型患者分别为353(92.2%),14(3.7%),16(4.1%)例,泄泻型患者中肝郁脾虚证、肝郁气滞证、脾胃湿热证、脾虚湿阻证分别为291(76.0%),18(4.7%),48(12.5%),26(6.8%)例。在泄泻型、便秘型、混合型的疾病亚型对比中,患者血型存在显著差异,疾病分型与过敏史、饮酒史、三餐不准时、很少或无休假、发病的其他原因共5个变量显著相关(P<0.05,<0.3),共15个症状和体征变量(畏寒、面色异常、胃脘胀满等)在各组间有显著差别(P<0.05),分别有5,8,5个变量是各自的独立影响因素,神经内分泌指标在各组间均无显著差异;在泄泻型肝郁脾虚证、肝郁气滞证、脾胃湿热证、脾虚湿阻证的中医证型对比中,患者性别、居住条件、职业存在显著差异,中医证型与饮酒史、吸烟史、很少或不吃早餐、每天睡眠时间少于8 h共4个变量呈显著相关(P<0.05,<0.3),共14症状和体征变量(手足心热、乏力、头胀等)在各组间有显著差别(P<0.05),分别有3,4,6,3个变量是各自的独立影响因素,神经内分泌指标仅乙酰胆碱(Ach)、血管紧张素Ⅱ(AT-Ⅱ)在肝郁脾虚证、脾虚湿阻证之间存在显著差异,Ach,AT-Ⅱ,促肾上腺素(ACTH),雌二醇(E2)在部分证素对比中存在显著差异。该研究初步明确本病社会学分布、影响因素、证候分布、疾病和亚组微观机�In order to clarify the traditional Chinese medicine（ TCM） syndrome distribution and pathogenesis of irritable bowel syndrome（ IBS）,the patients in the first affiliated hospital of Guangzhou university of Chinese medicine were enrolled for the cross-sectional study. The data of 12 sociological variables,13 risk factors,84 symptoms and signs variables（ in 9 aspects）,and 19 neuroendocrine indices were extracted for group-between analysis with one-way ANOVA,chi-square test and nonparametric test,and the relationship analysis between clinical symptoms and diseases sub-types was done with binary Logistic regression. In addition,the patterns of TCM syndromes were divided by several syndrome factors to analyze the difference in neuroendocrine indices between various patterns and syndrome factors. A total of 383 IBS patients were enrolled,including 353（ 92. 2%） cases of diarrhea,14（ 3. 7%） cases of constipation and 16（ 4. 1%） cases of mixed types. In IBS-diarrhea patients,there were 291（ 76. 0%）,18（ 4. 7%）,48（ 12. 5%） and 26（ 6. 8%） cases of syndrome of liver depression and spleen deficiency（ s LDSD）,syndrome of liver depression and qi stagnation（ s LDQS）,syndrome of dampness-heat in the spleen and stomach（ s DHSS）,and syndrome of spleen deficiency with dampness encumbrance（ s SDDE） respectively. There was significant differences in blood groups between IBS-diarrhea patients,IBS-constipation patients and IBS-mixed types patients; their disease classification was significantly correlated with the allergies,drinking,irregular meals habits,no or less vacations,and other causes of morbidity（ P 0. 05,f 0. 3）. A total of 15 symptoms and signs variables（ e. g.,chills,facial abnormalities,epigastric fullness,etc.） had significant differences between different groups（ P 0. 05）,and 5,8,5variables were respective independent factors for IBS-diarrhea,constipation and mixed type. There was no significant difference in neuroendocrine indices between various groups. Th

关 键 词：肠易激综合征 证候 发病机制 影响因素 肝郁脾虚证 乙酰胆碱(Ach) 血管紧张素Ⅱ(AT-Ⅱ) 

分 类 号：R259[医药卫生—中西医结合]