早发型发作性睡病的证候学特点

TCM syndrome characteristics of early-onset narcolepsy

目的比较分析早发型及晚发型发作性睡病患者的证候学特点及证类分布特征。方法88例发作性睡病患者,其中15岁以下起病的早发型患者61例,平均发病年龄(9.36±2.69)岁;15岁以上起病的晚发型患者27例,平均发病年龄(19.78±6.11)岁。制定并采用统一的中医证候学观察表进行临床观察,对比分析证型学观察结果。临床研究数据采用SPSS 12.0进行分析。结果①全部患者均有嗜睡。两组患者肌无力、猝倒、睡瘫、入睡幻觉及夜间睡眠紊乱的发生率相近(P均(0.05)。②早发型发作性睡病患者主要证候类型为脾虚湿困(83.6%)。晚发型患者仅有2例患者为脾虚湿困证,而湿热困脾证、脾虚肝旺证、痰浊蒙遮清窍证以及胆热痰扰证构成比率明显高于早发型患者(P均(0.05)。两组脾肾阳虚证、瘀阻脑窍证构成无显著差异。结论早发型睡病证候表现多以脾虚为本、痰湿为标,可能与体质因素关系密切。

Objective To compare and analyze the symptoms and syndrome characteristics of early and late onset narcolepsy. Methods The clinical data of 88 consecutive patients with narcolepsy, 61 of which with an onset age of 9.36 ±2.69 on average and 27 with an onset age of 19.78 ±6.11 on average. Epidemiological survey was adopted in the study, including inquiry to 88 narcolepsy patients, according to unified standards, filling out questionnaire for TCM symptoms and signs, statistical data processing by using SPSS12.0 software. Unified standards were set out and adopted to assist the clinical study and the comparision and analysis of the results of syndrome patterns. SPSS12.0 was adopted in data analysis. Results （1）All 88 patients showed lethargy. There were no significant differences in the rates of amyasthenia, cataplexy, sleep paralysis, hypnagogic hallucination, and disrupted sleep patterns bwtween the two groups （ P 〉 0.05 ）. （2）The main clinical syndrome type of the early onset group was stagnation of dampness due to splenic asthenia（ 83. 6% ） ,but only two cases of this type were involved in the late onset group. The rates of dampness and heat in the spleen, splenic asthenia and liver sthenia, turbid phlegm disturbing brain, and phlegm-fire disturbing gallbladder in the late onset group were significantly higher than those of the early onset group （P 〈 0.05 ）. There were no significant differences in the rates of spleen and kidney Yang deficiency and blood stasis in the brain. Conclusions The disease nature of early onset narcolepsy was root deficiency present with pleen deficiency and branch excess present with phlegm dampness. The key reason for occurrence of this disease is closely related to TCM constitution.