腹泻型肠易激综合征重叠功能性消化不良的中医证候及证素特征研究  

Study on the Characteristics of Traditional Chinese Medicine Syndromes andSyndrome Elements in the Patients with Diarrhea-Predominant IrritableBowel Syndrome Overlapping Functional Dyspepsia

作　　者：苏桂芳 吴皓萌 刘颖盈 杨元明 黄绍刚 SU Gui-Fang;WU Hao-Meng;LIU Ying-Ying;YANG Yuan-Ming;HUANG Shao-Gang(Dongguan Hospital of Guangzhou University of Chinese Medicine,Dongguan 523000 Guangdong,China;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学东莞医院,广东东莞523000 [2]广州中医药大学第二附属医院,广东广州510120 [3]广州中医药大学第一附属医院,广东广州510405

出　　处：《广州中医药大学学报》2024年第9期2280-2288,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家中医药管理局2023年度中医证候全国重点实验室项目(编号:QZ2023ZZ18);广东省中医院临床研究专项(1010专项)(编号:YN10101907);广东省中医药科学院“优秀青年人才青苗计划”项目(编号:SZ2022QN08);东莞市卫健局“黄绍刚东莞市名中医传承工作室”建设项目(东卫涵·号[2021]·134号)。

摘　　要：【目的】分析腹泻型肠易激综合征(IBS-D)重叠功能性消化不良(FD)的中医证素分布规律,探讨IBS-D重叠FD的中医证候特征。【方法】通过临床调查收集IBS-D、FD和IBS-D重叠FD(简称重叠组)各50例患者的临床资料,运用证素辨证学方法分析其中医证素,并采用频数分析、关联规则分析以及聚类分析归纳其中医证候和证素特征。【结果】(1)频数分析结果显示:重叠组以情志异常为主要诱发或加重因素,其次为饮食不节。主要证候是腹泻、腹胀、胃脘痞满、腹痛和食后痞胀。舌色多为舌淡、舌淡红、舌暗或舌红,舌体大多胖大或有齿痕,舌苔以薄白或白为主;最常见的脉象是脉滑、脉弦、脉沉和脉细。病位证素主要是脾、胃、小肠和肝,病性证素主要是气滞、湿、气虚和阳虚。(2)关联规则分析结果显示:中医证候方面,腹胀和腹泻的支持度最高,为70.00%;病位证素方面,脾和胃的支持度最高,为80.00%;病性证素方面,湿和气滞、气虚和气滞两组的支持度最高,均为36.00%。(3)聚类分析结果显示:中医证候方面,共聚为4类,分别为脾虚湿滞证、脾虚气滞证、脾阳虚证和脾气虚证的主要表现;证候和证素组合方面,共聚为5类,分别为肝郁脾虚证和肠道湿滞证表现、食滞胃脘证表现、脾虚气滞证表现、苔腻以及胃失和降、胃气上逆表现。【结论】IBS-D重叠FD的主要病位在脾,与胃、肝和小肠密切相关,主要证候是脾虚湿滞证和肝郁脾虚证、肠道湿滞证。气滞与湿阻是重叠病机的关键,病性表现为虚实夹杂,疾病后期可出现痰湿、食积、血瘀等病理产物。Objective To investigate the distribution of traditional Chinese medicine(TCM)syndrome elements in the patients with diarrhea-predominant irritable bowel syndrome(IBS-D)overlapping functional dyspepsia(FD),and to explore the characteristics of TCM syndromes in IBS-D overlapping FD.Methods Clinical investigation was performed for collecting the clinical data of patients with IBS-D,FD and IBS-D overlapping FD(overlapping group),50 cases for each disease.The TCM syndrome elements were analyzed by syndrome-element dialectical methods,and the characteristics of TCM syndromes and syndrome types were summarized by frequency analysis,association rule analysis and cluster analysis.Results(1)The results of frequency analysis showed that emotional disorder was the main inducing or aggravating factor in the overlapping group,followed by improper diet.The primary syndromes in the overlapping group were diarrhea,abdominal distension,epigastric fullness,abdominal pain and postprandial fullness;the tongue color was usually pale,pale red,dark or red,the tongue body was usually enlarged or tooth-marked,and the tongue coating was usually thin white or white;slippery pulse,wiry pulse,deep pulse and thin pulse were the common pulses.The diseases-location syndrome elements mainly involved spleen,stomach,small intestine and liver,and the disease-nature syndrome elements mainly involved qi stagnation,dampness,qi deficiency and yang deficiency.(2)The results of association rule analysis showed that the combination of abdominal distension and diarrhea had the highest support(accounting for 70.00%)associated with TCM syndromes,the combination of spleen and stomach had the highest support(accounting for 80.00%)associated with diseases-location syndrome elements,the two combinations of dampness and qi stagnation,qi deficiency and qi stagnation had the highest support(both accounting for 36.00%)associated with disease-nature syndrome elements.(3)The results of cluster analysis showed that TCM syndromes in the overlapping group were clustered

关 键 词：腹泻型肠易激综合征(IBS-D) 功能性消化不良(FD) 情志异常 饮食不节 中医证候 脾虚湿滞证 肝郁脾虚证 肠道湿滞证 

分 类 号：R256.34[医药卫生—中医内科学] R259.744[医药卫生—中医学]