摘要
目的归纳重症肌无力的中医证候学特征及分型,探讨中医辨证分型与西医Osserman分型之间的关系,探寻重症肌无力的中西医结合辨治规律,为重症肌无力的防治提供理论依据。方法回顾整理370例患者临床资料,通过《重症肌无力中医证候临床调研表》,分析西医分型与中医证型的关系、各型转变与中医证型转变的规律。结果 OssermanⅠ型178例中以脾气亏虚证多见(130例),肝肾阴虚证(41例)次之,Ⅱa型89例中以脾气亏虚证(47例)、肝肾阴虚证(31例)多见,Ⅱb型76例中以气阴两虚证(19例)、肝肾阴虚证(18例)、脾肾阳虚证(22例)多见,Ⅲ、Ⅳ型共27例,以脾肾阳虚证多见。结论重症肌无力患者OssermanⅠ型、Ⅱa型以单纯脾气亏虚证为主者,病情相对较轻,受累的肌群较少,以眼外肌受累较多见,中医治疗效果明显,预后较好。Ⅱa型50岁以下患者以脾气亏虚为主,50岁以上以肝肾阴虚为主,病情相对较轻,常多组肌群受累,但不明显,延髓及呼吸肌受累不明显,临床疗效相对尚可;Ⅱb型肝肾阴虚、气阴两虚型、脾虚痰盛型、脾肾阳虚型均可见,常由上几型发展而成,多延髓肌受累明显,病情相对较重,治疗效果稍差,治疗较棘手;Ⅲ、Ⅵ型脾肾阳虚多见,疾病常反复,迁延难愈,预后较差。
Objective It is to summarize the characteristics and classification of TCM syndromes of myasthenia gravis (MG), to explore the relationship between TCM syndrome differentiation and Osserman classification of western medicine, and to explore the rule of differentiation and treatment of MG by Chinese and western medicine, thus to provides some theoretical evidence for the prevention and treatment of this disease. Methods A retrospective review of clinical datas of 344 patients were performed, and the relationship between TCM classification and TCM syndrome type, the rules of various types of transformation and changes of TCM syndromes were analyzed by <Clinical investigation table of TCM syndromes of myasthenia gravis>. Results Among the 152 cases of Osserman type Ⅰ, the spleen deficiency syndrome was more common (130/152), the liver and kidney Yin deficiency (22/152) was the second;among the 89 cases of type Ⅱa, spleen deficiency syndrome (47/89), liver and kidney Yin deficiency syndrome (41/89) were more common;among the 76 cases of Ⅱb type, Qi and Yin deficiency syndrome (19/76), liver and kidney Yin deficiency (18/76), spleen and kidney Yang deficiency syndrome (22/76) were more common;in a total of 27 cases of Ⅲ and Ⅳ, spleen and kidney Yang deficiency syndrome were more common. Conclusion The disease is milder with less involved muscles in which the extraocular muscle are more common in the patients with MG of Osserman type Ⅰ and type Ⅱa mainly with spleen deficiency syndrome, the efficiency of therapy with Chinese medicine is obvious and the prognosis is better. Type Ⅱa patients under the age of 50 are mainly spleen deficiency, and those over 50 years old are mainly liver and kidney Yin deficiency, the condition is relatively mild, multiple groups of muscles are involved, but not obvious, medullary and respiratory muscle involvement is not obvious, the clinical efficacy is relatively acceptable. The syndrome of liver and kidney Yin deficiency, Qi and Yin deficiency, spleen deficiency and abun
作者
唐桂华
况时祥
TANG Guihua;KUANG Shixiang(The Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang 550003, Guizhou, China)
出处
《现代中西医结合杂志》
CAS
2019年第15期1611-1613,1617,共4页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
贵州省中医药管理局研究项目(QZYY2012-68)
