原发免疫性血小板减少症同病异证分布规律的研究

Study on Distribution of Different Syndromes of Same Disease in Primary Immune Thrombocytopenia

目的分析原发免疫性血小板减少症(ITP)中医证候特征和分布规律,为证型与ITP免疫机制和调节机制研究奠定基础。方法采用流行病学调查方法和访谈获得四诊信息,由三位专业和中医诊断学专家分别辨证确定证型,分析中医证型分布特征和规律。结果①189例患者中其中汉族165例,维吾尔族24例;②ITP证型分布阴虚火旺证57例,气不摄血证56例,肝肾阴虚20例,脾肾气虚18例,气阴两虚18例,肝郁脾虚3例,还有部分复合证型;③新诊断ITP证型分布及排序为气不摄血>阴虚火旺>肝肾阴虚>气阴两虚>脾肾气虚>肝郁脾虚;持续性ITP证型分布和排序为阴虚火旺>脾肾气虚>气阴两虚>气不摄血>肝肾阴虚>肝郁脾虚;慢性ITP为气不摄血>阴虚火旺>肝肾阴虚>气阴两虚>脾肾气虚>肝郁脾虚证。结论证型总体上以气不摄血和阴虚火旺为主,还有肝肾阴虚、脾肾气虚、气阴两虚和肝郁脾虚等;六个证型有程度的差异,也有不同阶段的演化特征。

Objective To analyze the characteristics and distribution of TCM syndromes in primary immune thrombocytopenia and lay a foundation for the study of syndrome types and the immune mechanism and regulatory mechanism of ITP.Methods Epidemiological survey method and interview were used to obtain the information of the four diagnoses.Three professional and TCM diagnostic experts were selected to identify syndrome types and analyze the distribution characteristics and rules of TCM syndrome types.Results①Among 189 patients,165 were Han nationality and 24 were Uygur nationality.②ITP syndromes:57 cases were syndrome of hyperactivity of fire due to Yin deficiency,56 cases were Qi failing to control blood syndrome,20 cases were liver-kidney Yin deficiency syndrome,18 cases were spleen-kidney Qi deficiency syndrome,18 cases were liver Yin deficiency syndrome,3 cases were liver Qi depression and spleen deficiency syndrome,and there were some complex syndromes.③The newly diagnosed ITP syndromes distribution and order:Qi failing to control blood syndrome>syndrome of hyperactivity of fire due to Yin deficiency>liver and kidney Yin deficiency syndrome>Qi and Yin deficiency syndrome>spleen and kidney Qi deficiency syndrome>liver depression and spleen deficiency syndrome.The persistent ITP syndromes distribution and order:syndrome of hyperactivity of fire due to Yin deficiency>spleen-kidney deficiency syndrome>deficiency of Qi and Yin deficiency syndrome>deficiency of Qi and Yin deficiency syndrome>deficiency of liver and kidney Yin deficiency syndrome>deficiency of liver and spleen.The chronic ITP syndromes distribution and order:Qi failing to control blood syndrome>syndrome of hyperactivity of fire due to Yin deficiency>liver and kidney Yin deficiency syndrome>Qi and Yin deficiency syndrome>spleen and kidney Qi deficiency syndrome>liver depression and spleen deficiency syndrome.Conclusion The syndrome types are mainly deficiency of Qi and blood and deficiency of Yin and kidney,deficiency of spleen and kidney,deficiency of Qi and Yin and deficiency of liver and spleen.The six syndromes differ in degree and evolution in different stages.