基于真实世界中风痰热腑实的证候演变规律研究  

Study on the Syndrome Evolution Law of Phlegm Heat and Viscera Excess Based on Real World Stroke

作　　者：宋文英 古金晓 梁笑笑 杜雨轩 谢颖桢[2] SONG Wenying;GU Jinxiao;LIANG Xiaoxiao;DU Yuxuan;XIE Yingzhen(College of the First Clinical Hospital,Beijing University of Chinese Medicine,Beijing 100029,China;Second District of Encephalopathy,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学第一临床医学院,北京100029 [2]北京中医药大学东直门医院脑病二区,北京100700

出　　处：《中医药学报》2023年第7期46-51,共6页Acta Chinese Medicine and Pharmacology

基　　金：国家重点研发计划(2017YFC1700101);北京市科技计划(Z191100006619065)。

摘　　要：目的:通过分析中风痰热腑实证患者在中医治疗下的证候演变,探索中风痰热腑实的发生及演变规律,以期实现临床精确干预。方法:检索北京中医药大学东直门医院1990年1月1日—2020年1月1日以中风为第一诊断、发病72 h以内入院且本次住院时间累计超过30 d的患者的住院资料,病程中出现痰热腑实证的患者为痰热腑实证组,共169例,运用秩和检验及转移率矩阵分析痰热腑实的证候演变规律。结果:(1)始发状态为痰热证的患者更易出现痰热腑实(87.6%),尤其在中脏腑患者里更为突出(95.5%),而未出现痰热腑实证的患者,其始发状态以风痰瘀血痹阻脉络为主(51%);(2)痰热腑实的演变规律大致为痰热证—痰热腑实证—痰瘀阻络证—气虚证,但是中经络与中脏腑的演变规律存在部分差异。不同的证候发展阶段对于疾病总体存在不同意义。结论:痰热腑实证遵循着固定的发生及演变规律,合理地应用演变规律,可以优化治疗方案,实现精准干预。Objective:We aim to explore the occurrence and evolution rules of stroke with phlegm heat and viscera excess syndrome(PHVES)through analyzing the syndrome evolution of stroke patients with PHVES under traditional Chinese medicine treatment,the purpose of which is to achieve precise clinical intervention.Methods:We retrieved the hospitalization data of patients with stroke as the primary diagnosis and admitted within 72 hours of the attack to Dongzhimen Hospital,Beijing,from 1990 to 2020,with more than 30 days of acumulative hospital stay.Patients with PHVES during the course of the disease were classified as PHVES group(n=169),and the evolution rules of the syndrome manifestation were analyzed using rank-sum test and transition rate matrix.Results:1.Patients with the initial manifestation of phlegm-heat syndrome were more likely to develop PHVES(87.6%),especially those with lesions involving zang-fu organs(95.5%).Patients without PHVES were primarily diagnosed with wind-phlegm and blood stasis obstructing vessels and collaterals(51%)at the initial stage.2.The evolution rule of PHVES roughly followed the sequence of phlegm-heat syndrome-phlegm heat and viscera excess syndrome-phlegm-stasis and vessel obstruction syndrome-Qi deficiency syndrome.But there were some differences in the evolution rules between the stroke involving channels and collaterals and the stroke involving zang-fu organs.Different stages of syndrome development had different implications for the disease as a whole.Conclusion:PHVES follows a fixed pattern of occurrence and evolution,and reasonable application of these rules can help optimize treatment plans and achieve precise intervention.

关 键 词：中风 痰热腑实 演变规律 转移率矩阵 

分 类 号：R259[医药卫生—中西医结合]