混合性焦虑抑郁障碍患者的中医证候与中医体质

The study of TCM syndrome and TCM physique in patients with mixed anxiety and depressive disorder

目的:探讨混合性焦虑抑郁障碍(MADD)患者的中医证候、中医体质的分布特点,及其与非焦虑、抑郁患者的差异,为中医手段治疗MADD患者提供支持依据。方法:通过医院焦虑抑郁调查量表(HADS)和症状自评量表(SCL-90),结合访谈由华北理工大学中西医结合医院临床心理科医师确诊患有MADD,共收集在我院就诊的MADD患者150人,对照组来访者134人,共284人。全部通过《中医体质分类与判定量表》进行判定其中医体质类型,并由经验丰富的中医专家组诊断其中医证候。结果:(1)HDS分量表总分与SCL-90抑郁因子分呈正相关,HAS分量表总分与SCL-90焦虑因子分呈正相关(r=0.349,0.370;P<0.01),有统计学意义;(2)中医证候在MADD组以肝气郁结证(27.3%)>痰气郁结证(26.0%)>气郁化火证(22.7%)>心脾两虚证(16.0%)>心肾阴虚证(6.0%)>心神失养证(2.0%);(3)MADD组中医体质以气郁质(27.3%)占绝大多数,其次是阴虚质(18.0%)、气虚质(13.3%)、血瘀质(12.0%)、湿热质(10.7%)、痰湿质(9.3%)、阳虚质(8.7%),特禀质(0.7%),没有平和质患者;对照组则以平和质(34.3%)占绝大多数,其次为阳虚质(14.2%)、湿热质(13.4%)、血瘀质(11.9%)、气虚质(9.7%)、阴虚质(9.0%)、痰湿质(7.5%),没有气郁质、特禀质,MADD组与对照组中医体质的比较,对照组体质明显好于MADD组;(4)不同证候对抑郁状态影响不同(χ^2=21.896,P<0.01),不同证候对焦虑状态的影响也不同(χ^2=12.376,P<0.05),有统计学意义;(5)肝气郁结证多与气虚质(31.71%)、血瘀质(26.83%)和气郁质(17.07%)密切相关;气郁化火证与气郁质(69.23%)相关性最密切;痰气郁结证多与痰湿质(29.41%)、湿热质(23.53%)和气郁质(20.59%)密切相关;心脾两虚证多与阴虚质(37.50%)、湿热质(29.17%)和气虚质(16.67%)密切相关;心肾阴虚证与阴虚质(77.78%)相关性最密切;心神失养证多与气虚质(66.67%)和阴虚质(33.33%)相关。结论:MADD组患者SCL-90中体现的抑郁、焦虑状况越严重,抑郁分量表(HDS)筛查得出的抑郁症状也越严重、焦虑分量表(HAS分量表)的焦虑症状也越严重。在MADD组以肝气郁结证、痰气郁结证最常见,其次是气郁化火证、心脾两虚证、心肾阴虚证、心神失养证。气郁质中医体质的人更容易得MADD。中医证候越严重,焦虑抑郁状况也越严重。中医体质与证候虽然密切相关,但并不完全一致。

Objective:To explore the difference between mixed anxiety and depressive disorder(MADD)and nonmixed anxiety depression disorder(control group)in the scores of SCL-90 factors and TCM syndrome,so as to provide support for the treatment of MADD with traditional Chinese medicine.Methods:According to the Hospital Anxiety and Depression Scale(HADS)and Symptoms self-rating scale(SCL-90),combined with interview,diagnosed with MADD by the clinical psychology doctor in the hospital of integrated TCM&WM at north China university of science and technology,150 patients with MADD and 134 patients of the control group were treated.All types of Chinese traditional Chinese medicine were determined by the " TCM constitutions classification and determination scale",at the same time,the TCM syndrome were diagnosed by experienced TCM expert group.Results:(1)he score of HDS scale was positively correlated with SCL-90 depression factor score and the score of HAS scale was positively correlated with SCL-90 depression factor score(r=0.349,0.370;P<0.01)(2)The TCM syndromes of six TCM syndromes in MADD group was:Liver qi stagnation syndrome(27.3%)>phlegm stagnation syndrome(26.0%)>qi stagnation of fire syndrome(22.7%)>heart and spleen deficiency syndrome(16.0%)>heart and kidney deficiency syndrome(6.0%)>lack of heart and energy syndrome(2%).(3)The traditional Chinese medicine physique of MADD patients had most qi stagnation(27.3%),followed by yin deficiency(18.0%),qi deficiency(13.3%),blood stasis(12.0%),damp heat(10.7%),phlegmatic hygrosis(9.3%),yang deficiency(8.7%),intrinsic physical characteristics(0.7%),no moderate physical quality.In the control group,the highest was moderate physical quality(34.3%),followed by yang deficiency(14.2%),damp heat(13.4%),blood stasis(11.9%),qi deficiency(9.7%),yin deficiency(9.0%),phlegmatic hygrosis(7.5%),no qi stagnation and intrinsic physical characteristics.Compared with the MADD group and control group,the TCM syndromes of the control group was significantly better than that of MADD group.(4)The depression were heavily influenced by TCM syndromes(=21.896,P<0.01).The anxiety were heavily influenced by TCM syndromes(=12.376,P<0.05),which was statistically significant.(5)The liver qi stagnation syndrome was closely related to qi deficiency(31.71%),blood stasis(26.83%)and qi stagnation(17.07%).The qi stagnation of fire syndrome was closely related to qi stagnation(69.23%).The phlegm stagnation syndrome was closely related to phlegmatic hygrosis(29.41%),damp heat(23.53%)and qi stagnation(20.59%).The heart and spleen deficiency syndrome was closely related to yin deficiency(37.50%),damp heat(29.17%)and qi deficiency(16.67%).The heart and kidney deficiency syndrome was closely related to yin deficiency(77.78%).The lack of heart and energy syndrome was closely related to qi deficiency(66.67%)and yin deficiency(33.33%).Conclusion:The more severe the depression and anxiety in the SCL-90 in MADD group,the more severe the depression symptoms of the depression scale(HDS component table)and the more anxiety symptoms of anxiety scale(HAS component table).In the MADD group,the most common cases are liver qi stagnation syndrome and phlegm stagnation syndrome,followed by qi stagnation of fire,heart and spleen deficiency syndrome,heart and kidney deficiency syndrome and lack of heart and energy.The person more with qi stagnation easily get to the MADD.The more seriously the TCM syndromes it gets the seriously depression or anxiety it is.Although the TCM physique is closely related to the TCM syndromes,they are not complete coincident.