单纯性肥胖就诊患者的中医证素特征分析

Characteristics analysis of traditional Chinese medicine elements of patients with simple obesity

目的:辨证论治是中医治疗肥胖的主流,但相关证候报道并不多。本研究旨在调查现阶段肥胖就诊患者的证素特征。方法:招募在上海中医药大学附属曙光医院就诊的肥胖患者,参考《证素辨证学》判定证素,证素分布以频数和构成比表示,证素组合采用系统聚类模型。结果:共纳入资料完整的受试者223例[男/女=107/116例,年龄(47.5±13.2)岁,体质量指数(29.6±1.7)kg/m2]。常见证素依次为肝[131(22.6%)],痰[85(14.7%)]、湿[83(14.3%)]和肾[63(10.9%)],病位证素降序排列依次为肝、肾、脾和胃,病性证素依次为痰、湿、气虚和气滞,上述排列男女间没有差异,50岁以下患者中肾的构成比低于脾和胃。81.6%受试者中证素数量≤4个,56.5%受试者中并存的证素数量≤2个。脾+气虚、气滞+胃、痰+湿、脾+气虚+肾是主要证素组合。结论:肥胖就诊患者中,肝和肾、痰和湿是常见的病位和病性证素,脾+气虚/肾、气滞+胃、痰+湿的病位病性证素组合是常见的证素组合。

Objective： Treatment based on syndrome differentiation is the mainstream of treating obesity with traditional Chinese medicine（TCM）, but the related reports of syndromes are rare. This study aims to investigate the characteristics of syndrome elements of obesity patients at the present stage. Methods： The obesity patients being treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were recruited, and the syndrome elements of patients were judged according to Syndrome Elements Differentiation Science. The element distribution was indicated with frequency and constituent ratio, and the syndrome elements were composed by using hierarchical clustering model. Results： The complete information of 223 patients was included. The common syndrome elements were, in order, liver [131（22.6%）], phlegm [85（14.7%）], dampness [83（14.3%）], and kidney [63（10.9%）]. Syndrome elements of disease location in descending order were liver, kidney, spleen, and stomach, the syndrome elements of disease nature were, in order, phlegm, dampness, qi deficiency, and qi stagnation, and there was no difference in the above sequences between male and female. The constituent ratio of kidney during the patients under the age of 50 was lower than that of spleen and stomach. The syndrome elements of 81.6% patients were less than or equal to 4, and the syndrome elements of 56.5% patients were less than or equal to 2. Spleen＋qi deficiency, qi stagnation＋stomach, phlegm＋dampness, and spleen＋qi deficiency＋kidney were the main composition of syndrome elements. Conclusion： In obesity patients, liver and kiney were the common syndrome elements of disease location, and phlegm and dampness were the common syndrome elements of disease nature. Spleen or kidney＋qi deficiency, qi stagnation ＋stomach, and phlegm＋dampness were the commom combinations of syndrome elements.