中老年股骨头坏死患者中医证候特点
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摘要
目的:探讨中老年股骨头坏死患者的中医证候特点,以更好地指导临床辨证论治。方法:收集自2012年1月至2016年8月中国中医科学院望京医院骨关节三科收治的发病年龄≥50岁的股骨头坏死患者资料,对中老年股骨头坏死中医证候进行聚类分析并分析其证候特点。结果:共收集302例中老年股骨头坏死患者信息,对所有患者中医证候信息分为气滞血瘀型、痰瘀阻络型、经脉痹阻型、肝肾亏虚型4类时,能够最大限度地概括其证候信息。中老年股骨头坏死以肝肾亏虚型最常见,其后依次为经脉痹阻,痰瘀阻络,气滞血瘀;病程按痰瘀阻络型、经脉痹阻型、气滞血瘀型、肝肾亏虚型的排序递增,差异有统计学意义(P<0.05);不同证型之间年龄分布差异无统计学意义;肝肾亏虚型与痰瘀阻络型体重指数大于经脉痹阻型与气滞血瘀型(P<0.05);不同证型之间性别差异有统计学意义(P<0.05),男女均以肝肾亏虚型最常见,女性气滞血瘀型患病率高于男性;不同病因之间证型分布差异有统计学意义(P<0.05),激素、饮酒和特发性主要表现为痰瘀阻络、经脉痹阻、肝肾亏虚三型,激素以经脉痹阻型最多见,饮酒和特发性以肝肾亏虚型最多见,外伤性以气滞血瘀型最多见。结论:中老年股骨头坏死中医证候的聚类分析结果与中医临床辨证基本吻合,以气滞血瘀型、痰瘀阻络型、经脉痹阻型、肝肾亏虚型进行分型客观地反映了股骨头坏死的中医证候特点,可以为临床治疗提供可靠的辨证依据。
Objective: To investigate the TCM syndrome characteristics of middle-aged and senile patients with osteonecrosis of the femoral head(ONFH) in order to guide clinical diagnosis and treatment by reviewing clinical data retrospectively. Methods: The middle-aged and senile(age≥50) ONFH patients in Wangjing Hospital of China Academy of Chinese Medicine Sciences from Jan 2012 to Aug 2016 were selected as research objects. Results: A total of 302 middle-aged and senile ONFH patients included in this study. The cluster analysis showed that the TCM syndrome divided into qi stagnation and blood stasis syndrome, phlegm and blood stasis syndrome, meridian blocking syndrome, deficiency of the liver and kidney syndrome are the best expression of TCM syndrome classification. The deficiency of the liver and kidney syndrome was the most common TCM syndrome, while meridian blocking syndrome, phlegm and blood stasis syndrome and qi stagnation and blood stasis syndrome were the next; The course of disease was the scale going up by step from phlegm and blood stasis syndrome,meridian blocking syndrome, qi stagnation and blood stasis syndrome to deficiency of the liver and kidney syndrome, and the difference was statistically significant(P<0.05). Age of each syndrome group were no difference compared with other group. The BMI of deficiency of the liver and kidney syndrome and phlegm and blood stasis syndrome were higher than meridian blocking syndrome and qi stagnation and blood stasis syndrome, and the difference was statistically significant(P<0.05). The liver and kidney syndrome was the most common TCM syndrome of both sexes, qi stagnation and blood stasis syndrome was more common in females than males, and the difference was statistically significant(P<0.05). The cause of disease of each syndrome group were different compared with other group(P<0.05), The most common TCM syndrome of steroid-induced, alcohol induced and idiopathic were phlegm and blood stasis syndrome, meridian blocking syndrome, deficiency of the liver and kidney syndrome,meridian blocking syndrome was the most common TCM syndrome of steroid-induced, deficiency of the liver and kidney syndrome are the most common TCM syndrome of alcohol induced and idiopathic, qi stagnation and blood stasis syndrome is the most common TCM syndrome of traumatic. Conclusion: The clustering results of middle-aged and senile patients with ONFH agree well with the dialectical synthesis of TCM clinical, which may provide the evidence for syndrome differentiation of clinical treatment for middle-aged and senile patients with ONFH. The treatment for middle-aged and senile patients with ONFH should be considered stages, cause, syndrome, the feature of deficiency of the liver and kidney of middle-aged and senile patients.
Objective: To investigate the TCM syndrome characteristics of middle-aged and senile patients with osteonecrosis of the femoral head(ONFH) in order to guide clinical diagnosis and treatment by reviewing clinical data retrospectively. Methods: The middle-aged and senile(age≥50) ONFH patients in Wangjing Hospital of China Academy of Chinese Medicine Sciences from Jan 2012 to Aug 2016 were selected as research objects. Results: A total of 302 middle-aged and senile ONFH patients included in this study. The cluster analysis showed that the TCM syndrome divided into qi stagnation and blood stasis syndrome, phlegm and blood stasis syndrome, meridian blocking syndrome, deficiency of the liver and kidney syndrome are the best expression of TCM syndrome classification. The deficiency of the liver and kidney syndrome was the most common TCM syndrome, while meridian blocking syndrome, phlegm and blood stasis syndrome and qi stagnation and blood stasis syndrome were the next; The course of disease was the scale going up by step from phlegm and blood stasis syndrome,meridian blocking syndrome, qi stagnation and blood stasis syndrome to deficiency of the liver and kidney syndrome, and the difference was statistically significant(P<0.05). Age of each syndrome group were no difference compared with other group. The BMI of deficiency of the liver and kidney syndrome and phlegm and blood stasis syndrome were higher than meridian blocking syndrome and qi stagnation and blood stasis syndrome, and the difference was statistically significant(P<0.05). The liver and kidney syndrome was the most common TCM syndrome of both sexes, qi stagnation and blood stasis syndrome was more common in females than males, and the difference was statistically significant(P<0.05). The cause of disease of each syndrome group were different compared with other group(P<0.05), The most common TCM syndrome of steroid-induced, alcohol induced and idiopathic were phlegm and blood stasis syndrome, meridian blocking syndrome, deficiency of the liver and kidney syndrome,meridian blocking syndrome was the most common TCM syndrome of steroid-induced, deficiency of the liver and kidney syndrome are the most common TCM syndrome of alcohol induced and idiopathic, qi stagnation and blood stasis syndrome is the most common TCM syndrome of traumatic. Conclusion: The clustering results of middle-aged and senile patients with ONFH agree well with the dialectical synthesis of TCM clinical, which may provide the evidence for syndrome differentiation of clinical treatment for middle-aged and senile patients with ONFH. The treatment for middle-aged and senile patients with ONFH should be considered stages, cause, syndrome, the feature of deficiency of the liver and kidney of middle-aged and senile patients.
引文
[1]王荣田,陈卫衡,林娜,等.股骨头坏死的病因构成及发病特征分析.中国骨与关节损伤杂志,2009,24(9):792-795
[2]王振涛,郭跃,谢斌,等.中老年股骨头坏死发病特点的研究.中国骨与关节损伤杂志,2017,32(8):796-799
[3]Mont M A,Hungerford D S.Non-traumatic avascular necrosis of the femoral head.J Bone Joint Surg(Am),1995,77(3):459-474
[4]李子荣.股骨头坏死临床诊疗规范(2015年版).中华关节外科杂志:电子版,2015(1):97-100
[5]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:353
[6]陈卫衡,刘道兵,张洪美,等.股骨头坏死的三期四型辨证思路.中国中医基础医学杂志,2003,9(12):51-52
[7]王荣田,林娜,陈卫衡,等.股骨头坏死的证素辨证初步研究.北京中医药大学学报,2011,34(7):495-499
[8]北京市中医管理局,北京地区中医常见病证诊疗常规.北京:中国中医药出版社,2007:429-430
[9]Kaushik A P,Das A,Cui Q.Osteonecrosis of the femoral head:An update in year 2012.World Journal of Orthopedics,2012,3(5):49-57
[10]中华医学会骨科分会显微修复学组.成人股骨头坏死诊疗标准专家共识(2012年版).上海医药,2013,6(2):89-92
[11]中国医师协会骨科医师分会显微修复工作委员会.成人股骨头坏死临床诊疗指南(2016).中华骨科杂志,2016,36(15):945-954
[12]仝小林.论辨症、辨病、审因与辨证论治在临床中的应用.中医杂志,2013,54(2):93-95
[13]李泰贤,陈志伟,王荣田,等.基于文献计量学分析中医药治疗股骨头坏死的研究现状.中国中医骨伤科杂志,2017,25(4):41-46
[14]朱燕宾,马信龙,韩鸿宾,等.京津冀地区1334例60岁及以上患者股骨颈骨折流行病学特征分析.中国临床医生杂志,2015,43(10):47-49
[2]王振涛,郭跃,谢斌,等.中老年股骨头坏死发病特点的研究.中国骨与关节损伤杂志,2017,32(8):796-799
[3]Mont M A,Hungerford D S.Non-traumatic avascular necrosis of the femoral head.J Bone Joint Surg(Am),1995,77(3):459-474
[4]李子荣.股骨头坏死临床诊疗规范(2015年版).中华关节外科杂志:电子版,2015(1):97-100
[5]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:353
[6]陈卫衡,刘道兵,张洪美,等.股骨头坏死的三期四型辨证思路.中国中医基础医学杂志,2003,9(12):51-52
[7]王荣田,林娜,陈卫衡,等.股骨头坏死的证素辨证初步研究.北京中医药大学学报,2011,34(7):495-499
[8]北京市中医管理局,北京地区中医常见病证诊疗常规.北京:中国中医药出版社,2007:429-430
[9]Kaushik A P,Das A,Cui Q.Osteonecrosis of the femoral head:An update in year 2012.World Journal of Orthopedics,2012,3(5):49-57
[10]中华医学会骨科分会显微修复学组.成人股骨头坏死诊疗标准专家共识(2012年版).上海医药,2013,6(2):89-92
[11]中国医师协会骨科医师分会显微修复工作委员会.成人股骨头坏死临床诊疗指南(2016).中华骨科杂志,2016,36(15):945-954
[12]仝小林.论辨症、辨病、审因与辨证论治在临床中的应用.中医杂志,2013,54(2):93-95
[13]李泰贤,陈志伟,王荣田,等.基于文献计量学分析中医药治疗股骨头坏死的研究现状.中国中医骨伤科杂志,2017,25(4):41-46
[14]朱燕宾,马信龙,韩鸿宾,等.京津冀地区1334例60岁及以上患者股骨颈骨折流行病学特征分析.中国临床医生杂志,2015,43(10):47-49