职业性慢性铅中毒中医临床证候的前瞻性研究

目的:分析职业性慢性铅中毒中医证候分布特点及其相关因素,探讨其不同证候的发生发展规律。方法:依据流行病学调查获得的病例四诊资料,经过动态聚类和探索性因子分析,结合中医辨证,获得每一个患者所属的中医证候分型,比较群体特征的证候类型构成及其与西医临床类型的关系。结果:470例职业性慢性铅中毒患者中医证候类型构成中不同证候所占比例由高到低依次为:脾胃虚寒(27.45%)、心脾两虚(22.34%)、痰火扰心(14.47%)、大肠结热(12.98%)、痰毒阻络(10.85%)、肾阳虚(7.02%)、肾阴虚(4.47%)、痰毒蒙闭(0.43%)。从虚实来看,61.28%的患者以虚证为主(第一、二、四、五证型),38.72%以实证为主。不同年龄组的中医证型构成不同,其差异有统计学意义(P<0.01)。中医证型的性别分布:男女患者均以脾胃虚寒的比例最高,其次为心脾两虚,最低为痰毒蒙闭,男女两组比较,无统计学意义(P>0.05)。西医诊断分级与中医证型的关系:本组患者中,铅吸收主要存在5个中医证型,其显现率从高至低依次为脾胃虚寒(50%)、心脾两虚(18.55%)、大肠结热(16.94%)、肾阳虚(8.06%)、痰火扰心(6.45%);轻度中毒则依次为心脾两虚(24.16%)、脾胃虚寒(24.16%)、大肠结热(20.13%)、痰火扰心(20.13%)、肾阳虚(6.71%)、肾阴虚(6.7%);中度中毒依次为痰毒阻络(26.15%)、心脾两虚(23.59%)、脾胃虚寒(15.9%)、痰火扰心(15.38%)、肾阴虚(7.18%)、肾阳虚(6.67%)、大肠结热(5.13%);中毒仅出现属痰毒蒙闭型的铅脑病2例,暂未收集到铅麻痹病例。结论:本结果初步揭示职业性慢性铅中毒中医证候分布特征,为中医辨证驱铅提供依据。

The Forward Looking Research of the Profession Gender Chronic Lead Poisoning Traditional Chinese Medicine Clinic Syndrome or Symptom Complex

Objective:The occur law of development of the analyses chronicity kidney wane colony Traditional Chinese Medicine proof type distributional point very correlation factors,approach his differ syndrome or symptom complex.Methods:The TCM syndrome or symptom complex typing,compare colony diagnostic syndrome or symptom complex style constitute very with Western medicine clinic typal relation of the both gist epidemiological survey acquired case four diagnostic methods material,transit dynamic clustering and trial test factor analysis,incorporation traditional Chinese medicine differentiation of symptoms and signs,obtain every last sufferer what is affiliated with.Results:The led encephalopathy two case,temporary not collect led paralysis case up of the show the relation of the sex distribution of the Traditional Chinese Medicine proof type constitute differ,his difference has got statistics meaning(P<0.01)of the the sufferer withal deficiency syndrome give priority to(first,two,four,five proof type),38.72%withal excess syndrome give priority to the 470 case profession gender chronic lead poisoning sufferer Traditional Chinese Medicine syndrome or symptom complex style constitute middle differ syndrome or symptom complex station occupy scale by high to low take turns for:insufficiency of the spleen-yang(27.45%),heart spleen twain empty(22.34%),mental disturbance due to phlegmfire(14.47%),large intestine knot hot(12.98%),sputa poison block retinervus(10.85%),insufficiency of the kidney-yang(7.02%),deficiency of the kidney-yin(4.47%),sputa poison cover lockup(0.43%).Judge from the actual condition,61.28%.Differ age class.Traditional Chinese Medicine proof type:both sexes sufferer equal withal insufficiency of the spleen-yang in proper maxima,secondly for heart spleen twain empty,undermost for sputa poison cover lockup,both sexes two-sets compare,without statistics sense(P>0.05).Western medicine diagnose grade and traditional Chinese medicine proof type judge,61.28%sufferer withal deficiency syndrome give priority to(first,two,four,five proof type),38.72%withal excess syndrome give priority to from the actual condition came compare,without statistics sense(P>0.05).Western medicine diagnose grade with traditional Chinese medicine proof type' relation from among the actual condition came see,61.28%'sufferer withal deficiency syndrome give priority to(first,two,four,five proof type),38.72%withal excess syndrome give priority to differ age class' Traditional Chinese Medicine proof type constitute differ,his difference have got statistics meaning(P<0.01).Traditional Chinese Medicine proof type 'sex distribution:both sexes sufferer equal withal insufficiency of the spleen-yang in proper maxima,secondly for heart spleen twain empty,undermost for sputa poison cover lockup,both sexes two-sets compare,without statistics sense(P>0.05). Western medicine diagnose grade and traditional Chinese medicine proof type' relation:origin group sufferer,led assimilate prime presence five piece traditional Chinese medicine proof type,his show rate from high solstice low take turns for insufficiency of the spleen-yang(50%),heart spleen twain empty(18.55%),large intestine knot hot(16.94%),insufficiency of the kidney-yang(8.06%),mental disturbance due to phlegmfire(6.45%);mild intoxication then take turns for heart spleen twain empty(24.16%),insufficiency of the spleen-yang(24.16%),large intestine knot hot(20.13%),mental disturbance due to phlegmfire(20.13%),insufficiency of the kidney-yang(6.71%),deficiency of the kidney-yin(6.7%);moderate intoxication take turns for sputa poison block retinervus(26.15%),heart spleen twain empty(23.59%),insufficiency of the spleen-yang(15.9%),mental disturbance due to phlegmfire(15.38%),deficiency of the kidney-yin(7.18%),insufficiency of the kidneyyang(6.67%),large intestine knot hot(5.13%);poisoning poisoning hardly face genera sputa poison cover lockup type.Conclusion:Origin with the result that introduction reveal profession gender chronic lead poisoning traditional Chinese medicine syndrome or symptom complex distributional characteristics,supply gist with traditional Chinese medicine differentiation of symptoms and signs drove led.