发作性睡病临床特征及中医证候特征10年变化分析
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摘要
目的:研究发作性睡病临床特征及中医证候特征10年的变化情况。方法:观察51例发作性睡病患者,首诊时收集患者一般情况、核心症状及中医证候信息,并于10年后复诊随访,对比临床特征及中医证候特征变化情况。结果:完成病例49例,日间发作性嗜睡、猝倒发作、部分夜间睡眠紊乱症状(夜间睡眠易醒、肌肉抽搐、梦语、踢腿等)比例较10年前降低,睡眠瘫痪、入睡前幻觉无明显变化;中医证候方面,肝郁气滞证为首诊时最常见证候类型,且10年后其分布比例并无降低,复诊时脾虚湿困证分布较10年前显著增多(P<0.05),证候积分显著升高(P<0.01),为复诊时占比最高的证候类型;病位证素方面,首诊时最常见的病位依次为肝、脑(心神)、脾,10年后肝、脑(心神)比例显著降低(P<0.05,P<0.01),脾成为最常见病位;病性证素方面,首诊时最常见病性为气滞,复诊时最常见病性为湿,且复诊时火热、气虚积分显著增加(P<0.01),动风积分显著降低(P<0.01)。结论:发作性睡病经过10年发展,部分患者核心症状得到一定缓解,中医证候及证素发生变化,可为中医辨证论治发作性睡病提供依据,发病早期治疗应以疏肝解郁为主,并佐以平肝息风,久病则需加强健脾祛湿,并辅以化痰清热。
Objective: To study the 10 years of changes in clinical characteristics and TCM syndrome characteristics of narcolepsy. Methods: Fifty-one patients with narcolepsy were observed. General information, core symptoms, and TCM syndromes were collected at the first visit. Follow-up visits were conducted 10 years later to compare the clinical characteristics and changes of TCM syndromes. Results: Forty-nine cases were completed. The proportion of daytime paroxysmal sleepiness,sudden onset and night sleep disorder(easy to wake, muscle twitch, sleep-talking, kicking, etc) was lower than 10 years ago.There was no significant change in sleep paralysis and sleep hallucination before falling asleep. Syndrome of liver depression and qi stagnation was the most common type of syndromes at the first diagnosis. Its distribution rate did not decrease after 10 years. The distribution of spleen deficiency and dampness-distress syndrome increased significantly compared with 10 years ago(P<0.05), and the score of syndrome increased significantly(P<0.01), which was the highest type of syndrome in the second visit. In terms of location, the most common diseases were liver, brain(heart-spirit), spleen, and the proportion of liver and brain(heart-spirit) decreased significantly after 10 years(P<0.05, P<0.01). Spleen became the most common disease location. In terms of the nature of disease and syndrome factors, qi stagnation and dampness was the most common nature of the disease in the first visit and the second visit respectively. The distribution of heat and qi deficiency increased significantly(P<0.01), while the dynamic wind integral decreased significantly(P<0.01). Conclusion: After 10 years' development, some patients' core symptoms have been alleviated to some extent. The changes of TCM syndromes and syndrome factors can provide a basis for TCM syndrome differentiation and treatment of narcolepsy. Early treatment of narcolepsy should be based on soothing the liver and relieving depression, supplemented by calming the liver and quenching the wind. Long-term diseases should be strengthened by strengthening the spleen and removing dampness, supplemented by resolving phlegm and clearing heat.
Objective: To study the 10 years of changes in clinical characteristics and TCM syndrome characteristics of narcolepsy. Methods: Fifty-one patients with narcolepsy were observed. General information, core symptoms, and TCM syndromes were collected at the first visit. Follow-up visits were conducted 10 years later to compare the clinical characteristics and changes of TCM syndromes. Results: Forty-nine cases were completed. The proportion of daytime paroxysmal sleepiness,sudden onset and night sleep disorder(easy to wake, muscle twitch, sleep-talking, kicking, etc) was lower than 10 years ago.There was no significant change in sleep paralysis and sleep hallucination before falling asleep. Syndrome of liver depression and qi stagnation was the most common type of syndromes at the first diagnosis. Its distribution rate did not decrease after 10 years. The distribution of spleen deficiency and dampness-distress syndrome increased significantly compared with 10 years ago(P<0.05), and the score of syndrome increased significantly(P<0.01), which was the highest type of syndrome in the second visit. In terms of location, the most common diseases were liver, brain(heart-spirit), spleen, and the proportion of liver and brain(heart-spirit) decreased significantly after 10 years(P<0.05, P<0.01). Spleen became the most common disease location. In terms of the nature of disease and syndrome factors, qi stagnation and dampness was the most common nature of the disease in the first visit and the second visit respectively. The distribution of heat and qi deficiency increased significantly(P<0.01), while the dynamic wind integral decreased significantly(P<0.01). Conclusion: After 10 years' development, some patients' core symptoms have been alleviated to some extent. The changes of TCM syndromes and syndrome factors can provide a basis for TCM syndrome differentiation and treatment of narcolepsy. Early treatment of narcolepsy should be based on soothing the liver and relieving depression, supplemented by calming the liver and quenching the wind. Long-term diseases should be strengthened by strengthening the spleen and removing dampness, supplemented by resolving phlegm and clearing heat.
引文
[1]ICSD.3 International Classification of Sleep Disorders.AmericanAcademy of Sleep Medicine,2014:143-161
[2]杨嘉颐,戴中,白文,等.269例发作性睡病临床特征及中医证候特征研究.中华中医药杂志,2013,28(8):2315-2317
[3]Aldrich M.Narcolepsy and Related Disorders Sleep Medicine.New York:Oxford University Press,1999:152-174
[4]GB/T 16751.2-1997.中医临床诊疗术语证候部分.1997
[5]朱文锋.证素辨证学.北京:人民卫生出版社,2008:162-259
[6]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:361-392
[2]杨嘉颐,戴中,白文,等.269例发作性睡病临床特征及中医证候特征研究.中华中医药杂志,2013,28(8):2315-2317
[3]Aldrich M.Narcolepsy and Related Disorders Sleep Medicine.New York:Oxford University Press,1999:152-174
[4]GB/T 16751.2-1997.中医临床诊疗术语证候部分.1997
[5]朱文锋.证素辨证学.北京:人民卫生出版社,2008:162-259
[6]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:361-392