早发型和晚发型发作性睡病临床特点辨析

Clinical characteristics of early-onset and late-onset narcolepsy: A comparative study

目的:对比分析早发型和晚发型发作性睡病的临床特点,探讨病因病机,为临床辨证论治提供依据。方法:针对发作性睡病患者进行横断面研究。对比分析早发型和晚发型睡病的临床特征及中医证候特征。结果:1315例患者中,早发型睡病患者占85.71%,晚发性睡病患者占14.29%。2发作性睡眠、猝倒、睡瘫和睡眠幻觉是发作性睡病特征性的症状。猝倒在早发型睡病中更明显(P<0.01),睡眠瘫痪在晚发型睡病中更明显(P<0.01);344个伴随症状中,早发型患者中更为显著的症状包括易怒、消谷善饥、五心烦热、潮热盗汗、大便干结、排便费力(P<0.01,P<0.05),晚发型患者中更为显著的症状包括抑郁、健忘、肢体麻木、头目昏沉、口唇爪角色暗、腰膝酸软(P<0.05,P<0.01)。结论:由于发病年龄、体质和环境影响,早发型睡病患者症状多从阳化,而晚发型睡病多伴有肝气郁结。

Objective： To compare and analyze the clinical characteristics of early-onset and late-onset narcolepsy, and explore the etiology and pathogenesis to provide evidence for the clinical pattern differentiation and treatment. Methods： A crosssectional study was conducted based on patients with narcolepsy to collect the clinical characteristics and syndromes in traditional Chinese medicine（TCM） and do a comparative study. Results：1315 patients were included, with 85.71% being with the early onset and 14.29% with the late onset. 2Excessive daytime sleepiness, cataplexy, hypnogogic hallucination and sleep paralysis were typical symptoms of narcolepsy, with more frequent cataplexy in the early-onset group（P〈0.001） and more frequent sleep paralysis in the late-onset group（P〈0.001）. 3In the 44 accompanying symptoms, there were symptoms of irascibility, swift digestion with rapid hungering, burning sensation of chest, palms and soles, hot flash and night sweats, dry stools and difficulty in defecation（P〈0.01, P〈0.05） in the early-onset group, while depression, amnesia, limb numbness, dizziness, dark lip and nails and soreness and weakness in the low back and knees（P〈0.05, P〈0.01） were more significant in the late-onset group. Conclusion： The main symptoms of narcolepsy are characterized by sudden onset and quick alleviation, with the pathogenesis of wind-phlegm stirring internally and disturbing the mind and meridians. There are more yang factors in the early-onset group and symptom of liver qi stagnation in the late-onset group due to the influence of age, patients＇ constitution and environment.