主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2019, Vol. 42 ›› Issue (12): 1038-1042.doi: 10.3969/j.issn.1006-2157.2019.12.011

• 临床研究 • 上一篇    下一篇

基于认知分级的阿尔茨海默病证候演变规律*

时晶, 滕羽鸥, 魏明清, 李婷, 倪敬年, 张学凯, 李晨萌, 周梦玲, 黄强, 王旭, 田金洲#   

  1. 北京中医药大学东直门医院 北京 100700
  • 收稿日期:2019-06-12 出版日期:2019-12-30 发布日期:2020-01-06
  • 通讯作者: 田金洲,男,博士,主任医师,教授,博士生导师,主要研究方向:神经变性病的中医药防治,E-mail:jztian@hotmail.com
  • 作者简介:时晶,女,博士,主任医师,博士生导师
  • 基金资助:
    *国家自然科学基金面上项目(No.81573824),高等学校学科创新引智基地(No.B08006),教育部长江学者和创新团队发展计划(No.IRT0810),国家中医药管理局国家中医临床研究基地业务建设科研专项(No.JDZX2015297),北京中医药大学科研创新团队项目(No.2019-JYB-TD-007)

Research on progression in TCM pattern of Alzheimer’s disease based on cognitive levels*

Shi Jing, Teng Yu’ou, Wei Mingqing, Li Ting, Ni Jingnian, Zhang Xuekai, Li Chenmeng, Zhou Mengling, Huang Qiang, Wang Xu, Tian Jinzhou#   

  1. Third Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Received:2019-06-12 Online:2019-12-30 Published:2020-01-06
  • Contact: Prof. Tian Jinzhou, Ph.D., M.D., Chief Physician, Doctoral Supervisor. Dongzhimen Hospital, Beijing University of Chinese Medicine. No.5, Haiyuncang Street, Dongcheng District, Beijing 100700. E-mail:jztian@hotmail.com

摘要: 目的 探讨不同认知程度的阿尔茨海默病(AD)患者中医证候演变规律。方法 对在北京中医药大学东直门医院脑病三科就诊的5 410例受试者进行神经心理学检查,结合病史、影像学、实验室检查,筛查出认知功能正常组1 664例、轻度认知损害组928例、轻度AD组(MMSE 21~26分)223例、中度AD组(MMSES 11~20分)447例和重度AD组(MMSE 0~10分)299例,并对患者进行中医证候分型,从而得出不同程度AD的中医证候演变规律。 结果 正常组、轻度认知损害组、AD各组肝虚证、脾虚证分布比率逐渐减少(P<0.01)。正常组肾虚证分布比率显著低于轻度认知损害组、轻度AD组(P<0.01)。中度AD组痰浊证、火热证、血瘀证分布比率显著高于轻度AD组(P<0.01)及重度AD组(P<0.01或P<0.05)。重度AD组虚极证、毒盛证分布比率显著高于其他各组(P<0.01)。 结论 肾虚始终贯穿在AD发展过程中,轻度AD以肾虚、脾虚为主要证候,中度AD以痰浊、火热、血瘀为主要证候,重度AD以毒盛、虚极为主要证候,AD的证候发展符合“启动于肾虚,进展于痰瘀火,恶化于虚极毒盛”的证候级联规律。

关键词: 阿尔茨海默病, 中医证候, 演变规律, 认知

Abstract: Objective To explore the way of progression in terms of pattern in traditional Chinese medicine (TCM) of patients with Alzheimer’s disease (AD) based on different cognitive levels. Methods A total of 5410 subjects from the Third Department of Neurology of Dongzhimen Hospital, Beijing University of Chinese Medicine were assigned into normal control group (NC) (n=1664), mild cognitive impairment (MCI) group (n=928), mild AD group (MMSE score 21~26, n=223), moderate AD group (MMSE score 11~20, n=447) and severe AD group (MMSE score 0~10, n=299) based on their neuropsychological assessments, case histories, and neuro-imaging and laboratory tests. Patterns in TCM of the patients were then classified, and the way of progression in terms of TCM pattern of the five groups were explored. Results The prevalence of liver-deficiency pattern and spleen-deficiency pattern in the NC group was significantly higher than that in MCI group, which, in turn, was higher than that in the AD groups (all P<0.01). The percentage of kidney-deficiency pattern in the NC group was significantly lower than that in the MCI and mild AD groups (all P<0.01). The occurrence rate of phlegm-turbidity pattern, fire-heat pattern and blood-stasis pattern in the moderate AD group was significantly higher than that in the mild AD group (all P<0.01) and severe AD group (P<0.01 or P<0.05). Compared with the other groups, the rate of extreme-deficiency pattern and excess-toxin pattern in the severe AD group was the highest (all P<0.01). Conclusion Kidney-deficiency pattern existed in all stages of AD. Kidney-deficiency pattern and spleen-deficiency pattern were the main characteristic patterns of patients with mild AD. Phlegm-turbidity pattern, fire-heat pattern and blood-stasis pattern were the common patterns of patients with moderate AD. In severe AD patients, excess-toxin pattern and extreme-deficiency pattern were the prominent patterns. The Results proved that the progression of AD in terms of TCM pattern “begins with kidney deficiency, progresses to fire due to phlegm and stasis, and worsens with extreme deficiency and toxin excess”.

Key words: Alzheimer’s disease, pattern in Chinese medicine, progression, cognition

中图分类号: 

  • R277.743