难治性抽动障碍的中医证素及临床特征分析  

Analysis of TCM pattern elements and clinical characteristics of refractory tic disorders

作　　者：华智超 陈玉燕[2] 刘力维 汤晶晶 马青华 张辰杰 陈健[2] HUA Zhichao;CHEN Yuyan;LIU Liwei;TANG Jingjing;MA Qinghua;ZHANG Chenjie;CHEN Jian(The First Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053;The First Affiliated Hospital of Zhejiang Chinese Medical University)

机构地区：[1]浙江中医药大学第一临床医学院,杭州310053 [2]浙江中医药大学附属第一医院

出　　处：《现代中医临床》2024年第5期10-16,共7页Modern Chinese Clinical Medicine

基　　金：国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(No.GZY-ZJ-KJ-23014);浙江省中医药科技计划项目(No.2024ZL430)。

摘　　要：目的 分析Tourette综合征(Tourette syndrome,TS)的中医证素分布规律和临床特征。方法 将研究病例根据诊断标准分为TS组和难治性TD(tic disorders,TD)组,搜集人口学资料和中医四诊信息,以文献检索分析为基础,用卡方检验对2组临床相关因素进行比较分析,以中医证素辨证学为基础,对2组中医病性、病位证素以及难治性TD病性病位等级分布进行初步研究和分析。结果 TS组和难治性TD组在起病年龄、病程、发病诱因、家庭及养育情况、西药服用情况以及共患注意缺陷与多动障碍(ADHD)等临床因素方面差异有统计学意义(P<0.05)。2组中医病位证素主要表现为表、肝、肾、脾、肺,表证素差异有统计学意义(P<0.05);病性证素主要表现为痰、阳亢、血虚、阴虚、动风、气虚、热和血热,其中痰、阳亢、阴虚、气虚、血热证素差异有统计学意义(P<0.05),难治性TD病位等级分布中肝证素以Ⅱ级(中度病变)、Ⅲ级(重度病变)为主,病性等级分布中阴虚证素以Ⅱ级(中度病变)、Ⅲ级(重度病变)为主,动风证素以Ⅲ级(重度病变)为主。结论 起病年龄、家庭教养方式、西药服用时间以及共患ADHD是TS发展为难治性TD的危险因素;2组病位证素主要位于肝,TS病性证素主要是动风,难治性TD病性证素主要是阴虚、动风,提示病性随疾病发展由实转为本虚标实,难治性TD组病位等级分布提示肝是病变重点,病性等级分布提示阴虚动风是疾病发展到后期的主要病机之一。Objective To investigate the distribution and clinical characteristics of TCM pattern elements in Tourette syndrome.Methods According to the diagnostic criteria,the cases were divided into two groups:the common TS Group and the refractory TD Group.To compare and analyze the clinical related factors by using chi-square test,to study and analyze the TCM pattern elements of the nature and location of the disease and the grade distribution of the location of the refractory TD disease.Results There were significant differences in age at onset,course of disease,mental stimulation,disease induction,no obvious inducement,lack of father's education,family rearing pattern,parents' anxiety about disease,type and time of taking medicine and comorbidity of ADHD between the two groups.The main symptoms of TCM pattern elements in the two groups were surface,liver,kidney,spleen and lung,and the difference was significant(P<0.05).The main symptoms of the disease were phlegm,hyperactivity of Yang,deficiency of blood,deficiency of Yin,wind,deficiency of Qi,heat and blood heat,and there were significant differences in Phlegm,hyperactivity of Yang,deficiency of Yin,deficiency of qi and blood heat(P<0.05),in the distribution of disease location,liver syndrome elements were mainly in Grade Ⅱ(moderate lesion) and grade Ⅲ(severe lesion),while Yin deficiency syndrome elements were mainly in Grade Ⅱ(moderate lesion) and grade Ⅲ(-LRB-severe lesion),grade Ⅲ(severe pathological changes) is the main type of wind-moving syndrome.Conclusions The age of onset,family rearing pattern,time of taking medicine,and comorbidity of ADHD are the risk factors of developing common TS into refractory TD.The syndrome elements of the two groups were mainly located in the liver,the common syndrome elements of TS disease were mainly wind-induced,and the refractory syndrome elements of TS disease were mainly yin-deficiency,which indicated that the nature of the disease changed from excess to deficiency with the development of the disease,and the grade d

关 键 词：TOURETTE综合征 难治性TD 临床相关因素 中医证素 

分 类 号：R273[医药卫生—中西医结合]