单纯性肥胖症患者证候要素分布特征初探

Discuss on distribution characteristics of syndrome elements in patients with simple obesity

目的探索单纯性肥胖症患者证候要素(以下简称证素)分布特征。方法筛选481例单纯性肥胖症患者,通过证素判定条目表采集病位、病性证素信息,收集身高、体质量、血脂、血糖、尿酸(UA)等资料。按频次和构成比整理证素,以累积构成比>85%判定常见证素。分别按年龄段、肥胖程度、证素数量和种类分层,探索证素分布特征及肥胖程度的影响因素。结果481例单纯性肥胖症患者证素按出现频次降序排列,依次为湿、肝、痰、脾、气虚、气滞、胃、肾、热。男性患者中4种证素(湿、肝、痰和脾)频次构成比>10%,女性患者中6种证素(湿、肝、痰、脾、气虚、气滞)频次构成比>10%。所有证素中,湿、肝、痰、脾、气虚、气滞和胃证素是常见证素(累积构成比>85%)。按病位证素出现频次降序排列,依次为肝、脾、胃、肾;肝和肾证素在>50岁年龄段的构成比高于其他年龄段(P<0.05),脾证素在<30岁和30~50岁年龄段的构成比高于>50岁年龄段(P<0.05),胃证素在30~50岁年龄段的构成比高于>50岁年龄段(P<0.05);不同肥胖程度之间,肝证素构成比随着肥胖程度上升而下降(P<0.05)。按病性证素出现频次降序排列,依次为湿、痰、气虚、气滞、热。湿证素随着年龄增加构成比下降(P<0.05),并且在Ⅰ度肥胖的构成比低于Ⅱ度、Ⅲ度(P<0.05)。481例单纯性肥胖症患者中,有18.1%患者不存在任何一种证素。具备证素的患者中,43.1%呈现证素数量≤2个;呈现证素数量≤2种的患者频次构成比高于证素数量3~4种、证素数量≥5种患者(P<0.05);呈现证素数量≥5种与证素数量3~4种患者频次构成比比较差异无统计学意义(P>0.05);病位+病性组合是具备证素患者中的主体(65.7%);单病位、单病性、病性+病位两两比较差异均有统计学意义(P<0.05)。年龄、湿证素、肝证素、UA是可能影响肥胖程度的因素,其中年龄、湿证素与肥胖程度呈负相关(P<0.05),肝证素、UA与肥胖程度呈正相关(P<0.05)。结论单纯性肥胖症的病位证素主要为肝、脾、胃、肾,病性证素主要为湿、痰、气虚、气滞、热。肝和湿证素与肥胖程度存在相关性,治疗上要从肝、脾入手,化湿祛邪。

Objective To explore the distribution characteristics of syndrome elements(SE)in patients with simple obesity(SO).Methods In the study,the information of disease location and disease character,height,weight,blood lipids,and uric acid(UA)from the 481 SO patients were collected by SE items table.Based on frequency ratio and composition ratio,when the cumulative composition ratio of SE was>85%,the common SE are determined.The distribution characteristics of SE and the influencing factors of obesity were explored according to age group,obesity,number and type of SE.Results The frequency of SE statistically decreased in the order of wetness,liver,sputum,spleen,qi deficiency,qi stagnation,stomach,kidney,and heat;the frequency constituent ratios of SE more than 10%were four in the male(wetness,liver,sputum and spleen),and which were six in the female(wetness,liver,sputum,spleen,qi deficiency and qi stagnation);the cumulative composition ratio of SE was>85%were wetness,liver,sputum,spleen,qi deficiency,qi stagnation,and stomach in the all SE;the frequency of SE of disease location statistically decreased in the order of liver,spleen,stomach,kidney.The composition ratio of liver SE and kidney SE in over-50 age group was higher than that in other age-groups(P<0.05),the composition ratio of spleen SE in less-30 age group and 30-50 age group was higher than that in over-50 age group(P<0.05),and the composition ratio of stomach SE in 30~50 age group was higher than that in over-50 age group(P<0.05).Between different levels of obesity,the higher the obesity,while the lower the composition ratio of liver SE(P<0.05).The frequency of disease character SE statistically decreased in the order of wetness,sputum,qi deficiency,qi stagnation,and heat(P<0.05).The composition ratio of wetness SE statistically decreased with age(P<0.05);which in grade I obesity was lower than that in gradeⅡandⅢobesity(P<0.05).None of the frequency of SE existed nearly fifth(18.1%)of 481 SO patients,the number of presenting SE≤2 existed nearly half(43.1%)of the patients,the number of presenting SE≤2 was higher than that of 3-4 and≥5(P<0.05);there was no statistically significant difference in the frequency composition ratio of patients between the number of presenting SE of 3-4 and≥5(P>0.05).The combination of disease location and disease character was the main body of patients(65.7%).There was statistically significant difference between single disease location,single disease character,and combination of disease location and disease character(P<0.05).Age,wetness SE,liver SE,and UA may be factors affecting the obesity,age and wetness SE were negatively correlated with the obesity(P<0.05);liver SE and UA were positively correlated with the obesity(P<0.05).Conclusion The disease location SE of SO are mainly liver,spleen,stomach and kidney,and the disease character SE are wetness,sputum,qi deficiency,and qi stagnation.There is a correlation between liver and wetness SE and the obesity,the treatment should start with the liver and spleen to dispel dampness and evil.