老年人轻度认知功能障碍的中医证候分布情况初步研究

探讨老年人轻度认知功能障碍(MCI)患者的中医证候特点,为中医干预治疗提供辨证依据。方法按Petersen等(1999)制定的诊断标准选择有记忆力下降主诉的患者为观察对象。在历代文献研究的基础上,拟订MCI的基本证型为肾虚证、脾气虚证、心血虚证、痰浊证、血瘀证、肝郁证,建立了包括西医量表及中医证候调查表的《轻度认知障碍临床观察表》,对入选的44例MCI患者进行辨证。结果44例MCI患者的最常见证候是肾虚证,其后依次是心血虚证、血瘀证、脾虚证、痰浊证,未见有肝郁证。而其中虚实夹杂者占68.2%,单证者占9.1%,2证者占34.1%,3证以上者占56.8%。MCI与正常组之间比较结果提示,两组之间心血虚证、脾气虚证的差异有显著性意义(P<0.05),而两组的肾虚证、痰浊证、血瘀证及肝郁证差异未见显著性意义(P>0.05)。结论MCI为本虚标实之证,在肾、心、脾3脏虚损的基础上,兼有痰、瘀等实邪。其中心血虚、脾气虚可能是认知损害的基本病理因素。这为老年人认知功能障碍的辨证论治提供了流行病学调查的客观资料,对探索有效中医干预途径有重要意义。

Initial Study on Disposition of Chinese Medical Symptoms and Signs of Mild Cognitive Impairment for Elder People

Objective:To investigate characteristics of the symptoms and signs in Chinese medicine of mild cognitive impairment (MCI) of elder people,and to provide evidences of syndromes differentiation for Chinese medical intervention and treatment.Methods:Patients with remembrance breakdown as chief complaint were selected for observation according to the standard by Petersen etc (1999).On the basis of studies on literatures over successive dynasties,basic syndrome types were set up,i.e.a) Syndrome of kidney deficiency,b)Syndrome of spleen qi deficiency,c) Syndrome of heart blood deficiency,d) Syndrome of turbid phlegm,e) Syndrome of blood stasis,f) Syndrome of liver depression.Clinical observation form for Mild Cognition Impairment (MCI) were established,including measuring scale of western medicine as well as a questionnaire of Chinese medical syndromes and signs,accordingly,44 selected MCI cases were differentiated for syndromes.Results:44 MCI cases mostly belonged to a),then c),e),b),d) in order,as none of f) had been discovered.Deficiency and excess in complexity accounted for 68.2%,haplo-syndrome for 9.1%,di-syndromes for 34.1%,tri-syndromes for 56.8% respectively.Significant differences (P<0.05) were shown in c) and b) between MCI and normal groups,while no significant differences (P>0.05) had been shown in any other syndrome types between the two groups.Conclusion:CMI is deficiency in root cause and excess in syndrome:it is based on deficiency of kidney,heart,and spleen in combination with excessive pathogenic factors,such as phlegm and stasis.Heart blood deficiency and spleen qi deficiency might be main pathogenic causes for cognitive impairment.These findings provided objective epidemiologic data for differentiation of syndromes for MCI of elder people,thus are remarkable in exploring effective methods of Chinese medical intervention.