儿童注意缺陷多动障碍的中医辨证研究

TCM Syndrome Study of Children with Attention Deficit Hyperactivity Disorder

目的:在全面分析临床资料的基础上探索ADHD中医辨证研究的特点和方法。方法:采取横断面回顾性研究方法,对符合研究标准的170例初次就诊的ADHD患儿进行6个方面的临床因素调查和分析。总结其证候特点,探索符合临床实际的辨证方法。结果:在49例"无证可辨"型病例中,45例为轻症患儿,占全部无证可辨型病例的91.84%,仅有4例为中度,无重度病例。而在全部50例轻度病例中,"无证可辨"型病例有45例,占全部轻度病例的90%。中医分型与疾病严重程度具有显著相关性(P<0.01)。"肾虚肝旺,阴虚阳亢"型主要表现为混合型这一西医亚型,占81.6%的比例。混合型表现为"无证可辨"型的比例是最低的,仅有5例,不足7%。西医亚型与中医辨证分型之间具有显著相关性(P<0.01)。与正常儿童相比较,ADHD患儿的身高、体重及智商均有落后趋势(P<0.01)。结论:(1)ADHD存在"无证可辨"型中医证型,主要表现为注意缺陷型和多动、冲动型两种西医亚型。(2)对于ADHD无证可辨型的辨证方法,确立先辨病再辨证的中医诊断原则,辨病成立的基础上再通过考察其先天影响因素和生长发育方面的因素进行辨证,确立"无证可辨"型,在ADHD的发病早期或轻症阶段即给予整体调治,以解决疾病核心病机。

Objective ： To explore TCM syndrome characteristics and research methods of ADHD with a comprehensive analysis of clinical data. Methods：Taking a cross - sectional retrospective study method, the 6 aspects of clinical factors in 170 cases patients of initial treatment with ADHD were investigated and analyzed. Results ： In 49 cases of syndromeless differentiation type of the disease,d5 cases were mild cases, accounting for 91.84% , only 4 cases were moderate cases, and none was severe case. In all 50 cases of mild cases, syndromeless differentiation type cases were 45 cases, accounting for 90% in all mild cases. TCM type and severity of the disease had significant correlation （P 〈 0.01 ）. Liver and kidney yin deficiency syndrome and yang hyperactivity syndrome mainly show the composite subtypes,accounting for 81.6%. Composite subtypes performance syndromeless differentia- tion type ratio was the lowest, only 5 cases, accounting for less than 7%. There was a significant correlation between WM subtypes and TCM syndrome type （P 〈 0. 01 ）. Compared with normal children, the ADHD childreng heights, weights and IQ showed out of backward trend （ P 〈 0. 01 ）. Conclusion ： The syndromeiess differentiation type existed in ADHD syndrome are mainly attention deficit and hyperactivity subtypes. For syndrome differentiation method of ADHD syndromeless differentiation type, diagnosis is the first and syndrome differentiation of TCM diagnosis is the second. Early diagnosis of syndromeless differentiation type for the treat- ment of ADHD has important significance.