1918例子宫内膜异位症患者中医证候学特征分析的多中心研究  

Characteristics of Traditional Chinese Medicine Syndromes of Endometriosis: A Multi-centered Analysis of 1918 Cases

作　　者：梅珊珊 俞超芹[1,2] 丁杰 程雯 连方 段华[4] 薛晓鸥[5] 张明敏 罗颂平[7] 冯晓玲[8] 马堃 谭布珍[10] 王佩娟[11] 吴瑞瑾[12] 张晋峰[13] 徐琳[14] 王莉 许泓[16] 李佶[17] 张婷婷[18] 沈浣[19] 曹保利[20] 李力[21] MEI Shanshan;YU Chaoqin;DING Jie;CHENG Wen;LIAN Fang;DUAN Hua;XUE Xiaoou;ZHANG Mingmin;LUO Songping;FENG Xiaoling;MA Kun;TAN Buzhen;WANG Peijuan;WU Ruijin;ZHANG Jinfeng;XU Lin;WANG Li;XU Hong;LI Ji;ZHANG Tingting;SHEN Huan;CAO Baoli;LI Li(Shanghai University of Traditional Chinese Medicine,Shanghai,201203;Changhai Hospital;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine;Beijing Obstetrics and Gynecology Hospital,Capital Medical University;Dongzhimen Hospital,Beijing University of Chinese Medicine;Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology;The First Affiliated Hospital of Guangzhou University of Chinese Medicine;First Affiliated Hospital,Heilongjiang University of Chinese Medicine;Xiyuan Hospital,China Academy of Chinese Medical Sciences;The Second Affiliated Hospital of Nanchang University;Jiangsu Province Hospital on Integration of Chinese and Western Medicine;Women's Hospital,School of Medicine,Zhejiang University;Shanxi Province Hospital of Traditional Chinese Medicine;Kunming Tongren Hospital;Obstetrics&Gynecology Hospital of Fudan University;The International Peace Maternity&Child Health Hospital,Shanghai Jiaotong University School of Medicine;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine;Peking University People’s Hospital;Tianjin Nankai Hospital;Daping Hospital,Army Medical University(Third Military Medical University))

机构地区：[1]上海中医药大学,上海市201203 [2]海军军医大学第一附属医院 [3]山东中医药大学附属医院 [4]首都医科大学附属北京妇产医院 [5]北京中医药大学东直门医院 [6]华中科技大学同济医学院附属同济医院 [7]广州中医药大学第一附属医院 [8]黑龙江中医药大学附属第一医院 [9]中国中医科学院西苑医院 [10]南昌大学第二附属医院 [11]江苏省中西医结合医院 [12]浙江大学医学院附属妇产科医院 [13]山西省中医院 [14]昆明同仁医院 [15]复旦大学附属妇产科医院 [16]上海交通大学医学院附属国际和平妇幼保健院 [17]上海中医药大学附属龙华医院 [18]上海中医药大学附属岳阳中西医结合医院 [19]北京大学人民医院 [20]天津南开医院 [21]陆军军医大学大坪医院

出　　处：《中医杂志》2022年第2期149-156,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82074206,81774352);上海市中医药三年行动计划[ZY(2018-2020)-FWTX-1107]。

摘　　要：目的探讨子宫内膜异位症(简称"内异症")证型分布规律及证候特点。方法采用多中心、大样本流行病学调查研究,纳入内异症患者1918例,设计"子宫内膜异位症中医证候临床流行病学调查表",包括一般资料、月经情况及中医临床症状体征、舌象,建立Excel数据库,运用SPSS 22.0软件进行频数统计分析。通过因子分析提炼内异症的中医证候要素(包括病性要素和病位要素);运用聚类方法总结内异症主要中医证型及分布规律。结果共纳入内异症患者四诊信息中有意义的条目85项,其中月经情况表现为经行血块量多或瘀阻不畅,月经时间延长且伴随经行腹痛,并易伴有经行或经前胸胁乳房胀痛,带下色白量多。排名前10位的症状和体征为神疲肢倦、腰膝酸软、急躁易怒、畏寒肢冷、少气懒言、喜热饮、多梦、少寐易醒、面色萎黄、口干。构成比>10%的舌象指标有10项,包括苔白、苔薄、舌淡红、舌红、舌淡暗、苔厚、舌无苔、舌暗红、苔黄、舌边有齿痕。对85项四诊信息进行因子分子可得病位证素为胞宫、肝、肾、脾、胃;病性证素为痰、饮、湿、热、火、寒、气滞、血瘀、阴虚、阳虚、血虚、气虚。聚类分析提示内异症可拟定为5种证型分别为寒凝气滞血瘀证(34.1%)、湿热血瘀证(20.0%)、肝郁肾虚血瘀证(19.0%)、痰湿血瘀证(16.4%)、气虚血瘀证(10.5%)。结论子宫内膜异位症病机复杂,多为虚实夹杂,主要证型为寒凝气滞血瘀证、湿热血瘀证、肝郁肾虚血瘀证、痰湿血瘀证及气虚血瘀证。Objective To clarify the distribution law and the characteristics of traditional Chinese medicine(TCM) syndromes of endometriosis.Methods A large sample multi-center epidemiological survey was conducted in 1918 endometriosis patients with a self-made "Clinical Epidemiological Survey Questionnaire of TCM Syndromes of Endometriosis".The collected data included general information,menstrual condition,TCM syndromes and symptoms and tongue manifestation,based on which an Excel database was conducted.The SPSS 22.0 software was used for frequency analysis;factor analysis was performed to extract the TCM syndrome elements of endometriosis including nature and location of disease;cluster analysis was used to summarize the main TCM syndrome types and distribution rules of endometriosis.Results A total of 85 meaningful items related to the four examinations of endometriosis were included;menstruation-related items were inhibited menstruation or large menstrual clots,prolonged menstruation with abdominal pain during menstruation,distending pain of the breasts during and before menstruation,and large amount of white leukorrhea.The top ten symptoms were mental and limbs fatigue,sore and weak loins and knees,impatience and irritability,fear of cold with cold limbs,weak breathing and want of speech,preferring hot drinks,profuse dreaming,less sleep and waking up easily,sallow yellow complexion,and dry mouth.The top ten(frequency>10%) tongue manifestations were white coating,thin coating,light red tongue,red tongue,pale dusky tongue,thick coating,mirror-like tongue,black red tongue,yellow coating and teeth-marked tongue.Factor analysis showed that the syndrome elements related to location of disease were uterus,liver,kidney,spleen,and stomach;syndrome elements related to nature of disease were phlegm,rheum,dampness,heat,fire,cold,qi stagnation,blood stasis,yin deficiency,yang deficiency,blood deficiency,and qi deficiency.Cluster analysis suggested that endometriosis can be divided into five syndrome types,namely,qi stagnation and

关 键 词：子宫内膜异位症 证候要素 辨证分型 因子分析 聚类分析 

分 类 号：R271.9[医药卫生—中西医结合]