抑郁症消化道症状的证候特点研究

Syndrome characteristics of digestive symptoms of depression

目的在病证结合的前提下丰富证候内涵;为辨证论治规范化及异病同治提供参考依据。方法参照中南大学湘雅医院中西医结合研究所编制的调查表体例制定"抑郁症消化道症状的证候特点研究调查表",收集符合要求的病例资料115例,从症状出现频率、持续时间和性质程度3个方面进行量化评分,然后将符合纳入标准的病例录入数据库,采用无监督复杂系统熵聚类统计方法和SPSS 17.0统计软件包进行相应统计。结果抑郁症的消化道症状表现突出,将常见症状采用无监督复杂系统熵聚类方法进行聚类组合后得出6个证候要素:气滞、气虚、血虚、阳虚、郁火、痰湿。病位主要在肝,涉及脾、心、肾。根据聚类结果和患者四诊信息并结合辨证理论进行证型分布统计,其结果:肝郁脾虚证62人(53.9%),肝气郁结证33人(28.7%),心脾两虚证13人(11.3%),肾虚肝郁证5人(4.3%),痰浊内蕴证2人(1.7%)。结论抑郁症的主要证型为肝郁脾虚证和肝气郁结证,肝气郁结为其核心病机;肝郁脾虚为抑郁症病机发展的总趋势。

Objective To enrich the connotation of syndromes of depression on the premise of combination of diseases and syndromes,and to provide a base for standardization of syndrome differentiation and treatment and treating different diseases with the same therapy.Methods According to the Questionnaire on Syndrome Characteristics of Digestive Symptoms of Depression,edited by the Institute for Integration of Chinese and Western Medicine of Xiangya Hospital of Central South University,the patients with depression （n =115） were chosen and graded quantitatively from the frequency,duration and intensity of symptoms.The cases according with the inclusion criteria were input into the database,and the data were analyzed by using the method of unsupervised complex system entropy clustering and SPSS 17.0 software.Results There were 6 syndrome factors summed up after clustering ensemble from common symptoms of depression,including qi stagnation,qi deficiency,blood deficiency,yang deficiency,depressive fire and phlegm-dampness.The disease location was liver involving spleen,heart and kidney.According to the result of clustering,information from TCM four examinations and syndrome differentiation,the syndrome distribution was showed as follows：there were 62 patients （53.9％） with syndrome of liver depression and spleen deficiency,33 （28.7％） with syndrome of liver qi stagnation,13 （11.3％） with syndrome of dual deficiency of heart and spleen,5 （4.3％） with syndrome of kidney deficiency and liver depression,and 2 （1.7％） with syndrome of internal phlegm turbidity.Conclusions The major syndrome types of depression are syndrome of liver depression and spleen deficiency,as well as syndrome of liver-qi stagnation.The former is the general tendency of depression,and the latter is the core pathogenesis of depression.