紧张型头痛风火候危险因素的logistic回归分析
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摘要
目的:探讨紧张型头痛风火候的危险因素,明确其部分危险因素,为其防治提供有用的参考资料,从而降低发病率,提高易患人群的生活质量。方法:本研究对60例紧张型头痛风火候患者和60例紧张型头痛风痰候、风瘀候、阳虚寒凝候、气血两虚候患者的一般资料(如性别、年龄、文化程度)、超重肥胖、遗传、A型行为性格、负性生活事件、焦虑抑郁不良精神状态、饮酒、失眠、春季、运动不足等导致紧张型头痛风火候发病的可能的危险因素进行认真调查,调查表回收后,统计数据,采用SPSS13.0版统计软件进行分析。先对各危险因素作频数统计后进行卡方检验,再对各危险因素和病例组、对照组进行logistic回归分析。结果:①就诊年龄:本研究所收集样本的就诊年龄分布为18-60岁,其中男性病例为19-58岁,女性病例为18-60岁。样本的平均就诊年龄为(30.82±9.73)岁,其中男性病例为(29.10±6.57)岁,女性病例为(31.53±10.60)岁。两性的平均就诊年龄无显著性差异(t′0.05= -1.50,P>0.05)。病例组和对照组就诊年龄比较无显著性差异(t=0.28,P>0.05)。②各发病危险因素的统计结果:病例组和对照组经卡方检验后显示:焦虑抑郁不良精神状态、春季、A型行为性格、负性生活事件4个发病危险因素存在显著性差异(P<0.05);性别、运动不足、文化程度的P>0.05,虽无明显统计学意义,但也可能为病例组和对照组共同危险因素而被排除;年龄、失眠、遗传、饮酒、超重肥胖经卡方检验P>0.05,无显著统计学意义,均不是紧张型头痛风火候的危险因素。③各危险因素的logistic回归分析:春季,A型行为性格,焦虑抑郁不良精神状态3个因素最终进入logistic回归方程式,说明A型行为性格因素是紧张型头痛风火候发病的危险因素;春季的回归系数为1.925,说明其是影响发病最明显的危险因素,但因仅有8人春季发病,虽有统计学意义,但临床意义不明,可能与调查存在误差有关;焦虑抑郁不良精神状态的OR=2.514,P=0.055,略大于0.05,而且病例组具有焦虑抑郁不良精神状态者28例,阳性率46.67%,因此该因素仍可作为危险因素,但需谨慎;负性生活事件最终未能进入回归方程式,提示该因素不是紧张型头痛风火候发病的危险因素;饮酒、运动少、性别、遗传、失眠、文化程度、超重肥胖均不是紧张型头痛风火候发病的危险因素。结论:logistic回归方程式说明A型行为性格是紧张型头痛风火候发病的危险因素,焦虑抑郁不良精神状态可作为危险因素,但需谨慎;春季虽有统计学意义,但临床意义不明;年龄、饮酒、运动少、性别、负性生活事件、遗传、失眠、文化程度、超重肥胖均不是紧张型头痛风火候发病的危险因素。
Tension type headache is the most prevalent headache type,affecting most women and men at time in their lives and can impair job productivity and interfere with family and social time.However,despite its impact,tension type headache is the most misunderstood headache type.Because of misperceptions,less affected people are to seek medical treament.We want to find out useful method to prevent the occurence of tension type headache,then to raise the quality of human life.Object:To explore the risk factors of feng-huo type of tension-type headache,preliminarily find out part of its risk factors.All is done in order to provide favourable reference datas for its prevention and cure.Methods:60 patients with feng-huo type of tension-type headache compare with 60 patients with the following four types (feng-tan、feng-yu、yangxuhanning、qixuekuixu) of tension-type headache.The observation of the contents of this investigation as following :age,sex,occupation,education,obesity,gene,depression,anxiety,insomnia,smoking,drinking,physical exercise,environmental variables,A type behavior character and so on.In order to find out whether there are some relations to tension type headache,a logistic regression model is used.SPSS13.0 is applied for data analysis.Result:①Statistical results of age of onset:the distribution of age of onset in this study was for 18-60 years.There were male patients for 19-58 years old,while female patients for 18-60 years old.The average age of onset was (30.82±9.73) years with male cases (29.10±6.57) years old,while female cases were (31.53±10.60) years.There was no significant difference between the average age at onset of the male and female(.t'0.05= -1.50,P>0.05).There was no significant difference between cases and controls age at onset(t=0.28,P>0.05).Although there was only 25 percent of male samples,it did not mean that prevalence rate of male was lower than that of female,which had been reported from abroad;②the incidence of risk factors results:cases and controls by chi-square test revealed:there was a significant difference among anxiety,depression,the spring,A type behavior character,negative life- events (P<0.05),whlie there was no significant difference among gender, sports, edu ca tional level (P>0.05).Although There was no significant statistical significance,they may be the common risk factors for cases and controls.The P value of insomnia,gene,age,drinking,overweight,obesity was 0.05.No significant statistical signi- ficance was exsited.They were not the risk factors of tension-type head of feng-huo;③the various risk factors logistic regression analysis showed:A Type A behavior,spring entered the logistic regression equation finally which showed that the both were the risk factors of tension-type headache of feng-huo type with coefficient 1.925,which indicated that it was the most obvious risk factor.Anxiety and Depression of the OR was 2.514,P was 0.055,which was slightly larger than 0.05.Because the equation was to exclude the application of standard and the rate of patients with depression and other adverse mental state were 28 cases which was with 46.67 percent,this risk factors could still be a risk factor for the disease.If the size of sample was expanded,there may be significant differences;negative life events failed to enter the regression equation,suggesting that the factor was not the risk factor of tension-type headache;alcohol consumption,the loss of the exercise,sex,gene,insomnia,education,obesity and overweight were not the risk factors of tension-type headache feng-huo type.Conclusion:Tension-type headache was significantly related to a series of psychosocial variables.Although there was statistical significance between tension type headache and spring,it was still uncertain that spring was one risk factor.A type behavior character andnegative events occurred in life were related to the disease.Physical exercise could not be sure of having function.There was no obvious difference of prevalence between female and male.Education was to have no relationship with the disease.The current knowledge about headache and sleep was still sparse and further research was advocated.Heredity,overweight,obesity and other probable risk facors including age, drinking were not significantly related to tension-type headache.
Tension type headache is the most prevalent headache type,affecting most women and men at time in their lives and can impair job productivity and interfere with family and social time.However,despite its impact,tension type headache is the most misunderstood headache type.Because of misperceptions,less affected people are to seek medical treament.We want to find out useful method to prevent the occurence of tension type headache,then to raise the quality of human life.Object:To explore the risk factors of feng-huo type of tension-type headache,preliminarily find out part of its risk factors.All is done in order to provide favourable reference datas for its prevention and cure.Methods:60 patients with feng-huo type of tension-type headache compare with 60 patients with the following four types (feng-tan、feng-yu、yangxuhanning、qixuekuixu) of tension-type headache.The observation of the contents of this investigation as following :age,sex,occupation,education,obesity,gene,depression,anxiety,insomnia,smoking,drinking,physical exercise,environmental variables,A type behavior character and so on.In order to find out whether there are some relations to tension type headache,a logistic regression model is used.SPSS13.0 is applied for data analysis.Result:①Statistical results of age of onset:the distribution of age of onset in this study was for 18-60 years.There were male patients for 19-58 years old,while female patients for 18-60 years old.The average age of onset was (30.82±9.73) years with male cases (29.10±6.57) years old,while female cases were (31.53±10.60) years.There was no significant difference between the average age at onset of the male and female(.t'0.05= -1.50,P>0.05).There was no significant difference between cases and controls age at onset(t=0.28,P>0.05).Although there was only 25 percent of male samples,it did not mean that prevalence rate of male was lower than that of female,which had been reported from abroad;②the incidence of risk factors results:cases and controls by chi-square test revealed:there was a significant difference among anxiety,depression,the spring,A type behavior character,negative life- events (P<0.05),whlie there was no significant difference among gender, sports, edu ca tional level (P>0.05).Although There was no significant statistical significance,they may be the common risk factors for cases and controls.The P value of insomnia,gene,age,drinking,overweight,obesity was 0.05.No significant statistical signi- ficance was exsited.They were not the risk factors of tension-type head of feng-huo;③the various risk factors logistic regression analysis showed:A Type A behavior,spring entered the logistic regression equation finally which showed that the both were the risk factors of tension-type headache of feng-huo type with coefficient 1.925,which indicated that it was the most obvious risk factor.Anxiety and Depression of the OR was 2.514,P was 0.055,which was slightly larger than 0.05.Because the equation was to exclude the application of standard and the rate of patients with depression and other adverse mental state were 28 cases which was with 46.67 percent,this risk factors could still be a risk factor for the disease.If the size of sample was expanded,there may be significant differences;negative life events failed to enter the regression equation,suggesting that the factor was not the risk factor of tension-type headache;alcohol consumption,the loss of the exercise,sex,gene,insomnia,education,obesity and overweight were not the risk factors of tension-type headache feng-huo type.Conclusion:Tension-type headache was significantly related to a series of psychosocial variables.Although there was statistical significance between tension type headache and spring,it was still uncertain that spring was one risk factor.A type behavior character andnegative events occurred in life were related to the disease.Physical exercise could not be sure of having function.There was no obvious difference of prevalence between female and male.Education was to have no relationship with the disease.The current knowledge about headache and sleep was still sparse and further research was advocated.Heredity,overweight,obesity and other probable risk facors including age, drinking were not significantly related to tension-type headache.
引文
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[1]曹文斌,周伟雄,阎淑丽.解止痛散与阿米替林治疗紧张型头痛的临床对照.医药产业资讯,2006;3(14):32.
[2]刘军玲,刘晓辉.舒肌止痛煎治疗紧张性头痛的疗效观察.时珍国医国药,2006;16(6):564.
[3]胡志强,侯书伟,田财军,等.复方芍甘颗粒治疗紧张型头痛疗效观察.山东中医杂志,2007;12(26):810-811.
[4]黄文溪.清肝通络汤治疗紧张性头痛.中国中医急症,2004;13(7):473.
[5]徐因,李子印,樊建平,等.头痛康饮治疗紧张型头痛临床观察.河北中医药学报,2002;17(4):21.
[6]陈春富,郭述苏,韩守峰,等.五种天麻类中成药治疗发作性紧张型头痛的比较.中国疼痛医学杂志,2002;8(3):141.
[7]施慧芬.头痛2号方配合放松疗法治疗紧张型头痛疗效观察.上海中医药杂志,2006;40(2):18.
[8]张敏,虹娜,熊云.柴胡疏肝散配合针刺治疗紧张型头痛40例.中国中医药信息杂志,2006;13(9):60.
[9]黄年斌,邱联群.逍遥散治疗紧张性头痛28例观察.实用中医药杂志,2004;20(5):232.
[10]杨洪军,严华,王永炎,等.头风病病机研究.中国中医基础医学杂志,2000;6(12):777-779.
[11]邵明.偏头痛的证治.新中医,1991;23(3):52.
[12]朱建贵.偏头痛从肝论治经验.中医杂志,1996;37(11):659.
[13]颜红,汪瑜菡,陈立伟.理气活血汤治疗慢性紧张型头痛的临床研究.辽宁中医药大学学报,2006;6(8):11-12.
[14]何子明,饶建跃.偏头痛从肝论治45例疗效分析.江西中医药,2005;36(274):25.
[15]孟庆莉.正清汤治疗紧张性头痛78例.陕西中医,2007;28(10):1294.
[16]张世筠,周群清,张茹兰,等.中医肝证积分的增高与内伤头痛患病关系的研究.中国中医基础医学杂志,2005;11(2):158-159.
[17]蒋旭九.阿米替林与复方羊角颗粒联合治疗紧张型头痛.医学信息手术学分册,2007;20(2):177.
[18]王礼正.阿咪替林联合养血清脑颗粒治疗紧张性头痛.实用医学杂志,2007;24(4):424.
[19]孙岩,陈眉.加味柴胡疏肝散合舍曲林治疗紧张型头痛46例疗效观察.中国中医药科技,2007;14(4):290.
[20]许玲,侯东强,徐坤,等.紧张型头痛患者的生活质量与应对方式以及社会支持的相关性研究.中国健康心理学杂志,2007;15(10):924.
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