不同中医证型围绝经综合征妇女身心症状、抑郁情绪和血清性激素水平差异

Differences of physical and mental symptoms,depressive emotion and sex hormone level in serum of women with climacteric syndrome of different traditional Chinese medicine syndromes

目的:观察不同中医证型绝经综合征妇女身心症状、抑郁情绪和性激素水平,并与健康女性进行比较。方法:①选择2003-05/2005-10在广东省普宁华侨医院妇产科门诊就诊或住院治疗的绝经期妇女154例,年龄42～55岁。选择同期本院进行健康体检的健康女性39人为对照组,年龄41～59岁。上述对象均自愿接受量表调查和指标检测。②参照全国高等医学院校教材《中医诊断学》关于“围绝经综合征”所确定的辨证标准,并结合临床实际,初步拟设肝郁证(n=21),肾虚证(n=31),肝郁肾虚证(n=46),肝郁肾虚夹瘀证(n=56)4个证型。③身心症状调查采用稍作改动后的中南大学湘雅医院彭解英教授设计的绝经期妇女常见身心症状调查表。共分14项内容:烦恼、情绪低落、皮肤感觉异常、头晕、注意力不集中、肢体凉、梦多易醒、腰背酸痛、疑病、疲倦乏力、耳鸣、易激动、入睡困难、记忆力减退。每个项目根据无、轻、重评分为0～2分。④抑郁情绪评定采用汉密顿抑郁量表,内容:躯体化(包括精神性焦虑、躯体性焦虑、胃肠道症状、疑病和自知力);体质量变化;认知障碍(有罪感、自杀、激越和偏执);昼夜变化;迟缓(抑郁情绪、工作和兴趣迟缓);睡眠(入睡困难、睡眠浅和早醒);绝望感(能力减退感、绝望感和自卑感)。大部分评定结果分为5级(无、轻、中度、重和极重度),评分为0～4分,少部分为无、轻、中度和重度4级,评分0～3分。⑤采用RIA法测定血清雌二醇、睾酮、促卵泡素和促黄体生成素水平。⑥计量资料差异比较采用t检验。结果:围绝经期综合征妇女154例和健康女性39人均进入结果分析。①身心症状调查表分项评分比较:肾虚型围绝经期综合征妇女明显低于其他3种证型(P<0.05～0.01),各证型围绝经期综合征妇女身心症状分项评分明显高于对照组(P<0.05)。②汉密顿抑郁量表评分比较:各证型围绝经期综合征妇女汉密顿抑郁量表分项评分和总分均明显高于对照组(P<0.05～0.01)鸦肝郁型、肝郁肾虚夹型和肝郁肾虚型围绝经期妇女的多数穴除肝郁肾虚型妇女昼夜变化和迟缓评分及肝郁肾虚夹瘀型妇女认知障碍和昼夜变化及睡眠障碍评分外雪汉密顿抑郁量表分项评分和总分也明显低于肾虚型围绝经期妇女(P<0.05)。③血清性激素水平比较:肝郁型围绝经期妇女血清促卵泡素和促黄体生成素水平明显高于肾虚型妇女(P<0.05),肝郁肾虚夹瘀型围绝经期妇女血清雌二醇水平明显低于肾虚型妇女(P<0.05),促黄体生成素水平明显高于肾虚型妇女(P<0.05)。各证型围绝经期妇女血清睾酮、促卵泡素和促黄体生成素水平明显高于对照组(P<0.05～0.01),雌二醇水平明显低于对照组(P<0.05)。结论:各中医证型围绝经期妇女身心症状和抑郁情绪均较健康女性严重,血清中性激素水平异常。各中医证型中肾虚型围绝经期妇女的身心症状和抑郁情绪最轻微,性激素水平与健康女性最接近。

AIM： To observe the physical and mental symptoms, depression emotion and level of sex hormone in serum of women with Climacteric syndrome （CS） of different traditional Chinese medicine （TCM） syndromes, and compare with healthy women. METHODS： ①Totally 154 climacteric women, who were inpatients or outpatients and aged 42-55 years, were selected from Puning Overseas Chinese Hospital from May 2003 to October 2005. And 39 healthy women who conducted health examinations in same hospital simultaneously were selected as control group, aged 41-59 years. They all participated in the study voluntarily to complete measuring scale and marker detection. ② According to the standards for ＂climacteric syndrome＂ defined in the Diagnostics of Traditional Chinese Medicine which was applied in national senior medical colleges, the subjects were divided into 4 types of syndrome： liver-Qi stagnation （n=21）, kidney-deficiency （KD, n=31）, liver- Qi stagnation combined with KD （n =46） and inclusion of liver-Qi stagnation combined with KD and stasis （n=56）. ③Physical and mental symptoms of climacteric women were assessed with Common Physical and Mental Symptoms Scale, modified by Professor Peng Xie-ying, Xiangya Hospital of Central South University and included 14 items： worry, depression, paresthesia of skin, dizziness, impaired concentration, cool extremity, multidream and restless sleep, lumbago and backache, hypochondriasis, languor and debilitation, tinnitus, easy to excite, difficulty falling asleep and memory decrease. Each item was scored 0-2 points according to pathogenic degrees of none, mild and severe. ④Depression emotion was evaluated with Hamilton Depression Rating Scale, consisted of somatization （psycho-anxiety, somatic anxiety, gastrointestinal tract symptom, hypochondriasis and insight）; changes of body mass; cognitive handicap （guilty, suicide, agitation and intolerance）;diurual variation; retardation （depression emotion, work and interest retardation）;sleep （difficulty falling asleep, superficial sleep and early awakening）;feeling of despair （feeling of ability decrease, feeling of despair and feeling of inferiority）. Most evaluations comprised 5 degrees （none, mild, moderate, severe and extremely severe） and scored 0-4 points, while part evaluations included 4 degrees （none, mild, moderate and severe） and scored 0-3 points. ⑤Levels of estradiol （E2）, testosterone （T）, follicle-stimulating hormone （FSH）, luteinizing hormone （LH） in serum were determined with RIA.⑥Measurement data were compared with t test. RESULTS： All the 154 CS women and 39 healthy women entered the analysis of results. ① Comparison of Physical and Mental Symptoms Scale： The score of women with KD Syndrome was lower than other 3 types （P 〈 0.05-0.01）, and the scores of CS women were higher than those of control group （P 〈 0.05）, ②Comparison of Hamilton Depression Rating Scale： The scores of each item and total score in CS women were higher than control group （P 〈 0.05-0.01）, and also higher in most women with KD syndrome than other 3 types （P 〈 0.05）, except scores of diurnal variation and retardation in women with liver-Q/stagnation combined with KD and scores of cognitive handicap, diurnal variation and sleep disorder in women with inclusion of liver-Q/ stagnation combined with KD and stasis. ③Comparison of levels of sex hormone： FSH and LH in serum of women with liver-Qi stagnation syndrome were higher than that with KD syndrome （P 〈 0.05）. E2 level was notably lower in women with inclusion of liver-Qi stagnation combineA with KD and stasis than with KD syndrome （P 〈 0.05）, but LH level was significantly increased （P 〈 0.05）. T, FSH and LH levels of CS women were remarkably higher than those of control group （P 〈 0.05-0.01） while E2 level was remarkably lower （P 〈 0.05）. CONCLUSION： Physical and mental symptoms as well as depression emotion of CS women are more serious than in healthy women, with the abnormal sex hormone levell in serum. The CS women with KD syndrome possess the lightest physical and mental symptoms as well as depression emotion, and most similar level of sex hormone with normal women.