基于经验辨证的更年期综合征围绝经期和绝经后期常见证候及证候要素分布

1、基于经验辨证的更年期综合征围绝经期和绝经后期常见证候及证候要素分布                         作者：辛意, 王天芳, 杜彩凤, 李力, 任婕 金哲, 赵红,                

2、        经燕, 邹小娟, 刘宏奇, 陈莹, 王丽娜, 刘瑞芬, 王庆国 【摘要】  目的：通过规范专家经验辨证，提取证候要素，总结更年期综合征围绝经期和绝经后期两个阶段的常见证候及其证候要素的分布特点，并比较两者的异同。 方法：纳入2006年10月2007年6月就诊于全国7家三级甲等医院且符合疾病诊断和纳入标准的1 582例更年期综合征门诊患者，对其进行临床流行病学调查，在专家经验辨证证候名称规范化的基础上，提取病位和病性类证候要素，并进行统计学分析。 结果：经初步规范后，涉及证候名称105个，常

3、见证候是肾阴虚、肝肾阴虚、肝气郁结和肾阴阳两虚证。在此基础上提取病位类证候要素6个，病性类证候要素17个。出现较多的病位类证候要素是肾、肝、脾、心，病性类证候要素是阴虚、气滞、气虚、阳虚、虚。围绝经期肝气郁结、脾肾两虚及气滞的分布较绝经后期明显增多，而绝经后期则多见肾阴虚证，且病位多在肾，其余证候与证候要素的分布趋势基本相似。结论：更年期综合征的证候分布具有复杂多样的特点，证候要素分布则相对简约。围绝经期和绝经后期两阶段的证候、证候要素在总体分布上具有一致性，但在一些证候及证候要素的出现频率上存在明显差异，可为揭示该疾病常见中医证候与证候要素分布规律提供依据，并为临床治疗更年期综合征提供理论基

4、础。 【关键词】  绝经; 绝经前期; 绝经后期; 证候    Objective: To compare the distribution characteristics of common syndrome types and syndrome elements of menopause syndrome in perimenopausal and postmenopausal women on the basis of standardized syndrome differentiation extracted by experts experi

5、ences.    Methods: A total of 1 582 outpatients with menopause syndrome who met with the diagnosis and inclusion criteria in seven grade 3 hospitals from October 2006 to June 2007 were included. A clinical epidemiological survey in the patients was carried out. The syndrome elements o

6、f disease location and characteristics were extracted and analyzed statistically by standardizing the syndrome differentiation of experts experience in traditional Chinese medicine.    Results: There were 105 syndrome types after initial standardization, and the common syndrome types

7、were kidney yin deficiency, deficiency of liver and kidney yin, stagnation of liver qi, and deficiency of both kidney yin and yang. Six syndrome elements of the disease location were extracted, among which the common elements were kidney, liver, spleen and heart. Seventeen syndrome elements of the d

8、isease characteristics were extracted, among which the common elements were yin deficiency, qi stagnation, qi deficiency, yang deficiency and deficiency. Syndrome types of stagnation of liver qi, deficiency of spleen and kidney, and qi stagnation were more frequently diagnosed during perimenopausal

9、period, while the syndrome type of kidney yin deficiency was more frequently diagnosed during postmenopausal period, and the kidney was the main disease location. The distribution characteristics of the other syndrome types and elements were similar during the two periods.    Conclusi

10、on: The syndrome type distribution in women with menopause syndrome is complex, while the syndrome element distribution is simple. Generally, the syndrome type and syndrome element distributions during perimenopausal and postmenopausal periods are similar, but there are significant differences in so

11、me syndrome types and syndrome elements between the two periods. All of these can give support for revealing the distribution rule of the common syndrome types and syndrome elements and give a theoretical basis for clinical treatment of menopause syndrome.    Keywords: menopause; prem

12、enopause; postmenopause; syndrome    更年期综合征指由于精神心理、神经内分泌和代谢变化引起的症候群，严重时可影响患者的生活、工作及家庭。中医辨证诊疗该疾病具有较强的优势，然而以绝经这一生理现象为分界点对患病人群进行分割，比较两者在常见证候、证候要素类型的差异性研究，现仍较少。本研究将更年期综合征患者分为围绝经期和绝经后期两个时期进行临床调查，在规范专家经验辨证的基础上提取证候要素，探讨本病证候、证候要素不同时期的分布特点并比较两者的不同，为揭示更年期综合征常见证候与证候要素分布规律提供一定的依据，并为临床治疗本病提供一定的理论基础。    1  资料与方法    1.1  临床资料    绝经后期：（1）符合绝经后期诊断标准；（2）Kupperman评分标准410分；（3）近3个月未经过雌、孕激素替代治疗；（4）患者本人同意参与本次调查研