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1.中国中医科学院 广安门医院,北京 100053
2.眉山市中医医院,四川 眉山 620000
3.中国中医科学院 针灸医院,北京 100027
4.北京中医药大学 研究生院,北京 100029
鲍美如,硕士,住院医师,从事中医妇科学研究,E-mail:1913696435@qq.com
赵瑞华,博士,主任医师,从事中医药治疗子宫内膜异位症、子宫腺肌病的临床和基础研究,E-mail:rhzh801@126.com
收稿日期:2022-09-05,
网络出版日期:2022-12-30,
纸质出版日期:2023-03-20
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鲍美如,杨新春,杭天等.1 895例子宫内膜异位症患者证候分布及特征[J].中国实验方剂学杂志,2023,29(06):128-136.
BAO Meiru,YANG Xinchun,HANG Tian,et al.Syndrome Distribution and Characteristics of Endometriosis in 1 895 Cases[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(06):128-136.
鲍美如,杨新春,杭天等.1 895例子宫内膜异位症患者证候分布及特征[J].中国实验方剂学杂志,2023,29(06):128-136. DOI: 10.13422/j.cnki.syfjx.20230421.
BAO Meiru,YANG Xinchun,HANG Tian,et al.Syndrome Distribution and Characteristics of Endometriosis in 1 895 Cases[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(06):128-136. DOI: 10.13422/j.cnki.syfjx.20230421.
目的
2
探究子宫内膜异位症(EMS)患者中医证候分布及其特征。
方法
2
通过横断面调查对全国19个省/自治区/直辖市的省/市/县/区级医院的1 895例EMS患者的中医证候特征进行分析。
结果
2
本研究中1 895例EMS患者证候以气滞血瘀证占比最高,其次为气虚血瘀证、寒凝血瘀证、肾虚血瘀证。不同地区、不同诊疗目标、不同治疗阶段、不同疾病类型的EMS患者中医证候类型分布不同,差异具有统计学意义。但不同情况分层下,中医证候均以气滞血瘀证占比最高。不同地区分层下,北方地区寒凝血瘀证占比较高,华南地区肾虚血瘀证占比较高,西南地区痰瘀互结证占比较高。不同诊疗目标对应不同临床症状。以盆腔疼痛为主要表现者,寒凝血瘀证占比明显提高。婚久不孕患者中肾虚血瘀证占比明显升高。以控制包块、抑制复发为主要诊疗目标的患者,气虚血瘀证占比较高。不同治疗阶段中,术后、复发型EMS患者中气虚血瘀证占比提高。不同疾病类型中,卵巢型子宫内膜异位症(OEMS)患者中气虚血瘀证占比较高;深部浸润型子宫内膜异位症(DIE)患者中寒凝血瘀证占比较高;腹膜型EMS患者证型中肾虚血瘀证占比较高。不同证型患者年龄、身体质量指数(BMI)、病程分布差异具有统计学意义(
P
<
0.05)。气虚血瘀证患者年龄相对较大,病程相对较长。痰瘀互结证患者BMI相对较高。癌抗原(CA125、CA199)水平在各证型间差异无统计学意义。
结论
2
EMS中医证候类型分布具有一定规律性,各证候在地域分布、诊疗目标、治疗阶段、疾病类型存在差异。但不同条件分层下,气滞血瘀证均占比较大,提示气滞血瘀为EMS的关键环节。团队前期以解郁活血为首要治则,创制活血消异方,为治疗气滞血瘀型EMS核心方,临床常获良效。同时强调EMS治疗需融入慢病管理理念,结合健康管理,通过心理疏导、认知行为干预、科普讲座等多种方法,进一步调畅EMS患者情志,增加疗效。本研究为EMS临床论治提供一定的参考依据。
Objective
2
To explore the distribution and characteristics of traditional Chinese medicine (TCM) syndromes in patients with endometriosis (EMS).
Method
2
A cross-sectional survey was conducted to analyze the characteristics of TCM syndromes in 1 895 cases of EMS in hospitals of 19 provinces, autonomous regions, and municipalities.
Result
2
Among the 1 895 patients, Qistagnation and blood stasis syndrome accounted for the highest proportion, followed by Qi deficiency and blood stasis syndrome, cold coagulation and blood stasis syndrome, and kidney deficiency and blood stasis syndrome. The distribution of TCM syndrome types of patients with EMS in different regions, different treatment stages, and different disease types and with different therapeutic goals was different, and the differences were statistically significant. However, under different conditions, the Qi stagnation and blood stasis syndrome accounted for the highest proportion. Under the stratification of different regions, the cold coagulation and blood stasis syndrome in north China was relatively high, the kidney deficiency and blood stasis syndrome in south China was relatively high, and the combined phlegm and stasis syndrome was relatively high in southwest China. Different diagnosis and treatment goals corresponded to different clinical syndromes. With pelvic pain as the main manifestation, the proportion of cold coagulation and blood stasis syndrome was higher. The proportion of kidney deficiency and blood stasis syndrome was higher in married patients with infertility. Patients with the main diagnosis and treatment goals of controlling mass and inhibiting recurrence had a higher proportion of Qi deficiency and blood stasis syndrome. In different treatment stages, the proportion of Qi deficiency and blood stasis syndrome in postoperative patients and those with recurrent EMS was higher. Among different disease types, the Qi deficiency and blood stasis syndrome accounted for a higher proportion in patients with ovarian endometriosis (OEM). The cold coagulation and blood stasis syndrome accounted for a higher proportion in patients with deep invasive endometriosis (DIE). The kidney deficiency and blood stasis syndrome accounted for a higher proportion in patients with peritoneal EMS. There were significant differences in age, body mass index (BMI), and course of disease among patients with different syndromes. Patients with Qi deficiency and blood stasis syndrome was relatively older, and their course of the disease was relatively long. Patients with combined phlegm and stasis syndrome had relatively high BMI. There was no significant difference in CA125 and CA199 levels among all syndrome types.
Conclusion
2
The distribution of TCM syndromes of EMS has a certain regularity, and there are differences in regional distribution, therapeutic goals, treatment stages, and disease types(
P
<
0.05). However, the Qi stagnation and blood stasis syndrome accounts for a large proportion under different conditions, suggesting that Qi stagnation is the key link of EMS. In the early stage, the team took relieving depression and activating blood as the primary treatment, and created Huoxue Xiaoyi prescription, which was the core prescription for the treatment of EMS with Qi stagnation and blood stasis syndrome, achieving good clinical effect. At the same time, it is emphasized that EMS treatment should be integrated into the concept of chronic disease management and combined with health management. Through psychological counseling, cognitive behavior intervention, popular science lectures, and other methods, it is advised to adjust the emotion of patients with EMS, thereby increasing the curative effect. This study is expected to provide references for the clinical treatment of EMS.
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