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肠易激综合征的中医证候分布及神经内分泌机制:横断面研究

[Traditional Chinese medicine syndrome distribution and neuroendocrine mechanisms of irritable bowel syndrome: cross-sectional study].

作者信息

Hou Zheng-Kun, Li Mei, Xie Di, Liu Feng-Bin

机构信息

Gastroenterology Department, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.

Hepatology Department, Chongqing Hospital of Chinese Medicine, Chongqing 400021, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2016 Apr;41(7):1325-1337. doi: 10.4268/cjcmm20160727.

Abstract

In order to clarify the traditional Chinese medicine(TCM) syndrome distribution and pathogenesis of irritable bowel syndrome(IBS), the patients in the first affiliated hospital of Guangzhou university of Chinese medicine were enrolled for the cross-sectional study. The data of 12 sociological variables, 13 risk factors, 84 symptoms and signs variables(in 9 aspects), and 19 neuroendocrine indices were extracted for group-between analysis with one-way ANOVA, chi-square test and nonparametric test, and the relationship analysis between clinical symptoms and diseases sub-types was done with binary Logistic regression. In addition, the patterns of TCM syndromes were divided by several syndrome factors to analyze the difference in neuroendocrine indices between various patterns and syndrome factors. A total of 383 IBS patients were enrolled, including 353(92.2%) cases of diarrhea, 14(3.7%) cases of constipation and 16(4.1%) cases of mixed types. In IBS-diarrhea patients, there were 291(76.0%), 18(4.7%), 48(12.5%) and 26(6.8%)cases of syndrome of liver depression and spleen deficiency (sLDSD), syndrome of liver depression and qi stagnation (sLDQS), syndrome of dampness-heat in the spleen and stomach (sDHSS), and syndrome of spleen deficiency with dampness encumbrance (sSDDE) respectively. There was significant differences in blood groups between IBS-diarrhea patients, IBS-constipation patients and IBS-mixed types patients; their disease classification was significantly correlated with the allergies, drinking, irregular meals habits, no or less vacations, and other causes of morbidity (P<0.05, f<0.3). A total of 15 symptoms and signs variables (e.g., chills, facial abnormalities, epigastric fullness, etc.) had significant differences between different groups (P<0.05), and 5, 8, 5 variables were respective independent factors for IBS-diarrhea, constipation and mixed type. There was no significant difference in neuroendocrine indices between various groups. The sLDSD, sLDQS, sDHSS, sSDDE patients had significant differences in genders, living conditions and occupations, and the TCM syndrome type was significantly correlated with the drinking, smoking, no or less breakfast, less than 8 sleeping hours(P<0.05, f<0.3). Meanwhile, a total of 14 symptoms and signs variables (e.g., dysphoria heat, fatigue, stretching, etc.) had significant differences between various groups(P<0.05) and 3, 4, 6, 3 variables were respective independent factors for sLDSD, sLDQS, sDHSS, and sSDDE. There were significant differences in acetylcholine(Ach) and angiotensin Ⅱ(AT-Ⅱ) between the sLDSD group and sSDDE group. There were significant difference in Ach, AT-Ⅱ, adrenotrophin(ACTH) and estradiol (E2) in comparison between several pattern factors. This study preliminary identified the sociological characters, risk factors, syndromes distribution, diseases and subgroup mechanisms of this disease. More samples and multi-centers are required for future study to improve the scientificity and representativeness.

摘要

为阐明肠易激综合征(IBS)的中医证候分布及发病机制,选取广州中医药大学第一附属医院的患者进行横断面研究。提取12项社会学变量、13项危险因素、84项症状体征变量(9个方面)及19项神经内分泌指标的数据,采用单因素方差分析、卡方检验和非参数检验进行组间分析,并运用二元Logistic回归分析临床症状与疾病亚型之间的关系。此外,通过多个证素划分中医证候类型,分析各证型及证素间神经内分泌指标的差异。共纳入383例IBS患者,其中腹泻型353例(92.2%),便秘型14例(3.7%),混合型16例(4.1%)。腹泻型IBS患者中,肝郁脾虚证291例(76.0%),肝郁气滞证18例(4.7%),脾胃湿热证48例(12.5%),脾虚湿阻证26例(6.8%)。腹泻型IBS患者、便秘型IBS患者及混合型IBS患者之间血型存在显著差异;其疾病分类与过敏、饮酒、饮食习惯不规律、休假少等发病原因显著相关(P<0.05,f<0.3)。共有15项症状体征变量(如畏寒、面部异常、胃脘胀满等)在不同组间存在显著差异(P<0.05),其中5项、8项、5项变量分别是腹泻型、便秘型及混合型IBS的独立影响因素。各证型间神经内分泌指标无显著差异。肝郁脾虚证、肝郁气滞证、脾胃湿热证、脾虚湿阻证患者在性别、生活状况及职业方面存在显著差异,中医证型与饮酒、吸烟、不吃或少吃早餐、睡眠时间不足8小时显著相关(P<0.05,f<0.3)。同时,共有14项症状体征变量(如烦躁发热、乏力、舒展感等)在各证型间存在显著差异(P<0.05),其中3项、4项、6项、3项变量分别是肝郁脾虚证、肝郁气滞证、脾胃湿热证、脾虚湿阻证的独立影响因素。肝郁脾虚证组与脾虚湿阻证组之间乙酰胆碱(Ach)和血管紧张素Ⅱ(AT-Ⅱ)存在显著差异。多个证素间比较,Ach、AT-Ⅱ、促肾上腺皮质激素(ACTH)及雌二醇(E2)存在显著差异。本研究初步明确了该病的社会学特征、危险因素、证候分布、疾病及亚型机制。未来研究需要更多样本及多中心研究以提高科学性和代表性。

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