54例视神经脊髓炎谱系疾病患者的临床特点分析及中医证素研究  

Analysis of Clinical Characteristics of 54 Patients with Neuromyelitis Optic Spectrum Disease and Traditional Chinese Medicine Syndrome Elements Research

作　　者：王春琛[1] 陈志刚[2] 李彬[1] 王麟鹏[1] 邢怡[3] 马昕宇[1] 杨清玄 刘银霞 WANG Chunchen;CHEN Zhigang;LI Bin;WANG Linpeng;XING Yi;MA Xinyu;YANG Qingxuan;LIU Yinxia(Acupuncture Center,Beijing Traditional Chinese Medicine Hospital Affiliated to Beijing Capital Medical University,Beijing 100010,China;Neurology Department,Oriental Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100078,China;Neurology Department, Xuanwu Hospital, Beijing Capital Medical University,Beijing 100053,China;Peking University,Beijing 100091,China;Electroneurophsiology Department,Beijing Traditional Chinese Medicine Hospital Affiliated to Beijing Capital Medical University,Beijing 100010,China)

机构地区：[1]北京首都医科大学附属北京中医医院针灸中心,北京100010 [2]北京中医药大学东方医院神经内科,北京100078 [3]北京首都医科大学宣武医院神经内科,北京100053 [4]北京大学,北京100091 [5]北京首都医科大学附属北京中医医院神经电生理室,北京100010

出　　处：《世界中医药》2022年第1期98-103,共6页World Chinese Medicine

基　　金：国家重点基础研究计划项目(2014CB543203);北京市医疗管理局培育计划项目(PZ2016005);针灸神经调控北京市重点实验室(BZ0437)。

摘　　要：目的:探讨54例视神经脊髓炎谱系疾病(NMOSD)患者的临床特点及证素证候分析,为阐明该病的中西医病因、诊断和证候间关系提供依据。方法:按照2015年国际视神经脊髓炎诊断小组(IPND)的诊断标准招募54例NMOSD患者,收集资料进行统计分析。四诊信息根据病位和病性证素予以整理并分析其特征。结果:研究对象男女比例为1∶6.7,平均发病年龄(40.13±12.14)岁,AQP4-IgG阳性49例,合并自身免疫疾病抗体阳性的19例;家族史分布情况,肿瘤家族史占9.3%,自身免疫病家族占5.6%;平均发病病程为(3.91±4.60)年,平均发作为(5.91±4.56)次;最常见受累部位为视神经和颈胸髓;神经电生理检查异常18例。中医证素结果显示病位证素分布:脾>肝>肾>三焦>胃;病性实证分布为:湿>痰>血瘀>气滞>寒;虚性分布为:气虚>阴虚>阳虚>血虚>阳亢。结论:缓解期NMOSD患者发病以青中年女性为主,可合并自身免疫疾病,神经系统受累以视神经、视交叉和颈髓、胸髓最常见,周围血AQP4-IgG检测阳性率高,神经电生理诱发电位多异常。中医证素分析提示本病的病位证素在脾、肝、肾,本病的虚性证素多为气虚、阴虚、阳虚,实性证素多为湿、痰、瘀;病性本虚归纳为中焦气虚、肝肾阴虚、脾肾阳虚等,为本病发病基础,其实性证素多有痰湿、血瘀、气滞等兼证。Objective:To explore the clinical characteristics and syndrome analysis of 54 patients with neuromyelitis optica spectrum disease(NMOSD),and to provide evidence for elucidating the relationship between the etiology,diagnosis and syndromes of the disease.Methods:According to the 2015 International Optic Neuromyelitis Diagnostic Group(IPND)diagnostic criteria,a total of 54 patients with NMOSD were recruited,and data were collected for statistical analysis.The information of the 4 clinics was sorted and analyzed according to the location of the disease and the symptoms of the disease.Results:The male to female ratio of the study subjects was 1∶6.7,the average age of onset(40.13±12.14)years old,49 cases of AQP4-IgG positive,19 cases of autoimmune disease antibody positive;family history distribution,tumor family history accounted for 9.3%,autoimmune disease family accounted for 5.6%;the average course of disease was(3.91±4.60)years,and the average number of attacks was(5.91±4.56);the most common involved sites were the optic nerve and cervical thoracic spinal cord;18 cases of abnormal neuroelectrophysiological examination.The results of TCM syndrome elements show that the distribution of disease location syndrome elements:spleen>liver>kidney>three Jiao>stomach;the distribution of disease symptoms was:wet>phlegm>blood stasis>qi stagnation>cold;the distribution of deficiency is:qi deficiency>yin deficiency>yang Deficiency>blood deficiency>yang hyperactivity.Conclusion:The incidence of NMOSD patients in remission is mainly young and middle-aged women,which may be associated with autoimmune diseases.The nervous system is most commonly affected by the optic nerve,optic chiasm,cervical spinal cord,and thoracic spinal cord.The positive rate of AQP4-IgG detection in peripheral blood is high,and neuroelectrophysiological induction potential is abnormal.The analysis of TCM syndrome elements indicates that the pathological factors of this disease are in the spleen,liver,and kidney.The deficiency syndrome factors of this di

关 键 词：视神经脊髓炎谱系疾病 神经免疫 中医证素 临床特点 辨证论治 证素 自身免疫 证候分析 

分 类 号：R259[医药卫生—中西医结合] R277.7[医药卫生—中医内科学]