基于证素分析的复发性流产中医证型分布特征研究

Study on distribution characteristics of traditional Chinese medicine syndrome types in recurrent abortion based on syndrome element analysis

关键词:  复发性流产  中医  证素  证型

Key words:  recurrent abortion  traditional Chinese medicine  syndrome element  syndrome type

摘要:

[目的] 基于证素分析探讨复发性流产（RSA）的中医证型分布特征。[方法] 将 2019 年 9 月—2021 年 3 月就诊于天津中医药大学第二附属医院妇科符合纳入标准的 RSA 患者作为研究对象， 采用证素辨证方法研究其病位、病性证素， 并进行聚类分析。[结果] 共纳入 RSA 患者 329 例， RSA 主要的病位证素为肾、胞宫、肝、脾， 21 岁≤年龄＜28岁组、28 岁≤年龄＜35 岁组、35 岁≤年龄＜42 岁组 RSA 患者最主要病位证素均为肾； 流产 2 次 RSA 患者最主要的病位证素也为肾； 而流产 3 次和＞3 次 RSA 患者的最主要病位证素为胞宫。RSA 主要的病性证素为气虚、血瘀、湿、阳虚、热、气滞、血虚。年龄和流产次数不同， 病性证素改变， 21 岁≤年龄＜28 岁 RSA 患者最主要病性证素为热；28 岁≤年龄＜35 岁 RSA 患者最主要病性证素为湿；35 岁≤年龄＜42 岁 RSA 患者最主要病性证素为气虚。流产 2 次RSA 患者最主要病性证素为气虚； 流产 3 次和＞3 次 RSA 患者最主要病性证素为血瘀。[结论] RSA 的中医证型为肾虚证、湿热瘀阻证、脾肾阳虚证、肝郁气滞证、气血两虚证。其主要的病位为肾、胞宫、肝、脾。随着流产次数增多， 病位则以胞宫为主， 与年龄无关。RSA 主要的病因为气虚、血瘀、湿、阳虚、热、气滞、血虚。年龄不同， 病因也不同， 21～28 岁RSA 的主要病因为热， 28～35 岁 RSA 的主要病因为湿， 35～42 岁 RSA 的主要病因为气虚。随着流产次数增多， 血瘀成为各年龄段 RSA 的主要病因。

Abstract:

[Objective] To explore the distribution characteristics of recurrent abortion （RSA） syndromes based on syndrome element analysis. [Methods] Patients with RSA who met the inclusion criteria in the department of Gynecology of our hospital from September， 2019 to March，2021 were selected as research objects，and their disease locations and syndrome elements were studied by syndrome differentiation method，and cluster analysis was conducted. [Results] A total of 329 patients with RSA were included. The main syndrome elements of RSA are kidney，cell palace，liver and spleen. 21≤age<28 years old，28≤age<35 years old，35≤age<42 years old RSA patients were the most important site syndrome elements were kidney；Kidney was also the most important syndrome element in RSA patients with two abortions. In the patients with 3 abortions and >3 RSA，the most important syndromes were cell palace. The main syndromes of RSA are qi deficiency，blood stasis，dampness，yang deficiency，heat，qi stagnation and blood deficiency. The age and the number of abortion were different，and the pathogenesis was changed. The main pathogenesis was heat in RSA patients aged 21≤age< 28 years. Dampness was the main pathogenic factor in RSA patients aged 28≤age<35 years；Qi deficiency was the main symptom of RSA patients aged 35≤age<42 years. Qi deficiency was the main symptom of RSA patients with two abortions. Blood stasis was the main pathogenic factor in patients with 3 abortions and >3 RSA. [Conclusion] The traditional Chinese medicine syndromes of RSA include kidney deficiency syndrome，dampness-heat stasis syndrome，spleen and kidney yang deficiency syndrome，liver qi stagnation syndrome， qi and blood deficiency syndrome. Its main disease sites are kidney，cell palace，liver，spleen. With the increase of the number of abortion，the position of the disease was mainly in the cell palace，which had nothing to do with age. The main diseases of RSA are qi deficiency，blood stasis，dampness，yang deficiency，heat，qi stagnation and blood deficiency. The etiology varies by age. Heat is the main cause of RSA between 21 and 28 years old，dampness is the main cause of RSA between 28 and 35 years old and qi deficiency is the main cause of RSA between 35 and 42 years old. With the increase of abortion，blood stasis becomes the main cause of RSA in all ages.