子宫内膜异位症中医证候初探

Primary Research on TCM Syndromes of Endometriosis

目的子宫内膜异位症(简称"内异症")是指具有生长功能的子宫内膜组织(腺体和间质)出现在子宫腔被覆内膜及宫体肌层以外部位而导致一种育龄期妇女常见疾病,临床以进行性加重的痛经、性交痛、不孕、月经异常等为主要表现。中医药在内异症的治疗中发挥了重要的作用,但内异症的证型目前尚无统一标准,不仅影响内异症临床治疗,而且严重影响内异症中医临床研究的科学性及可重复性。因此本课题拟通过临床流行病学调研,初步分析、总结内异症中医证候规律,从而能促进内异症的中医临床辨证论治体系的规范化、标准化。方法本课题采用临床流行病学调研的设计方法,对患者一般情况、部分相关危险因素以及中医证候信息资料进行调查,结合因子分析、聚类分析等多元统计方法进行统计分析,初步探讨内异症中医证候规律特点。结果子宫内膜异位症中医证候规律的分析,通过对383例内异症患者中医证候的频数分析,删除构成比≤10%的症状指标,得到有意义的症状指标74项,并将这些症状信息作为观察指标。其中项目频率最高的为夹血块,或经行不畅,构成比为84.3%,其次是经行或经前胸胁乳房胀痛,构成比为77.3%,经行腹痛,构成比为73.9%。综合因子分析结果中每个变量的构成比、载荷值,以及聚类分析的分类结果,并结合专业知识及专家建议,参照《中药新药临床研究指导原则》《中医妇科学》《中西医结合妇科学》等书籍,将五类证候群命名为气滞血瘀型、气滞寒凝血瘀型、气虚血瘀型、湿热瘀结型、气滞肾虚血瘀型,其中以气滞寒凝血瘀型病例数最多,占60.6%,其次是气滞肾虚血瘀型,占14.6%,气虚血瘀型占8.9%,气滞血瘀型占8.1%,湿热血瘀占5.7%,单纯血瘀证2例。根据内异症血瘀之病机兼夹证进行证型拆分,统计气滞血瘀、寒凝血瘀、肾虚血瘀、气虚血瘀、湿热瘀结各个证型在383病例中的频次,其中气滞血瘀频次最高为324,占比为84,3%,其次为寒凝血瘀证,240例,62.7%。结论通过本次调查分析383例内异症患者的中医证候信息得出内异症的中医证候分布规律特点如下:①结合变量因子分析、聚类分析结果及专业知识,可得出气滞血瘀证、气滞寒凝血瘀证、气滞肾虚血瘀证、气虚血瘀证、湿热血瘀证为内异症临床常见5种证候,其中以寒凝气滞血瘀最多见。②血瘀证是内异症共有证候。内异症临床多见复合证型,血瘀证兼有气滞、寒凝、肾虚、气虚、湿热;或虚或实或虚实寒热夹杂。③内异症的病因病机为血瘀,气滞血瘀为内异症的临床基础证型。

Endometriosis is caused by the appearance of endometrial tissues(glands and stroma)with growth function outside the endometrium and myometrium of the uterine cavity.Endometriosis is a common disease of women of childbearing age with progressive dysmenorrhea,sexual pain,infertility,menstrual abnormalities and other major symptoms.Traditional Chinese medicine(TCM)plays an important role in the treatment of endometriosis,but there is no unified standard for syndrome types of endometriosis,which not only affects the clinical treatment of endometriosis,but also seriously affects the scientific and repeatable clinical research of TCM.Therefore,through clinical epidemiological investigation,the preliminary analysis and summary of TCM syndrome characteristics of endometriosis can provide certain basis for standardizing TCM clinical diagnosis and treatment of endometriosis.Methods:This subject is designed by clinical epidemiological investigation method to investigate the general situation of patients,some related risk factors and TCM syndrome information.Combining factor analysis,cluster analysis and other methods of statistical analysis,the characteristics of TCM syndromes of endometriosis were initatively discussed.Results:The frequency of TCM syndrome information of 383 patients with endometriosis was statistically analyzed,and 74 significant variables were obtained by eliminating the variables whose occurrence rate was less than or equal to 10%.Among them,the most frequent variable was blood stasis,or menstrual disorder,accounting for 84.3%,followed by menstrual or chest pain 77.3%and menstrual abdominal pain 73.9%.Combined with the results of cluster analysis,professional knowledge,expert advice,as well as reference books such as Guiding Principles for Clinical Research of New Chinese Medicine,Gynecology of Traditional Chinese Medicine and Gynecology of Integrated Traditional Chinese and Western Medicine.Five types of syndromes were named Qi stagnation and blood stasis type,cold coagulation and Qi stagnation and blood stasis type,Qi deficiency and blood stasis type,damp-heat and blood stasis type,kidney deficiency and Qi stagnation and blood stasis type.Among them,cold coagulation and Qi stagnation and blood stasis type accounted for 60.6%,followed by kidney deficiency and Qi stagnation and blood stasis type 14.6%,Qi deficiency and blood stasis type 8.9%,Qi stagnation and blood stasis type 8.1%,damp-heat and blood stasis type 5.7%,blood stasis syndrome alone in 2 cases.According to the etiology and pathogenesis of endometriosis,we counted the frequency of syndrome types of Qi stagnation and blood stasis,cold coagulation and blood stasis,kidney deficiency and blood stasis,Qi deficiency and blood stasis,damp-heat and blood stasis in 383 cases.The results showed that the highest frequency of Qi stagnation and blood stasis was 324(84.3%),followed by cold coagulation and blood stasis syndrome(240 cases,62.7%).Conclusion:According to the investigation and analysis of 383 endometriosis cases′syndrome information of TCM,we summarized that TCM syndrome distribution characteristics of endometriosis were as follows:1.Combined with the results of factor analysis,cluster analysis and professional knowledge,it can be concluded that Qi stagnation and blood stasis syndrome,cold coagulation and Qi stagnation and blood stasis syndrome,kidney deficiency and Qi stagnation and blood stasis syndrome,Qi deficiency and blood stasis syndrome,damp-heat and blood stasis syndrome were the five common clinical syndromes of endometriosis,of which cold coagulation and Qi stagnation and blood stasis were the most common.2.Blood stasis syndrome was a common syndrome of endometriosis.Multiple syndromes were more common in clinic.Blood stasis syndrome often coexists with Qi stagnation,cold coagulation,kidney deficiency,Qi deficiency and damp-heat.Clinical syndromes were either deficiency or excess or mixed deficiency-excess and cold-heat.3.Blood stasis is the etiology and pathogenesis of endometriosis.Qi stagnation is the main factor of its development and Qi stagnation and blood stasis is the clinical basis of endometriosis.Qi stagnation is the main factor for the occurrence and development of endometriosis and Qi stagnation and blood stasis are the basic clinical syndromes of endometriosis.