髋痹病临床治疗关键技术问题研究之中医证候学研究

Key techniques in the clinical treatment of the hip impediment disease: TCM syndrome studies

目的:运用中医四诊探讨髋痹病患者临床病例资料中的中医证候分布特征。方法:收集确诊为髋痹病的患者共321例的临床资料,统计各证候中医四诊内容并采用STATA 12.0统计软件进行计算分析。通过统计计算分析和Logistic多因素回归分析筛选出中医证候出现的频数与频率,髋痹病患者舌象、脉象出现的频数与频率和中医诊断模型的建立。结果:321例髋痹病病例中,共有证候21个,出现频率由高到低依次为关节活动受限、腹股沟区压痛、负重后加重、阴雨天加重、行走乏力、劳累后加重等。髋痹病患者的舌象以红、暗为主,出现频率分别为20.9%、17.8%;淡胖舌出现频率为20.2%,舌边有瘀斑和舌静脉曲张共占34.5%;苔质以腻为主,苔色以白、黄为主,脉象以细数、脉虚弱为主。气滞血瘀型63例以关节刺痛、苔白、关节活动受限等为主要证候;肝肾亏虚型134例以阴雨天加重、负重后加重、腹股沟区压痛等为主要证候;痰湿痹阻型124例以关节活动受限、腰膝酸软、失眠等为主要证候。对3个症型进行多元素回归分析获得了髋痹病各证型的常见证候。结论:初步筛选出不同中医证候髋痹病患者常见的证候,能够较准确的反映髋痹病的临床特点,达到正确诊断的目的。

Objective： To investigate the distribution characteristics of traditional Chinese medicine（TCM） syndromes by studying the clinical data of patients with hip impediment disease with the four TCM examinations. Methods： The clinical data of 321 patients diagnosed with hip impediment disease were collected, and the four examinations in each TCM syndrome were analyzed with the STATA 12.0 statistical software. Through statistical analysis and logistic multivariate regression analysis, the frequencies of TCM syndromes, the tongue manifestation and pulse condition of the patients were screened to establish models for diagnosis. Results： In the 321 patients of hip arthralgia disease cases, a total of 21 syndromes, syndrome frequency from high to low was limited joint mobility, inguinal tenderness, weight-bearing after aggravating, rainy days increase, walking fatigue, fatigue after the increase, etc. Patients of hip arthralgia with red tongue and dark, frequencies were 20.9% and 17.8%; pale tongue appears 20.2%, tongue with ecchymosis and tongue varicosity accounted for 34.5%. The high frequency tongue and pulse were greasy coating, fur with white or yellow, thready and rapid pulse or weak pulse. The main syndromes of the qi stagnation and blood stasis type（63 cases） were joint pain, moss white, limited joint mobility, etc. The main syndromes of liver and kidney deficiency type（134 cases） were rainy days increase, after loading increase, inguinal tenderness, etc. The main syndromes of the phlegm obstruction type（124 cases） were limited joint mobility, soreness and weakness of waist and knees, insomnia, etc. Multi element regression analysis was carried out on three types of syndrome types. Conclusion： The common syndromes of patients with hip impediment disease are primarily screened and can be applied to accurately reflect the clinical characteristics of the disease so as to make accurate diagnosis.