从"天人相应"角度探讨胆囊炎和胆结石患者发病时间的气候特点

Research on climatic characteristics of onset time of cholecystitis and gallstone patients based on"correspondence between man and universe"

目的 通过分析某医院胆囊炎和胆结石患者急性发病的时间规律,探讨气候因素与胆系疾病发病的关系.方法 回顾性分析2018年12月1日至2021年11月30日在天津中医药大学第二附属医院急诊科就诊的以腹痛为第一主诉患者的临床资料,包括性别、年龄、发病时间,比较不同月份、不同年龄段男性和女性患者胆囊炎和胆结石发病率的差异,分析气候与胆囊炎和胆结石发病的关系.结果 共收集符合标准的腹痛患者2721例,其中男性1287例,女性1434例.腹部超声诊断为胆囊炎334例,胆结石679例.不同年龄段人群性别构成中以30~39岁的青年患者所占比例最高为22.23%,各年龄段性别比较差异无统计学意义.一年中胆囊炎的发病率在4月最高为16.47%,8月次之为15.02%,最低值出现在5月为7.56%;胆结石发病率3月最高为31.90%,7月次之为26.62%,最低值出现在2月为5.00%.女性胆结石的发病率显著高于男性 〔27.3%(392/1434)比22.3%(287/1287),P<0.05〕.不同月份不同年龄段患者胆结石发病率差异有统计学意义,外界气候的动态变化对老年男性胆结石的发病率有重要影响.结论 在天津地区,外感湿热可能并不是造成胆系疾病最主要的病机,春季亦是胆系疾病高发的季节,肝藏血主疏泄功能在春季的变化可能通过脏腑联系,影响到胆腑功能,故除夏季外,在春季也应重视对胆囊功能的保护.

Objetive To analyze the time regularity of acute onset in patients with cholecytis and gllstones and discuss the relationship between climatic factors and the incidence of biliary diseases.MethodsThe clinical data of patients with abdominal pain as the first chief complaint who were treated in the department of emergency in the Second Afiliated Hospital of Tianjin University of Traditional Chinese Medicine from December 1,2018 to November 30,2021 were retrospectively analyzed.The diferences in gender,age and time of onset,as the frequency of onset in dfferent months and age groups,n male and female patients with cholecystis and gallstones were compared,and the relationships between climate and onset of cholecystitis and gallstones were analyzed.ResultsA total of 2721 patients consistent with the criteria of abdominal pain were collected,including 1287 males and 1434 females.334 cases of cholecystitis and 679 cases of gallstones were diagnosed by abdominal ultrasound.Among the dfferent age groups,the onsets occurring in patients aged 30-39 accounted for 22.23%,the highest proportion.There were no significant differences in gender among diferent age groups.The incidence of onset of cholecystitis was the highest in April,16.47%,followed by 15.02%in August and the lowest in May,7.56%;the morbidity of gallstone was the highest in March,31.90%,followed by 26.62%in July and the lowest in February,5.00%.The incidence of gallstones in female was significantly higher than that in male[27.3%(392/1434)vs.22.3%(287/1287),P<0.05].There were statistically significant differences in the morbidity of gallstones patients in different months and in different age,and the dynamic change of extermnal climate has important impact on the incidence of gallstones in elderly men.,Conclusion Exogenous damp heat may not be the main pathogenesis of biliary diseases in Tianjin district,the high incidence of biliary diseases is in spring,the changes of the liver functions of storing blood and dispersing in spring may affect the gallbladder function via internal organ connection,therefore,besides summer,the function of gallbladder should also be protected in spring.