舌象在慢性盆腔炎中应用价值的探讨

目的客观评价中医药治疗慢性盆腔炎前后的舌象变化,初步探讨舌象形成的机制,为舌象应用于慢性盆腔炎的疗效评价提供依据。方法根据慢性盆腔炎辨证依据,收集肝郁肾虚证和湿热瘀阻证患者共66例,运用ZBOX-Ⅰ型中医舌象数字化分析仪采集治疗前后的舌象客观化参数,采用t检验比较治疗前后舌象客观化参数,采用逐步回归方法分析与各舌象客观化参数相关的主要因素。结果 （1）66例肝郁肾虚证和湿热瘀阻证患者,舌象客观化参数比较后发现治疗前两组在腐腻指数上差异有统计学意义（P〈0.01）,湿热瘀阻证大于肝郁肾虚证;治疗后,两组在瘀斑指数上差异有统计学意义（P〈0.05）,肝郁肾虚证小于湿热瘀阻证。治疗后,肝郁肾虚证患者瘀斑指数与治疗前比较,差异有统计学意义（P〈0.01）;湿热瘀阻证患者的腐腻指数与治疗前比较,差异有统计学意义（P〈0.01）。（2）结合实验室指标,对各舌象客观化参数进行逐步回归分析得出,瘀斑指数的的血小板偏回归系数为0.396,经t检验,其对瘀斑指数的形成作用显著;胖瘦指数的血沉偏回归系数为0.016,经t检验,其对胖瘦指数的形成作用显著;剥苔指数的血小板偏回归系数为0.007,CRP的偏回归系数为0.108,血沉的偏回归系数为-0.115,经t检验,三者对剥苔指数的形成作用显著。结论不同证型的慢性盆腔炎舌象分布不同,不同治法对舌象客观化参数的影响不同;各种舌象的形成有一定的相关因素,表现为血小板与瘀斑指数的形成密切相关,血沉与胖瘦指数的形成密切相关,血小板、CRP、血沉与剥苔指数的形成密切相关。

Discussion on the application value of tongue manifestation in chronic pelvic inflammatory disease

Objective To objectively evaluate the tongue manifestation changes of chronic pelvic inflammatory disease before and after treatment by traditional Chinese medicine, and to initially discuss the formation mechanism of tongue manifestation, so as to provide basis for the efficacy evaluation of tongue manifestation in the treatment of chronic pelvic inflammatory disease. Methods Sixty-six patients of liver depression and kidney deficiency, damp-heat and blood-stasis obstruction were collected, according to the chronic pelvic inflammation based on syndrome differentiation, the objective parametersof tongue manifestation were collected before and after treatment by using the ZBOX-Ⅰ type TCM tongue manifestation digital analyzer, the comparison of the objective parameters of tongue manifestation before and after treatment was used by t test, the method of stepwise regression was used to analyze the major factor which was related with the objective parameters of tongue manifestation. Results (1) After the comparison on the objective parameters of the tongue manifestation of 66 patients of the syndrome of liver depression and kidney deficiency, and syndrome of damp-heat and blood-stasis obstruction. It was found by the author that, before the treatment, there was a difference between index of greasiness and likeness of curd of the two groups, which had a statistical significance (P < 0.01), that of the syndrome of damp-heat and blood-stasis obstruction were greater than the syndrome of liver depression and kidney deficiency; after the treatment, the difference between the ecchymosis indexes of the two groups had a statistical significance (P < 0.05), that of the syndrome of liver depression and kidney deficiency were less than that of the syndrome of damp-heat and blood-stasis obstruction. After the treatment, the difference between the ecchymosis indexes of liver depression and kidney deficiency before treatment and that after treatment had a statistical significance (P < 0.01); the difference between the index of greasiness and likeness of curd of the patent of damp-heat and blood-stasis obstruction had a statistical significance (P < 0.01). (2) Combining the laboratory index and through stepwise regression analysis on the objective parameters of the tongue manifestation, it came to the following conclusion: the partial regression coefficient of the blood platelet of the ecchymosis index was 0.396 and it had a distinctive influence on the formation of the ecchymosis index through t test; the partial regression coefficient of the blood platelet of BMI was 0.016 and it had a distinctive influence on the formation of BMI through t test; the partial regression coefficient of the blood platelet of the peeling tongue fur was 0.007, the partial regression coefficient of CRP was 0.108, the partial regression coefficient of ESR was -0.115, and the three ones had a distinctive influence on the formation of the peeling tongue fur. Conclusion The tongue manifestation distributions of chronic pelvic inflammatory disease with different syndromes are different and the influences of different treatment methods on the objective parameters of the tongue manifestation are different; there are certain relevant factors on tongue manifestation formation. Specifically, the blood platelet closely relates to the formation of ecchymosed index, ESR closely relates to the formation of BMI, and blood platelet, CRP, ESR closely relates to the formation of peeling tongue fur index.