不同临床分型与分期的肌萎缩侧索硬化症患者中医证候特征研究

Study on TCM syndrome characteristics of amyotrophic lateral sclerosis patients with different clinical types and stages

目的:观察肌萎缩侧索硬化症(ALS)患者不同临床分型与分期的中医证候特征。方法:采用回顾性研究方法,收集530例ALS患者的临床资料,分析不同临床分型与分期患者的中医证候分布特征。结果:ALS患者以经典型、延髓型为主,中医证候以脾肾亏虚、肝肾亏虚、脾胃亏虚居多。经典型、延髓型、连枷腿综合征ALS患者中,脾肾亏虚证候患者占比均超过50%。ALS早期(Ⅰ期、Ⅱa期),痰湿阻滞、气虚血瘀、中焦湿热证候患者比例较高;中晚期(Ⅱb期后),脾肾亏虚、肝肾亏虚、脾胃亏虚证候患者占比逐渐增多。结论:脾肾不足或肝肾不足证候贯穿于ALS全程,疾病早期在虚证基础上伴有痰湿、瘀血、湿热等病理因素存在,晚期肝、脾、肾亏虚更严重。温肾健脾为治疗ALS的基本大法,同时应根据患者的临床分型及分期辨证施治。

Objective:To observe the syndrome characteristics of traditional Chinese medicine(TCM)in patients with amyotrophic lateral sclerosis(ALS)of different clinical types and stages.Methods:A retrospective study was applied. The clinical data of 530 patients with ALS were collected,and the TCM syndrome distribution characteristics of the patients with different clinical types and stages were analyzed.Results:The patients with ALS were mainly classical type and bulbar type,and the TCM syndromes of the patients mainly include deficiency of spleen and kidney,deficiency of liver and kidney,and deficiency of spleen and stomach. Among the ALS patients of classical type,bulbar type and flail leg syndrome,the proportion of the patients with syndrome of spleen and kidney deficiency was more than 50%. In early stage of ALS(stages Ⅰ and Ⅱa),the proportion of the patients with syndromes of phlegm-dampness stagnation,qi deficiency and blood stasis,and dampness-heat in middle jiao was higher. In the middle and advanced stages of ALS(after stage Ⅱb),the proportion of the patients with syndromes of spleen and kidney deficiency,liver and kidney deficiency,and spleen and stomach deficiency gradually increased.Conclusion:Syndromes of spleen and kidney deficiency or liver and kidney deficiency run through the whole process of ALS,the disease is often accompanied by the pathological factors such as phlegm-dampness,blood stasis,dampness-heat based on deficiency syndrome in the early stage. And liver,spleen and kidney deficiency is more serious in the advanced stage. Warmingthe kidney and fortifying the spleen is the basic treatment for ALS,meanwhile,syndrome differentiation and treatment should be adopted according to the clinical types and stages of the patients.