成都地区男性不育症中医证型分布的调查研究

Distribution of traditional Chinese medicine syndrome types of male infertility in Chengdu area

目的:通过对成都地区男性不育症中医证型的分布调查,探索男性不育症中医证型的分布特点,为男性不育症的临床治疗和相关研究提供客观依据。方法:收集2017年1~12月在成都中医药大学附属医院及成都中医药大学附属生殖妇幼医院门诊及住院部就诊的男性不育症患者500例,根据患者的中医四诊情况进行辨证分型,分析并总结其证型的分布特点。结果:①男性不育症患者基本特征分布:调查分析500例患者的基线特征,卡方检验显示患者在性交频次、体质量指数、泌尿系感染史、睾丸体积、睾丸质地、输精管、精索静脉曲张等方面分布存在差异(P<0.05)。②男性不育患者症型分布结果:无证可辨115例(23.0%);肾阳不足型109例(21.8%);肾精亏损型36例(7.2%);肾阳不足兼肝气郁结型30例(6.0%);肾阳不足兼脾虚湿盛型30例(6.0%);肾阴亏虚型28例,占5.6%;其他证型共152例,包括脾虚湿盛型20例(4.0%),肝气郁结型、痰湿内阻型、肾阳不足兼肾精亏损型均为19例(3.8%);湿热下注型16例(3.2%);肾阴亏虚兼肾阳不足型11例(2.2%);气滞血瘀型10例(2.0%);其余证型38例(7.6%)。结论:成都地区男性不育症独立证型以肾阳不足型为主,复合证型以肾阳不足兼肝气郁结型、肾阳不足兼脾虚湿盛型为主,症型分布与影响因素尚需大样本、高质量的调查研究进一步探索和明确。

Objective: To explore the distribution characteristics of the traditional Chinese medicine(TCM) syndrome types of male infertility in Chengdu area, China, in order to provide some objective evidence for the clinical treatment and studies of male infertility. Methods: We collected the clinical data on 500 cases of male infertility treated in the outpatient and inpatient departments of the Affiliated Hospital of Chengdu University of Chinese Medicine and Chengdu Hospital for Reproduction, Women and Children from January to December 2017. Based on the results of examinations using the four diagnostic methods of TCM, namely, observation, auscultation and olfaction, interrogation, and palpation, we differentiated the TCM syndromes of the patients and analyzed the distribution characteristics of the syndrome types. Results: Analysis of the baseline characteristics and the results of Chi-square test showed statistically significant differences in the distribution of the frequency of sexual intercourse, body mass index, history of urinary tract infection, testis volume, testicular texture, vas deferens and varicocele among the 500 patients(P < 0.05). As for the distribution of the TCM syndrome types, 115 cases(23.0%) were diagnosed with the unlicensed discernible type of syndrome, 109(21.8%) with kidney-yang deficiency, 36(7.2%) with kidney-essence deficiency, 30(6.0%) with both kidney-yang deficiency and liver-qi stagnation, 30(6.0%) with both kidney-yang deficiency and spleen-asthenia with excessive dampness, 28(5.6%) with kidney-yin deficiency, 20(4.0%) with spleen-asthenia and excessive dampness, 19(3.8%) with liver-qi stagnation, 19(3.8%) with phlegm dampness obstruction, 19(3.8%) with kidney-yang and kidney-essence deficiency, 16(3.2%) with downward damp-heat, 11(2.2%) with both kidney-yin and kidney-yang deficiency, 10(2.0%) with qi-stagnation and blood stasis, and 38(7.6%) with other types of syndromes. Conclusion: The main TCM syndrome types of male infertility in Chengdu area include kidney-yang deficiency, kidney-yang deficiency with liver-qi stagnation, and kidney-yang deficiency with spleen-asthenia and excessive dampness. The distribution and influencing factors of the syndrome types need to be further explored and clarified by more large-sample and high-quality studies.