Analysis on the Distribution Pattern of TCM Syndrome Types in Primary Ovarian Insufficiency Sleep Disorders
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摘要:
目的 探究早发性卵巢功能不全(Primary ovarian insufficiency, POI)伴睡眠障碍中医证型分布规律及不同证型间睡眠质量指数分布差异性, 以期为POI伴睡眠障碍的辨证治疗和预防提供依据。 方法 收集符合纳入标准的600例POI患者进行流行病学调查, 选取满足睡眠障碍诊断的405例患者作为研究组, 采集患者一般资料、中医四诊及性激素水平信息，采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)量表评估患者睡眠情况，分析POI伴睡眠障碍中医证型特征及影响因素。 结果 POI伴睡眠障碍的主要中医证型为心肾不交证(41.98%)、脾肾阳虚证(22.22%)、肾虚肝郁证(20.99%)和肾虚血瘀证(14.81%), 其中心肾不交证入睡时间最长, 睡眠时间最短, 更依赖于催眠药物，PSQI总分最高; 心肾不交证与肾虚肝郁证睡眠质量最差; 脾肾阳虚证日间功能障碍得分最高; 各中医证型间FSH水平无显著性差异；E2值由低到高分布为: 心肾不交证、肾虚肝郁证、脾肾阳虚证、肾虚血瘀证, 多组间比较存在显著差异(P < 0.05)。 结论 POI伴睡眠障碍患者主要中医证型为心肾不交证、脾肾阳虚证、肾虚肝郁证和肾虚血瘀证, 其中最常见及睡眠质量最差的中医证型为心肾不交证, 可能与雌激素E2水平密切相关。 Abstract:OBJECTIVE To explore the distribution pattern of traditional Chinese medicine (TCM) syndrome types of primary ovarian insufficiency (POI) sleep disorders and the differences in the distribution of sleep quality index among different syndrome types, in order to provide a basis for syndrome differentiation treatment and prevention of POI associated with sleep disorders. METHODS 600 POI patients who met the inclusion criteria were collected for epidemiological investigation, and 405 patients who met the diagnosis of sleep disorders were selected as the research group. The patients' general information, TCM four diagnosis and sex hormone level information were collected, and the Pittsburgh sleep quality index (PSQI) scale was used to evaluate patients' sleep conditions, and analyze the characteristics and influencing factors of TCM syndrome types of POI associated with sleep disorders. RESULTS The main TCM syndrome types of POI accompanied by sleep disorders were heart and kidney disharmony syndrome (41.98%), spleen and kidney yang deficiency syndrome (22.22%), kidney deficiency and liver stagnation syndrome (20.99%), and kidney deficiency and blood stasis syndrome (14. 81%). The heart and kidney disharmony syndrome had the longest sleep latency and shortest sleep time, relied more on hypnotic drugs, and had the highest PSQI total score; the heart and kidney disharmony syndrome and kidney deficiency and liver stagnation syndrome had the worst sleep quality; the spleen kidney yang deficiency syndrome had the highest daytime dysfunction score. There was no significant difference in FSH levels among different TCM syndrome types; the distribution of E2 values from low to high was: heart and kidney disharmony syndrome, kidney deficiency and liver stagnation syndrome, spleen and kidney yang deficiency syndrome, and kidney deficiency and blood stasis syndrome, and there were significant differences among multiple groups (P < 0.05). CONCLUSION The main TCM syndrome types of patients with POI and sleep disorders are heart and kidney disharmony syndrome, spleen and kidney yang deficiency syndrome, kidney deficiency and liver stagnation syndrome, and kidney deficiency and blood stasis syndrome. Among them, the most common TCM syndrome type with the worst sleep quality is heart and kidney disharmony syndrome, which may be closely related to estrogen E2 levels. -
表 1 POI睡眠质量的单因素分析
Table 1. Univariate analysis of POI sleep quality
组别 年龄 BMI 职业体力 文化程度 重体力劳动 中体力劳动 轻体力劳动 坐式的工作 初中及初中以下 高中 大中专 大学本科及以上 睡眠障碍组
(n=405)34.00±4.04 21.88±2.78 2 99 216 88 22 25 106 252 睡眠正常组
(n=195)32.99±5.62 22.06±2.66 4 41 95 55 14 20 45 116 P值 0.262 0.199 0.083 0.235 组别 婚姻状况 吸烟 饮酒 熬夜 未婚 已婚 离婚 丧偶 有 无 有 无 有 无 睡眠障碍组
(n=405)41 334 29 1 59 346 212 193 240 165 睡眠正常组
(n=195)45 148 2 0 16 179 83 112 94 101 P值 < 0.001 0.027 0.025 0.011 组别 情绪 环境因素 孕产史 易生气 情绪起伏大 易情绪低落 抑郁焦虑 居住地装潢史 环境噪音 经常染发 妊娠次数 生产次数 流产次数 睡眠障碍组
(n=405)161 169 115 124 102 90 117 1.92±1.63 0.70±0.73 1.19±1.26 睡眠正常组
(n=195)61 50 34 16 58 19 61 1.46±1.47 0.62±0.74 0.79±0.99 P值 0.044 < 0.001 0.004 < 0.001 0.237 < 0.001 0.548 0.001 0.151 < 0.001 组别 压力 既往史 没有 一般 大 非常 免疫性疾病史 感染性疾病 盆腔手术史 睡眠障碍组
(n=405)23 141 204 37 121 235 270 睡眠正常组
(n=195)25 101 62 7 36 75 84 P值 < 0.001 0.003 < 0.001 < 0.001 注: ①本研究将POI患者职业按照体力情况分为重体力劳动(搬运工、清洁工、农场工人等)，中体力劳动(家政服务人员、服务生、厨师、医护人员等)，轻体力劳动(教师、美容美发师、批发商、职员等)，坐式工作(收银员、出纳员、接线员、秘书等)4种。②根据中国睡眠协会推荐, 本研究将熬夜划定为每周因具体事务(工作、学习、游戏等)自愿或非自愿的情况下晚上11点之后入睡≥1次, 但不包括因失眠而无法入睡的情况。③既往史包括免疫性疾病史(系统性红斑狼疮、类风湿关节炎、雷诺病、血液系统相关疾病、甲状腺疾病、糖尿病)，感染性疾病(子宫内膜息肉、盆腔炎、腮腺炎)，盆腔手术史(输卵管切除术、卵巢囊肿剥除术、输卵管整形术、输卵管通液、造影术、子宫肌瘤剔除术、子宫内膜诊刮术、子宫内膜息肉切除术、清宫术、剖宫产)。 
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表 2 POI伴睡眠障碍患者中医证候频率分布情况
Table 2. Frequency distribution of TCM syndromes in POI patients with sleep disorders
症状 频数 构成比/% 症状 频数 构成比/% 月经量少 252 62.2 经色暗红 151 37.3 腰膝酸软 238 58.8 健忘或记忆力下降 148 36.5 耳鸣或听力下降 229 56.5 经质清稀 138 34.1 经质黏稠 203 50.1 干涩 136 33.6 脱发 197 48.6 性欲下降 134 33.1 潮热 177 43.7 盗汗 134 33.1 便干(燥结) 176 43.5 两目干涩 134 33.1 头晕 164 40.5 心烦 132 32.6 手足心热 156 38.5 胸闷 129 31.9 失眠 155 38.3 烦躁 128 31.6
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表 3 POI伴睡眠障碍患者中医舌脉分布情况
Table 3. Tongue and pulse distributions in TCM for POI patients with sleep disorders
舌象 频数 构成比/% 脉象 频数 构成比/% 苔白 230 56.8 沉 239 59 苔薄 193 47.7 细 199 49.1 舌淡暗 115 28.4 弦 120 29.6 苔黄 113 27.9 数 108 26.7 少苔 99 24.4 涩 67 16.5 舌淡红 98 24.2 弱 50 12.3 舌红 74 18.3 迟 42 10.4 齿痕 64 15.8 舌紫暗 63 15.6 舌体瘦薄 62 15.3
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表 4 POI伴睡眠障碍的中医证候分型
Table 4. TCM syndrome classification of POI with sleep disorders
证型 例数 构成比/% 心肾不交证 170 41.98 脾肾阳虚证 90 22.22 肾虚肝郁证 85 20.99 肾虚血瘀证 60 14.81
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表 5 各中医证型睡眠质量指数分布情况[M(P25, P75)]
Table 5. PSQI distribution of each TCM syndrome type [M(P25, P75)]
组别 例数 主观睡眠质量 入睡时间 睡眠时间 睡眠效率 心肾不交证 170 2.00(1.00, 2.00) 2.00(1.00, 3.00) 1.00(1.00, 2.00) 2.00(1.00, 3.00) 脾肾阳虚证 90 1.00(1.00, 2.00)** 1.00(1.00, 2.00)## 1.00(1.00, 1.00)## 1.00(1.00, 2.50) 肾虚肝郁证 85 2.00(2.00, 3.00) 2.00(2.00, 2.00) 1.00(1.00, 1.00)## 1.00(0.50, 3.00) 肾虚血瘀证 60 1.00(1.00, 2.00)** 1.00(1.00, 2.00)## 1.00(1.00, 1.00)## 2.00(2.00, 3.00) P值 < 0.001 < 0.001 < 0.001 0.06 组别 例数 睡眠障碍 催眠药物使用 日间功能障碍 PSQI总分 心肾不交证 170 2.00(1.00, 2.00) 1.00(0.00, 2.00) 3.00(2.00, 3.00) 12.00(10.00, 15.00) 脾肾阳虚证 90 2.00(1.00, 2.00) 0.00(0.00, 1.00)## 3.00(2.00, 3.00) 10.00(8.00, 11.00) 肾虚肝郁证 85 2.00(1.50, 2.00) 0.00(0.00, 2.00) 3.00(2.00, 3.00) 12.00(10.00, 14.00) 肾虚血瘀证 60 2.00(1.00, 2.00) 0.00(0.00, 0.00)## 2.00(2.00, 3.00) 8.50(7.00, 11.00) P值 0.006 < 0.001 0.019 < 0.001 注: 与肾虚肝郁证比较, **P < 0.01;与心肾不交证比较, ##P < 0.01。
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表 6 各中医证型FSH、E2分布情况(x±s)
Table 6. Distribution of FSH and E2 in each TCM syndrome type (x±s)
组别 例数 FSH/(U·L-1) E2/(pg·mL-1) 心肾不交证 170 36.16±16.10 34.51±22.39 脾肾阳虚证 90 34.51±15.39 45.24±38.29 肾虚肝郁证 85 38.16±19.16 38.41±33.98 肾虚血瘀证 60 33.56±11.74 47.72±44.74 P值 0.192 0.014
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