血液透析患者的心理状态及个性特征与中医证候相关性

Association of traditional Chinese medicine syndromes with mental state and personality characteristics of patients undergoing hemodialysis

目的:探讨血液透析患者的心理状态、个性特征与中医证候的相关性。方法:选取2000-07/2001-03在辽宁鞍山鞍钢铁西医院门诊部及住院部的血液透析患者180例作为受试对象。使用症状自评量表(以躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子作为观察指标,按照0～4的5级评分,0=无,l=轻度,2=中度,3=相当重,4=严重)、艾森克个性问卷犤由内-外向、神经质、精神质维度和掩饰量表组成。结果采用标准T分表示,根据各维度T分高低判断人格倾向和特征,还将神经质和内-外向维度组合,进一步分出外向稳定(多血质)、外向不稳定(胆汁质)、内向稳定(黏液质)、内向不稳定(抑郁质)4种人格特征犦心理学量表及中医证候诊断问卷对血液透析患者进行心理状态、个性特征和中医证候方面的问卷调查分析;使用Logstic回归分析的方法分析血液透析患者心理状态、个性与中医证候之间的相关性。结果:180例患者均进入本观察,无脱落者。①中医证候与心理状态的相关性:在血液透析患者中,躯体化因子与肾虚(OR=3.635,P=0.002)、脾虚(OR=8.362,P<0.001)、肝郁(OR=8.325,P<0.001)均有较强的正相关联系,敌对因子与肾虚(OR=5.652,P=0.002)、强迫因子与肝郁(OR=13.362P<0.001)正相关。②中医证候与个性特征的相关性分析:抑郁质倾向的血液透析患者较易出现肾虚(OR=2.268,P=0.035)、脾虚(OR=3.365P=0.004)及肝郁(OR=8.265,P<0.001)表现,胆汁质倾向的患者较易出现肝郁表现。结论:肾虚、脾虚、肝郁等证候表现至少部分是由心理因素所引起的心身反应或心身紊乱;抑郁质倾向的血液透析患者较易出现肾虚、脾虚、肝郁表现,胆汁质倾向的患者较易出现肝郁表现;初步显示了中医证候类型与个性特征、异常心理状态之间的某些相关性,提示特定的气质类型、情志因素与脏腑之间可能具有内在联系。

AIM： To investigate the relationship of mental state and personality characteristics to traditional Chinese medicine （TCM） syndromes in patients receiving hemodialysis. METHODS： From July 2000 to March 2001, 180 patients who received hemodialysis treatment in the outpatient or inpatient departments of Anshan Steel West Hospital of Liaoning were enrolled in the study. Symptom checklist 90 （SCL-90）, measure of mental health, Eysenck personality questionnaire （EPQ） and diagnostic questionnaire of TCM syndromes were adopted to analyze patients ＇mental state, personality characteristics and TCM syndromes, respectively. SCL-90 consisted of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism, scoring ranged from grade 0 to grade 4, grade 0 as no, 1 as mild, 2 as moderate, 3 as bad, and 4 as severe. EPQ included 4 subscales, introversion-extraversion, neuroticism, psychoticism and lie score. The results were expressed by standard T to estimate individual personality and characteristics. Neuroticism subscale was combined with introversion- extraversion sub,ale further to divide four personality characteristics, extroverted stability （plethora）, extroverted instability （choleric）, introverted stability （mucus） and introverted instability （melancholic temperament）. Logstic regression analysis was used to analyze the association of mental state and personality characteristics with TCM syndromes. RESULTS： All the 180 subjects were enrolled in the result analysis, and nobody withrew from the study. ① TCM syndromes and mental state： Somatization was strongly positively correlated with deficiency of the kidney（OR=3.635,P=0.002）, insufficiency of the speen（OR=8.362,P 〈 0.001）, and stagnation of the liver-qi （OR =8.325,P 〈 0.001）. hostility and obsessive-compulsive were positively correlated with deficiency of the kidney（OR=5.652,P=0.002） and stagnation of the liver-q/（OR=13.362,P 〈 0.001）,respectively. ② TCM syndromes and personality characteristics： Deficiency of the kidney（OR=2.268,P=0.035）, insufficiency of the spleen （OR=3.365, P=0.004）and stagnation of the liver-qi（OR=8.265,P 〈 0.001） were easily found in patients with melancholic temperament. And stagnation of the liver-qi was also found in patients with choleric. CONCLUSION： The syndromes of kidney deficiency, spleen deficiency, and liver-qi stagnation at least partially result from the psychosomatic reaction or psychosomatic disorder induced by mental factors. Deficiency of the kidney, insufficiency of the spleen and stagnation of the liver-qi are easily found in patients with melancholic temperament. And stagnation of the liver-qi is also commonly found in patients with choleric. It is primarily indicated that TCM syndromes have a relationship with mental state and personality characteristics. Some specific temperament types and emotional factors may relate to viscera internally.