老年结膜松弛症患者中医证候及证型的相关研究

Study on TCM symptom and syndrome type in elderly patients with conjunctivochalasis

目的探讨老年结膜松弛症(CCh)患者中医证候分布特点,归纳其中医证型,了解各相关危险因素与本病的关系。方法收集2019年2月至2020年1月上海中医药大学附属普陀医院眼科门诊及病房60岁及以上符合纳入标准的CCh患者250例,采用CCh流行病学调查表记录其的危险因素(BMI、VDT使用时间、使用空调时间、睡眠情况)及合并疾病(高血压病、糖尿病、冠心病);采用CCh中医证候调查表归纳其中医证型,并行统计学分析。结果(1)症状频率:症状频率依次为腰膝酸软(62.40%)、耳鸣(59.60%)、失眠多梦(55.20%)、神疲乏力(40.40%)、自汗(37.60%)、口淡食少(27.20%)、口干少津(22.80%)、便干(22.00%)、盗汗(19.60%)、口渴少饮(17.20%)。(2)舌脉分布:舌象排名前5位的红舌(49.60%)、淡红舌(46.40%)、裂纹舌(39.20%)、瘦薄舌(33.60%)、齿痕舌(32.00%);脉象排名前5位的依次为脉细(63.20%)、脉弱(54.40%)、细数(51.60%)、脉沉细(35.60%)、脉濡(30.40%)。(3)中医证型分布频次:肝肾阴虚(57.60%)、脾虚气弱(18.60%)、气阴两虚(14.00%)、阴虚湿热(5.60%)、肺阴不足(4.40%)。(4)中医证型分布与危险因素的关系:CCh中医证型分布与空调使用时长相关(χ^(2)=12.891,P=0.012),与BMI异常、VDT使用时间≥4h、失眠之间,均无统计学意义(P>0.05)。(5)中医证型分布与合并疾病的关系:中医证型分布与糖尿病相关(χ^(2)=17.427,P=0.002),与高血压病、冠心病之间,均无统计学意义(P>0.05)。结论CCh以肝肾阴虚为多见,其次为脾虚气弱型。CCh与长时间使用空调、糖尿病相关。

OBJECTIVE To explore the distribution characteristics of Traditional Chinese Medicine(TCM)symptom in elderly patients with conjunctivochalasis(CCh),summarize their syndrome types,and understand the relationship between relevant risk factors and the occurrence and development of the disease,so as to provide effective reference for the comprehensive prevention and treatment of early CCh.METHODS A total of 250 patients aged 60 and above with CCh who met the inclusion criteria were collected from the ophthalmic clinic and ward of Putuo Hospital Affiliated to Shanghai University of TCM from February 2019 to January 2020.Epidemiological questionnaire for CCh was used to record the risk factors such as body measurement index(BMI),video display terminal(VDT)use time,air conditioning time,sleep condition,and comorbiditis,such as hypertension,diabetes mellitus,coronary heart disease.TCM symptom questionnaire for CCh was applied to summarize TCM syndrome type of CCh.Statistical analysis was performed for final results.RESULTS(1)Frequency of TCM symptoms in elderly patients with CCh:weak waist and knees(62.40%),tinnitus(59.60%),insomnia and dreaminess(55.20%),mental fatigue(40.4%),spontaneous sweating(37.60%),light mouth and poor appetite(27.20%),dry mouth and less fluid(22.80%),dry stool(22.00%),night sweat(19.60%),thirst and drink less(17.20%).(2)Distribution of tongue and pulse condition:The top five tongue manifestation is red tongue(49.60%),light red tongue(46.40%),cracked tongue(39.20%),thin tongue(33.60%),dented tongue(32.00%).The top five pulse manifestation is thin pulse(63.20%),weak pulse(54.40%),thready and rapid(51.60%),heavy and thready pulse(35.60%),floating and soft pulse(30.40%).(3)Distribution of TCM syndrome types:The frequency of TCM syndrome types is as follows:liver and kidney yin deficiency(57.60%),spleen deficiency and Qi weakness(18.60%),Qi and yin deficiency(14.00%),yin deficiency and damp-heat(5.60%),lung yin deficiency(4.40%).(4)Relationship between TCM syndrome type of CCh and risk factors:TCM syndrome type of CCh is related to the usage time of air-conditioning(χ^(2)=12.891,P=0.012),but has nothing to do with abnormal BMI,VDT use time≥4 h,and insomnia(all P>0.05).(5)Distribution of TCM syndrome and comorbidities:The distribution of TCM syndromes is related to diabetes mellitus(χ^(2)=17.427,P=0.002),but has nothing to do with hypertension and coronary heart disease(all P>0.05).CONCLUSIONS Elderly CCh is more common in liver and kidney yin deficiency,followed by spleen deficiency and Qi weakness.TCM syndrome of CCh is related to long time use of air conditioning and diabetes mellitus.Avoiding risk factors and considering systemic diseases play an important role in the comprehensive prevention and treatment of CCh.