2115例手足口病患者病因病机和分期辨证的研究

Research on the Pathogenesis and Stage Differentiation of 2 115 Cases with Hand-foot-and-mouth Disease

目的通过对手足口病证候学的研究,探讨手足口病分期辨证模式。方法收集符合手足口病诊断的住院病例2 115份,按照普通型、重型、危重型统计手足口病的症状、体征出现的频率,分析手足口病各期的主要证候和兼夹证候,再进行证素聚类分析,获得不同分型的手足口病的主要病机、次要病机,进而总结手足口病的传变发展规律,依据其规律进行分期辨证。结果证素分析发现普通型和重型都以湿(87.97%,96.75%)和热(98.66%,97.93%)为主要证素,并且贯穿整个病程。普通型患者病邪在表而解,外以邪盛为主,内以正气亏虚(43.06%)和气机逆乱(19.22%)为次;重型为疫毒循经入里,其证素除邪盛外,内风也成为主要证素(73.26%),邪盛正虚,正气亏虚(73.26%)进一步加重,气机逆乱(37.07%)仍然为较常见的次要病机;危重型以亡阳、气脱、厥证和内风占优势地位。结论依据各型手足口病的发展传变规律,提出分期辨证,表证期主要病机为邪犯太阴,湿热兼夹;里证期为内热郁蒸、气机逆乱,或兼肝风内动,或热扰心神,阴阳离绝。此法更能体现手足口病发展规律,是西医辨病与中医辨证更高层次的结合,更符合中医临床,值得推广验证。

OBJECTIVE To explore the stage differentiation pattern for hand-foot-and-mouth disease thorough studies on the symptomatology of hand-foot-and-mouth disease.METHODS 2 115 required hospitalized cases were divided into general,severe and emergent syndromes to collect frequency of symptoms and physical signs of hand-foot-and-mouth disease so as to analyse the main syndrome and supplemented symptoms if each stage for further evidence factorscluster analysis in order to have the primary and secondary pathogenesis,thus leading to the conclusion for disease transformation and development,which provides regular pattern for stage differentiation.RESULTS Evidence factor analysis found out that dampness（87.97%,96.75%） and heat（98.66%,97.93%）are the main evidence factors for both the general and severe syndrome thorough the whole course.For general syndrome,it has pathoenic factor from the exterior,health qi deficiency from the interior（43.06%）,as well as reversed qi circulation（19.22%）;for severe syndrome,epidemic toxin has moved into the interior along pathway of the channel,thus having internal wind（73.26%） as main evidence factor besides excess evils,and health qi deficiency（73.26%） became more severe and the reversed qi circulation（37.07%） can also be frequently seen secondary pathogenesis;for emergent syndrome,it has yang depletion,qi escaping,fainting syndrome and internal wind as primary pathogenesis.Therefore,the main pathogenesis for exterior syndrome is pathogenic evils invading Taiyin with both dampness and heat;the main pathogenesis for interior syndrome is internal heat retention,reversed qi circulation,together with the internal movement of the liver wind,evil heat attacking the heat and spirit,and dissociation of yin and yang.CONCLUSION It is very sensible to come with stage differentiation according to the transformation and development of hand-foot-and-mouth disease at each stage,which can not only better reflect progression of it,but also better serve the clinical requirement of TCM as a higher link between Western syndrome differentiation and TCM differentiation,thus is worth further application promotion.