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1、心境恶劣障碍患者中医证型的特点研究中文摘要目的：通过收集心境恶劣障碍患者的基本病历资料，应用汉密尔顿抑郁量表、症状自评量表和中医证候调查表对纳入患者进行评价，探讨本地区心境恶劣障碍患者的中医证型分布以及发病原因，并且找出不同证型与抑郁程度、症状之间的相关性，最终希望能为心境恶劣障碍患者实施包括社会心理干预在内的综合预防治疗措施提供一定的参考依据。方法：收集 166 名心境恶劣障碍患者按照中医病证诊断疗效标准中郁证的中医辨证分型标准进行辨证分型；同时，征得健康自愿者 20 例，设为对照组。接着用汉密尔顿抑郁量表和症状自评量表对 166 名患者和 20 名自愿者进行调查评分，最后将患者和自愿者的评
2、分结果进行对比，并且比较不同证型在症状自评量表中不同因子的差异及其相关性。结果：心境恶劣障碍患者在本地区的调查，发现存在有 6 个中医证型，分别为肝气郁结型、气郁化火型、气滞血瘀型、心脾两虚型、肝郁脾虚型、胆郁痰扰型。心境恶劣障碍患者的 6 个证型的构成比从大到小排列为：气郁化火型肝气郁结型肝郁脾虚型心脾两虚型胆郁痰扰型气滞血瘀型。在调查中发现女性患者明显多于男性患者，发病主要集中在 30 岁45 岁之间。心境恶劣障碍患者的肝气郁结型、气郁化火型、胆郁痰扰型、肝郁脾虚型以轻度抑郁程度为主；心脾两虚型以中度抑郁为主。躯体化障碍程度评分，心脾两虚型明显低于其他 5 型，但抑郁 障 碍 、 焦 虑
3、障 碍 以 及 睡 眠 障 碍 三 个 因 子 评分， 显 示 心 脾 两 虚 型 较 高 ， 经Kruskal-wallis H 检验，和其他证型比较有差异。心境恶劣障碍患者的精神病性程度因子评分，以肝郁脾虚型为最高，与其他 5 个中医证型进行组间比较 P0.01，具有统计学意义。心境恶劣障碍患者人际关系敏感、敌对、恐怖、偏执四个因子评分，中医各证型组与正常人对照组比较无统计学意义。结论：心境恶劣障碍的发病年龄和性别有一定的规律性。心境恶劣障碍的 6个中医证型与抑郁程度有一定的相关性，心脾两虚型抑郁程度较其它 5 个证型为重，提示抑郁程度因子测评可作为心脾两虚与其他 5 型鉴别的参考指标。心
4、境恶劣障碍的精神病性因子评分情况可作为肝郁脾虚型和其他 5 个中医证型在临床鉴别的参考。人际关系敏感、敌对、恐怖、偏执因子在各证型组间，虽各有不同的特点，3但其差异无统计学意义。关键词：心境恶劣障碍中医证型特点汉密尔顿抑郁量表症状自评量表4ABSTRACTObjective: Dysthymic disorder patients by collecting basic medical records, appliedthe Hamilton Depression Scale, SCL and TCM questionnaire included patients on theevaluati
5、on of patients with dysthymic disorder in this region of TCM syndromedistribution and cause of disease, and to identify different card type and severity ofdepression, the correlation between symptoms and ultimately hope for patients withdysthymicdisorder,includingpsychosocialinterventions,includingt
6、heimplementation of comprehensive prevention and treatment measures to provide aframe of reference.Methods: Collection of 166 patients with dysthymic disorder according to “ChineseJournal of Lung Cancer Standard“ depression syndrome in TCM Syndrome typestandard type; same time, the consent of 20 cas
7、es of healthy volunteers, as control.Then with the Hamilton Depression Scale and the SCL on 166 patients and 20volunteers to investigate score, and finally patients and volunteers score results werecompared, and compare evidence-based assessment in the symptom table between thedifferent factors and
8、their correlation.Results: dysthymic disorders survey in the region and found the existence of sixsyndromes, respectively, qi stagnation, Qi Yu of the fire type, qi stagnation type, heartand spleen deficiency type, the liver and spleen deficiency, gallbladder Yu disturbingthe sputum. dysthymic disor
9、der syndrome in patients with six constituent ratio ofbig to small order are: Qi Yu of the fire-type Qi stagnation type stagnation andspleen deficiency type heart and spleen deficiency type bile Yu phlegm disturbingthe qi stagnation of blood Blood Stasis. In the survey found that female patientsthan
10、 male patients, the incidence mainly in the age of 30 to 45 years old. dysthymic disorder qi stagnation, Qi Yu of the fire type, disturbing the bile phlegmdepression, stagnation and spleen deficiency type with mainly mild degree ofdepression; heart and spleen deficiency type with mainly moderate dep
11、ression. degree of somatization disorder score, heart and spleen deficiency type was5significantly lower than the other five types, but depression, anxiety disorders andsleep disorders in the three factor scores, showed a higher heart and spleen deficiencytype, by Kruskal-wallis H test, and Comparis
12、on of other syndromes are different. dysthymic disorder degree of mental factor score, with the highest stagnation andspleen deficiency, and the other 5 syndromes were compared between groups P 0.01,statistically significant. dysthymic disorder interpersonal sensitivity, hostility,phobia, paranoid f
13、our factor scores, TCM syndrome group and the normal controlgroup was not significant.Conclusion: age at onset of dysthymic disorder and sex with some regularity. dysthymic disorder of the six syndromes and depression have some degree ofcorrelation, heart and spleen deficiency type of depression is
14、higher than other 5 cardtype is important, suggesting that the degree of depression factor evaluation can beused as yang deficiency type with the other 5 Identification of reference. dysthymic disorder factor score of psychiatric conditions can be used as liverdepression and spleen deficiency, and o
15、ther 5 syndromes in the clinical identificationof reference. interpersonal sensitivity, hostility, phobia, paranoid syndrome in thegroup, although with different characteristics, but the difference was not statisticallysignificant.Keywords: Dysthymic disorderCharacteristics of TCMHamiltonDepression
16、Rating Scale symptom checklist6申明本人承诺：硕士学位论文心境恶劣障碍患者中医证型的特点研究是本人在成都中医药大学攻读硕士学位期间在导师指导下独立进行研究工作所取得的成果，无抄袭及编造行为。该论文著作权及涉及的有关知识产权归成都中医药大学所有，有关该学位论文成果的开发、转让、论文发表等，均需征得导师和成都中医药大学同意。本人同意：成都中医药大学有权通过影印、复印等手段汇编学位论文予以保存，并提供查阅和借阅；有权按照规定向国家有关部门、机构送交论文及电子版，公布（或刊登）论文内容。硕士生签名：导 师 签 名：42年月日引言心境恶劣障碍（dysthymia）是一种以持久的心境低落状态为主的轻度抑郁症，具有几乎整日存在，持续一段时间的抑郁心境为特征。病态的心境恶劣一词于 1980 年启用，在此以前现今认为心境恶劣障碍的大部分患者，被诊断为抑郁性神经症（或神经性抑郁症）；还有部分患者被划入环性情绪障碍的人格范畴1。心境恶劣障碍常伴有焦虑、躯体不适感(如头痛、背痛、自主神经功能
