73例运动神经元病患者辨治分析

Analysis about Differential Diagnosis and Treatment of 73 Cases of Motor Neuron Disease

目的:分析运动神经元病患者的临床资料,为防治该病提供理论依据。方法:选择2018年8月至2022年3月山东中医药大学附属医院神经内科收治的73例运动神经元病患者,采用回顾性调查分析方法对患者的一般情况、中医证候、中医体质、临床疗效等进行统计分析。结果:73例运动神经元病患者中男性多于女性,发病高峰期为51~70岁。危险因素分布前3位为饮酒吸烟史、高血压、糖尿病,另有31例原因不明。临床症状前3位分别为肢体活动不利、便秘、乏力,所有患者均无明显的感觉障碍。中医证型分布由高到低依次为脾胃虚弱,气血不足证;下元虚衰,痰浊上泛证;肝肾两亏,虚风内动证;奇经亏虚,络气虚滞证;湿热浸淫,筋脉不舒证。中医体质以金形人数量最多,为24例,占比32.88%;其次为木形人、土形人、火形人、水形人。治疗方案以中西医结合、内外治结合为主,治疗总有效率为93.15%,其中利鲁唑配合中药、针刺组疗效最佳。结论:中西医结合治疗运动神经元病在改善临床症状,延缓病情进展,降低致残率方面效果较好。

Objective:In order to provide theoretical basis for the prevention and treatment of motor neuron disease(MND),this retrospective study was conducted on the clinical data of patients with MND.Methods:From August 2018 to March 2022,the clinical data of 73 cases motor neuron patients admitted to the department of neurology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine were collected.Then,the retrospective investigation and analysis method was used to statistically analyze the general situation of the patients,traditional Chinese medicine(TCM)syndromes,TCM constitutions,and clinical curative effects.Results:Among the 73 patients with MND,males were more than females,and the peak age of onset was 51~70 years old.The top 3 risk factors were drinking and smoking history,hypertension,and diabetes,and another 31 cases with unknown causes.The top 3 risk of the clinical symptoms were poor physical activity,constipation,and fatigue.All patients had no obvious sensory disturbance.The distribution of TCM syndrome types from high to low is weakness of the spleen and stomach,deficiency of qi and blood;deficiency of kidney qi,generalization of phlegm turbidity;deficiency of both liver and kidney,internal movement of deficiency wind syndrome;deficiency of extra meridians,deficiency and stagnation of collateral qi;damp-heat immersion and syndrome of muscle and arteries discomfort.In TCM physique,golden-shaped people have the largest number of 24 cases,accounting for 32.88%,followed by wood-shaped people,earth-shaped people,fire-shaped people,and water-shaped people.The treatment plan is mainly based on the combination of traditional Chinese and western medicine,combination of internal and external treatment.The total effective rate of treatment is 93.15%,among which the riluzole combined with traditional Chinese medicine and acupuncture group has the best curative effect.Conclusions:Integrative traditional Chinese and western medicine treatment of MND is effective in improving clinical symptoms,delaying disease progression,and reducing disability rate.