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基于抑郁、焦虑、躯体形式障碍的郁证特质研究

Characteristics of depression pattern based on depression, anxiety and somatoform disorders
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摘要 目的通过对抑郁、焦虑、躯体形式障碍患者的临床调查,探讨中医郁证的症状、证候、脏腑病位等临床特征。方法将符合纳入标准的患者分为抑郁障碍(MDD)、焦虑障碍(AD)和躯体形式障碍(SFD)3组,分别进行抑郁自评量表(SDS)、焦虑自评量表(SAS)、复合自主神经症状量表(COMPASS-31)评分,采集3组患者临床信息评估中医证候、中医病症,运用频数统计法、卡方检验法、Wilcoxon秩和检验以及Spearman相关分析等方法进行统计,分析郁证患者的中医特质。结果①共观察291例,MDD124例、AD92例、SFD75例,3组均以女性和脑力劳动者偏多(P>0.05);②3组患者平均症状数为(5.98±3.03)个,在MDD、AD组,病情越重症状数量越多(P<0.05);③各组及3组合并的COMPASS-31评分与症状数量均呈正相关(P<0.05);④仅有精神心理症状或躯体症状者分别为1.37%、38.49%,兼有二类症状者占60.14%;⑤3组患者临床表现以脾胃病系为最多,其次为气血津液系、心病系;证候以复证多于单证;脏腑病位以心系为最多(44.67%),其次为肝、脾、肾、胃、胆、肺;COMPASS-31评分值以肾病系最高;病名以心病系为最多,其次为气血津液病系、肝病系、脾胃病系、肾病系。结论中医郁证临床表现多以躯体症状形式出现,证候属性离散度较大,脏腑病位以心、肝、脾为主,可涉及多种病名。 Objective To discuss the symptoms,pattern manifestations and disease locations related to zang-fu organs of depression pattern of traditional Chinese medicine(TCM)through the clinical survey on patients with depression,anxiety and somatoform disorders.Methods The patients in accordance with internalized standard were divided into group of major depressive disorder(MDD group),group of anxiety disorder(AD group)and group of somatoform disorders(SFD group).All groups were given scoring by using Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS)and Composite Autonomic Symptom Scale(COMPASS-31).The clinical information was collected from 3 groups for reviewing TCM pattern manifestations and TCM diseases.The TCM characteristics in patients with depression pattern were analyzed by using methods of frequency statistics,chi-square test,Wilcoxon rank sum test and Spearman correlation analysis.Results①There were totally 291 cases observed,and 124 in MDD group,92 in AD group and 75 in SFD group.There were more women and mental workers in 3 groups(P>0.05).②The average numbers of symptoms were(5.98±3.03)in 3 groups,and the more severe the condition,the more the symptoms in MDD group and AD group(P<0.05).③The scores of COMPASS-31 were positively correlated to symptom numbers in different groups and in combined 3 groups(P<0.05).④The patients with only psychosomatic symptoms or somatic symptoms accounted for 1.37%and 38.49%,and those with two of them accounted for 60.14%.⑤The most common clinical manifestations were in spleen-stomach disease system,and secondly in qi-blood-fluid-humor disease system and heart disease system.Compound pattern manifestations were more than simple pattern manifestations.The disease locations related to zang-fu organs were mostly in heart system(44.67%),and secondly in systems of liver,spleen,kidney,stomach,gallbladder and lung.The scores of COMPASS-31 were the highest in kidney disease system.The disease names were the most in heart disease system and secondly in qi-blood-flu
作者 李欣 王立伟 李敬伟 纪晓丹 王莹 赵婧玮 杨蒋伟 赵文芳 蒋健 Li Xin;Wang Liwei;Li Jingwei;Ji Xiaodan;Wang Ying;Zhao Jingwei;Yang Jiangwei;Zhao Wenfang;Jiang Jian(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Huashan Hospital,Fudan University,Shanghai 200040,China;Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China;Mental Health Center of Zhejiang Province,Zhejiang 310012,China)
出处 《北京中医药大学学报》 CAS CSCD 北大核心 2019年第3期226-234,共9页 Journal of Beijing University of Traditional Chinese Medicine
基金 国家科技重大新药创制资助项目(No.2017ZX09304002) 上海市名老中医学术经验研究工作室建设资助项目(No.SHGZS-2017024) 上海市教委重点学科中药临床药理学资助项目(No.J50303) 上海青年医师培养计划资助项目(No.沪卫人事2012-105号)~~.
关键词 抑郁 焦虑 躯体形式障碍 郁证 隐性郁证 depression anxiety somatoform disorders depression pattern concealed depression pattern
作者简介 李欣,女,博士,副主任医师,硕士生导师;通信作者:蒋健,男,博士,教授,主任医师,博士生导师,主要研究方向:中医内科临床,E-mail:jiangjiansg@126.com。
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