排卵障碍性异常子宫出血证候分布特征的临床流行病学调查

Distribution Characteristics of Traditional Chinese Medicine Syndromes for Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction:A Clinical and Epidemiological Investigation

目的:探究排卵障碍性异常子宫出血中医证候分布特征。方法:基于临床流行病学调查,对全国29个省、自治区、直辖市的省市县/区级医院的6 688例排卵障碍性异常子宫出血患者的中医证候特征进行分析。结果:全国范围内排卵障碍性异常子宫出血患者以肾气虚证(17.34%),脾气虚证(13.25%),气血两虚证(12.62%),气虚血瘀证(8.45%),肾阴虚证(6.88%)为常见中医证候。排卵障碍性异常子宫出血以气虚、阴虚、血虚为常见病性要素,并且多与肾、脾、肝密切相关。排卵障碍性异常子宫出血患者中医证候的地区分布具有一定规律,肾气虚证、脾气虚证、气血两虚证为共有证候;但因地域不同,各地区中医证候的分布也存在差异之处。华北、西北、西南、华东地区的肾气虚证出现频率较高,华中、东北、华南地区出现频率稍低。华中地区脾气虚证出现频率最高。华东地区气血两虚证频率最高。脾肾两虚证在华中、华北、西南地区分布较多。西北、华南、华北地区以气虚(肾虚)血瘀证为常见证候。华东、西北、东北地区以肾阴虚证较为多见,而虚热证主要分布在西南、华东地区。肾阳虚证则较多分布在华南地区。肝郁血热证在东北地区分布较多。肝郁脾虚证在华中地区频率较高。肾气虚证、脾气虚证、气血两虚证、气虚血瘀证、肾阴虚证与既往诊断标准差异不大。对肾气虚证有诊断意义的症状为阴道不规则流血,经量多,或月经周期缩短;腰酸痛,健忘。对脾气虚证有诊断意义的症状是月经周期缩短;神疲乏力,纳呆食少,便溏;苔白。对气血两虚证有诊断意义的症状是气短懒言,面色淡白无华,头晕,心悸。对气虚血瘀证有诊断意义的症状是经行不畅,经常或偶有血块;神疲乏力;舌紫暗。对肾阴虚证有诊断意义的症状是排卵期出血;头晕,耳鸣,五心烦热,盗汗。结论:排卵障碍性异常子宫出血中医证候类型分布具有一定规律性,地区分布存在差异,可为临床因地论治提供一定的参考依据。

Objective: To explore the distribution characteristics of traditional Chinese medicine(TCM)syndromes of abnormal uterine bleeding associated with ovulatory dysfunction(AUB-O). Method:A clinical and epidemiological investigation was conducted in 6 688 patients with AUB-O from the provincial,municipal,and county/district hospitals in 29 provinces,autonomous regions,and municipalities across China to identify the distribution characteristics of their TCM syndromes. Result: The AUB-O patients nationwide were mainly differentiated into the kidney Qi deficiency syndrome(17.34%),the spleen Qi deficiency syndrome(13.25%),the Qi and blood deficiency syndrome(12.62%),the Qi deficiency and blood stasis syndrome(8.45%), and the kidney Yin deficiency syndrome(6.88%). AUB-O resulted from Qi deficiency,Yin deficiency,and blood deficiency,often involving the kidney,spleen and liver. The analysis of the regional distribution of TCM syndromes in AUB-O patients revealed that kidney Qi deficiency,spleen Qi deficiency,and Qi and blood deficiency were the shared syndromes. However,due to regional discrepancy,the TCM syndrome varied widely from one geographic region to another. The kidney Qi deficiency syndrome was more frequently seen in North China,Northwest China,Southwest China,and East China,but less frequently in central China,Northeast China,and South China. The spleen Qi deficiency syndrome occurred most frequently in central China,while the East China had the highest frequency of Qi and blood deficiency syndrome. The spleen and kidney deficiency syndrome was mostly present in central China,North China,and Southwest China,the Qi deficiency(kidney deficiency)and blood stasis syndrome in Northwest China,South China,and North China,the kidney Yin deficiency syndrome in East China,Northwest China,and Northeast China,the deficiency-heat syndrome in Southwest China and East China,the kidney Yang deficiency syndrome in South China,the liver depression and blood heat syndrome in Northeast China, and the liver depression and spleen deficiency syndrome in central China. The diagnostic criteria for the kidney Qi deficiency,spleen Qi deficiency,Qi and blood deficiency,Qi deficiency and blood stasis,and kidney Yin deficiency syndromes were not significantly different from the previous ones. The distinctive symptoms for the kidney Qi deficiency syndrome were irregular vaginal bleeding, heavy menstrual flow, or shortened menstrual cycle, back soreness and pain, and forgetfulness,while those for the spleen Qi deficiency syndrome mainly included the shortened menstrual cycle,mental fatigue,lack of strength,poor appetite,loose stool,and white tongue coating. The Qi and blood deficiency syndrome were mainly manifested as the shortness of breath,laziness to speak,pale complexion,dizziness,and palpitation. The Qi deficiency and blood stasis syndrome were mainly judged by the scanty menstrual flow frequently or occasionally accompanied by blood clots,mental fatigue,lack of strength,and dark purple tongue. The ovulatory bleeding,dizziness,tinnitus,vexing heat in chest,palms and soles,and night sweat were the characteristic signs for the kidney Yin deficiency syndrome. Conclusion: There exist certain rules in the geographical distribution of TCM syndromes of AUB-O patients,which has provided a reference for the clinical treatment of AUB-O in accordance with the local conditions.