溃疡性结肠炎中医证型分布研究

目的了解溃疡性结肠炎(ulcerative colitis,UC)的中医证型分布情况及不同分期UC中医证型的分布。方法选取2007年3月—2010年4月广州市中医医院消化内科病房及门诊UC患者110例。统计患者症状,采用系统聚类法分析,将症状条目作为变量进行聚类,根据聚类结果确立证型名称,进行辨证分型,并对证型进行分析。结果 UC患者症状主要有64个,包括腹泻、糊状便、稀水便、腹痛、便血等。病情分期属于活动期70例,缓解期40例。UC证型按比例由高至低依次为:大肠湿热、脾胃气虚、肝郁脾虚、脾肾阳虚、血瘀肠络、阴血亏虚,各证型例数比较差异有统计学意义(P<0.05)。活动期证型以大肠湿热证28例(25.5%)]、肝郁脾虚证14例(12.7%)]、血瘀肠络证10例(9%)]为主,缓解期证型以脾胃气虚证18例(16.4%)]、脾肾阳虚证10例(9%)]为主,差异均有统计学意义(P<0.05)。大肠湿热证患者典型症状按比例由高至低依次为:苔黄31例(28.1%)]、里急后重26例(23.6%)]、黏液脓血便25例(22.7%)]、腹泻24例(21.8%)]、肛门灼热24例(21.8%)]、稀水便21例(19.0%)]、腹痛19例(17.2%)]、舌红19例(17.2%)]、苔腻19例(17.2%)];脾胃气虚证患者典型症状按比例由高至低依次为口淡25例(22.7%)]、脉细25例(22.7%)]、舌淡红22例(20.0%)]、嗳气21例(19.1%)]、乏力懒言21例(19.1%)]、纳食减少20例(18.2%)]、苔白20例(18.2%)];脾肾阳虚证患者典型症状按比例由高至低依次为:腹痛17例(15.5%)]、喜温17例(15.5%)]、腹泻16例(14.5%)]、遇寒加重15例(13.6%)]、苔白15例(13.6%)]、舌淡白14例(12.7%)];肝郁脾虚证患者典型症状按比例由高至低依次为:情志诱发18例(16.4%)]、嗳气16例(14.5%)]、苔白16例(14.5%)]、先硬后溏15例(13.6%)]、矢气频作15例(13.6%)]、善太息15例(13.6%)];血瘀肠络证患者典型症状按比例由高至低依次为:腹痛12例(10.9%)]、刺痛12例(10.9%)]、腰酸12例(10.9%)]、舌暗瘀点12例(10.9%)]、苔厚12例(10.9%)],除阴血亏虚证各证型症状比例比较,差异均有统计学意义(P<0.05)。其他症状比较差异无统计学意义(P>0.05)。结论 UC活动期证型以大肠湿热证、肝郁脾虚证、血瘀肠络证为主,缓解期证型以脾胃气虚证、脾肾阳虚证为主。

Study on the Chinese Medical Syndrome Distribution of Ulcerative Colitis

Objective To study on the Chinese medicine(CM) syndrome distribution of ulcerative colitis(UC) and the distribution of CM syndrome types at different staging periods.Methods From March 2007 to April 2010,110 UC out-or inpatients at the Department of Digestive Diseases of Guangzhou Municipal Hospital of Traditional Chinese Medicine were recruited.The patients’ symptoms were calculated.The systematic clustering was used.The symptom was taken as the variable in the clustering.The syndrome types were confirmed according to the clustering results.The syndrome typing was performed and its results were analyzed.Results There were 64 main symptoms in UC patients,including diarrhea,mushy stool,watery stool,abdominal pain,and bloody stool.Seventy cases belonged to the active period and 40 to the remission period.The UC syndrome types were sequenced from high to low as the dampness-heat of Dachang syndrome,Pi-Wei qi deficiency syndrome,Gan depression and Pi deficiency syndrome,Pi-Shen yang deficiency syndrome,blood stasis in the intestinal collaterals syndrome,yin and blood deficiency syndrome.There was statistical difference in the case number among different syndrome types(P<0.05).In the active period,dominated were the dampness-heat of Dachang syndrome(28 cases,25.5%),Gan depression and Pi deficiency syndrome(14 cases,12.7%),and blood stasis in the intestinal collaterals syndrome(10 cases,9.0%).In the remission period,dominated were Pi-Wei qi deficiency syndrome(18 cases,16.4%) and Pi-Shen yang deficiency syndrome(10 cases,9.0%),showing statistical difference(P<0.05).The typical symptoms of patients of the dampness-heat of Dachang syndrome were sequenced from high to low as yellow tongue fur(31 cases,28.1%),tenesmus(26 cases,23.6%),mucopurulent bloody stool(25 cases,22.7%),diarrhea(24 cases,21.8%),anal burning(24 cases,21.8%),watery stool(21 cases,19.0%),abdominal pain(19 cases,17.2%),red tongue(19 cases,17.2%),and greasy tongue fur(19 cases,17.2%).The typical symptoms of patients of Pi-Wei qi deficiency syndrome were sequenced from high to low as tastelessness(25 cases,22.7%),fine pulse(25 cases,22.7%),pink tongue(22 cases,20.0%),eructation(21 cases,19.1%),hypodynamia(21 cases,19.1%),loss of appetite(20 cases,18.2%),and white tongue fur(20 cases,18.2%).The typical symptoms of patients of Pi-Shen yang deficiency syndrome were sequenced from high to low as abdominal pain(17 cases,15.5%),preference for warmth(17 cases,15.5%),diarrhea(16 cases,14.5%),aggravation while encountering cold(15 cases,13.6%),white tongue fur(15 cases,13.6%),pale white tongue(14 cases,12.7%).The typical symptoms of patients of Gan depression and Pi deficiency syndrome were sequenced from high to low as emotions inducing(18 cases,16.4%),eructation(16 cases,14.5%),white tongue coating(16 cases,14.5%),dry stool before loose stool(15 cases,13.6%),frequent break wind(15 cases,13.6%),and frequent sigh(15 cases,13.6%).The typical symptoms of patients of blood stasis in the intestinal collaterals syndrome were sequenced from high to low as abdominal pain(12 cases,10.9%),sting(12 cases,10.9%),soreness of the waist(12 cases,10.9%),dark red tongue with petechiae(12 cases,10.9%),thick fur(12 cases,10.9%).There was statistical difference in the symptom ratio among each syndrome types(P<0.05).There was no statistical difference in other symptoms except yin and blood defeciency syndrome(P>0.05).Conclusions The dampness-heat of Dachang syndrome,Gan depression and Pi deficiency syndrome,and blood stasis in the intestinal collaterals syndrome were dominated in the UC active period.Pi-Wei qi deficiency syndrome and Pi-Shen yang deficiency syndrome were dominated in the remission period.