95例脾气虚证重症肌无力病例回顾及用药规律探析

Retrospective analysis of 95 cases of spleen qi deficiency syndrome of myasthenia gravis and characteristics of traditional Chinese medicine

目的:以95例重症肌无力(MG)脾气虚证患者为研究对象,回顾性研究其临床特点和中医用药规律,为MG临床诊疗方案的优化提供指导意见。方法:病例来源于2010年1月至2015年2月广州中医药大学第一附属医院明确诊断为脾气虚证MG住院患者95例,分析其临床特点和中医用药规律。结果:脾气虚证MG住院患者中,发病年龄(40.15±17.24)岁,21到30岁之间为发病高峰;病程最短1年,最长30年,平均(6.34±5.82)年;临床改良Osserman分型以Ⅱb型多见;伴随疾病以胸腺瘤最为多见,其次为胸腺增生;MG常见主症为眼睑下垂,其次为四肢乏力、吞咽困难、构音障碍等;常见中医症状及舌脉有倦怠乏力、吞咽无力、精神疲乏,舌淡、苔薄白、脉细;中药处方中以黄芪、党参、白术、五指毛桃等补气健脾之品频率最高。结论:MG脾气虚证患者从脾胃论治,补气健脾,辅以补肾益精、化湿行气中药,符合对MG主要病机的分析。

Objective: To study the clinical characteristics and regularity of TCM medication of 95 patients with myasthenia gravis(MG) of spleen qi deficiency syndrome retrospectively, and to provide guidance for the optimization of clinical treatment of MG. Methods: Clinical cases were collected from January 2010 to February 2015 in First Affiliated Hospital of Guangzhou University of Chinese Medicine. Ninety-five cases, which were diagnosed as MG with spleen qi deficiency syndrome, were analyzed from its clinical characteristics and regularity of TCM medication. Results: Among MG with spleen qi deficiency syndrome in hospitalized patients, the age was(40.15±17.24) years old, and the peak incidence was between 21 and 30 years old. The shortest course of disease was 1 year, while the longest was 30 years, and the average was(6.34±5.82) years. The type Ⅱb was most common in the clinical classification of Osserman type. Thymoma was the most common concomitant disease, followed by thymus hyperplasia. The common symptoms of MG were ptosis, followed by limb weakness, dysphagia and dysarthria. The common symptoms of traditional Chinese medicine were lassitude, dysphagia, mental fatigue, pale tongue with thin white fur and small and weak pulse. Astragalus, codonopsis, atractylodes and Radix Fici Simplicissimae which can strengthen spleen and invigorate qi were most in traditional Chinese medicine prescription. Conclusion: The MG patients with spleen qi deficiency syndrome should be treated from spleen and stomach, and strengthen spleen and invigorate qi. Combined with nourishing the kidney and strengthening the essence, eliminating dampness and promoting flow of qi medicine, it is in line with the analysis of main pathogenesis of myasthenia gravis.