勃起功能障碍患者155例中医证型流行病学特征调查

Epidemiologic survey on the differentiation of symptoms and signs of impotence in 155 cases

目的:调查来源于西安城区人口中勃起功能障碍(阳痿)患者的中医证型流行病学特征,总结其规律性,寻找可能的预防和中医药干预方法。方法:选择2003-01/2006-01在解放军第四军医大学西京医院泌尿外科门诊就诊或住院治疗的阳痿患者155例,入选病例均为年龄在25岁以上的西安城区人口,参照1993年卫生部《中药新药临床研究指导原则》关于“中药新药治疗阳痿的临床研究指导原则”所确定的辨证标准和临床实际,初步拟设肝郁气滞证、肝胆湿热证、肾阳微衰证、肝肾阴虚证和心脾两虚证。在治疗开始前由资深中医师进行辨证诊断,并同时进行了药物性阴茎勃起实验、发病季节和危险因素调查以及心理情绪评估。勃起状态判定采用Porst分级法:0级:完全没有反应;1级:轻微勃起;2级:不完全勃起;3级:正常勃起。采用临床精神卫生症状自评量表评估患者的心理情绪,分为9大症状:躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执和精神病性。勃起实验及心理测评时间均在治疗前1周内。结果:纳入对象155例,最终全部进入结果分析。①155例阳痿患者中医证型分布如下:肝郁气滞型39例、肝胆湿热型26例、肾阳微衰型22例、肝肾阴虚型41例和心脾两虚型27例。其中肝肾阴虚型患者最多,肝郁气滞型次之,肝胆湿热型和肾阳微衰型患者分布最少。②各证型与总体样本比较中,肾阳微衰型和心脾两虚型患者的平均年龄明显偏大,平均Porst分级显著降低。肾阳微衰型、肝胆湿热型和心脾两虚型患者平均病程偏长,而肝郁气滞型和肝肾阴虚型患者的平均年龄明显偏小,平均病程明显偏短,平均Porst分级较高。③心脾两虚型患者的平均文化程度明显偏高(P均<0.05～0.01)。肾阳微衰型和心脾两虚型患者合并高血压和冠心病者明显居多,而肝胆湿热型患者的平均吸烟指数和饮酒明显增高(P均<0.05～0.01)。④各证型患者的发病季节分布中,肾阳微衰型患者冬季发病明显居多(P<0.05)。各证型患者心理情绪评分比较中,肝郁气滞型和肝肾阴虚型患者大部分症状自评量表总分、阳性总分、阳性项目均数和阳性项目均分均明显高于总体样本,而肾阳微衰型和心脾两虚型患者的上述多数指标均明显低于总体样本(P均<0.05～0.01)。结论:西安城区阳痿患者中医证型以肝肾阴虚和肝郁气滞型分布较多,此两种分型患者年龄偏小,病程较短,病机以心理因素为主因。

AIM： To study the differentiation of symptoms and signs of patients with impotence from urban of Xi ＇an, and summarize the roles, so as to find out the potential preventive and treatment methods with Chinese herbs. METHODS： 155 outpatients or inpatients from Department of Urinary Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA between January 2003 and January 2006 were selected, who were all urban citizens aged 25 years old or above. According to the differentiation of symptoms and signs criteria and clinical practice identified by the “Guideline of New Traditional Chinese Medicine in Clinical Research on Treating Impotence” of Ministry of Health in 1993, the symptoms were preliminarily divided into stagnation of qi due to depression of the liver, dampness and heat in the liver and gallbladder, slight insufficiency of the kidney-yang, deficiency of liver-yin and kidney-yin and deficiency of qi and blood in the heart and spleen. The patients were diagnosed by traditional Chinese physician and given medicine penile erection test, investigation of invasion season and risk factors and psychological assessment before treatment. Erectile condition was evaluated by Porst grading： Grade 0：without any reaction; Grade 1： slight erection; Grade 2： incomplete erection; Grade 3： normal erection. The symptom checklist-90 （SCL-90） was used to evaluate the mental emotion of patients, which was divided into 9 symptoms： somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. All the tests and investigation were performed in 1 week before treatment. RESULTS： The 155 subjects were all involved in the result analysis. ① Distribution of Chinese medicine syndrome pattern of 155 patients： 39 examples were stagnation of qi due to depression of the liver; 26 examples were dampness and heat in the liver and gallbladder;, 22 were slight insufficiency of the kidney-yang; 41 were deficiency of liver-yin and kidney-yin and 27 were deficiency of qi and blood in the heart and spleen. There were most patients with deficiency of liver-yin and kidney-yin, following by stagnation of qi due to depression of the liver and dampness and heat in the liver and gallbladder and slight insufficiency of the kidney-yang were the least. ②In the comparison among syndrome patterns and total samples, the mean ages of patients with slight insufficiency of the kidoey-yang and deficiency of qi and blood in the heart and spleen were older and the average Porst grades were decreased obviously; The average disease courses of patients with slight insufficiency of the kidney-yang, dampness and heat in the liver and gallbladder and deficiency of qi and blood in the heart and spleen were longer; while the average age and disease courses of patients with stagnation of qi due to depression of the liver and deficiency of liver-yin and kidney-yin were younger and shorter obviously and their average Porst grades were higher obviously. ③The mean education degrees of patients with deficiency of qi and blood in the heart and spleen were higher （P〈 0.05-0.01）; The rates of patients with slight insufficiency of the kidney-yang.and deficiency of qi and blood in the heart and spleen combined with hypertension and coronary heart disease were higher; while the average smoking and drinking exponents of patients with dampness and beat in the liver and gallbladder were increased obviously （P 〈0.05-0.01）. ④The invasion season of slight insufficiency of the kidney-yang was almost in winter （P〈0.05）. In the comparison of psychological grade, the SCL-90 scores, positive scores, the mean and equipartition of positive item of patients with stagnation of qi due to depression of the liver and deficiency of liver-yin and kidney-yin were obviously higher than and total samples, while the indexes of patients with slight insufficiency of the kidney-yang and deficiency of qi and blood in the heart and spleen were significantly lower than total samples （P 〈 0.05-0.01）. CONCLUSION： The patients with stagnation of qi due to depression of the liver and deficiency of liver-yin and kidney-yin occupy the majority in the impotence patients of Xi ＇an; they are younger, their courses of disease are shorter and the important mechanisms are psychological factors.