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目的:分析职业性慢性铅中毒中医证候分布特点及其相关因素,探讨其不同证候的发生发展规律。方法:依据流行病学调查获得的病例四诊资料,经过动态聚类和探索性因子分析,结合中医辨证,获得每一个患者所属的中医证候分型,比较群体特征的证候类型构成及其与西医临床类型的关系。结果:470例职业性慢性铅中毒患者中医证候类型构成中不同证候所占比例由高到低依次为:脾胃虚寒(27.45%)、心脾两虚(22.34%)、痰火扰心(14.47%)、大肠结热(12.98%)、痰毒阻络(10.85%)、肾阳虚(7.02%)、肾阴虚(4.47%)、痰毒蒙闭(0.43%)。从虚实来看,61.28%的患者以虚证为主(第一、二、四、五证型),38.72%以实证为主。不同年龄组的中医证型构成不同,其差异有统计学意义(P<0.01)。中医证型的性别分布:男女患者均以脾胃虚寒的比例最高,其次为心脾两虚,最低为痰毒蒙闭,男女两组比较,无统计学意义(P>0.05)。西医诊断分级与中医证型的关系:本组患者中,铅吸收主要存在5个中医证型,其显现率从高至低依次为脾胃虚寒(50%)、心脾两虚(18.55%)、大肠结热(16.94%)、肾阳虚(8.06%)、痰火扰心(6.45%);轻度中毒则依次为心脾两虚(24.16%)、脾胃虚寒(24.16%)、大肠结热(20.13%)、痰火扰心(20.13%)、肾阳虚(6.71%)、肾阴虚(6.7%);中度中毒依次为痰毒阻络(26.15%)、心脾两虚(23.59%)、脾胃虚寒(15.9%)、痰火扰心(15.38%)、肾阴虚(7.18%)、肾阳虚(6.67%)、大肠结热(5.13%);中毒仅出现属痰毒蒙闭型的铅脑病2例,暂未收集到铅麻痹病例。结论:本结果初步揭示职业性慢性铅中毒中医证候分布特征,为中医辨证驱铅提供依据。
Objective: To analyze the distribution characteristics of traditional Chinese medicine syndromes and its related factors in chronic occupational chronic lead poisoning, and to explore the occurrence and development of different syndromes. Methods: According to the four diagnostic data of cases obtained from the epidemiological investigation, through dynamic clustering and exploratory factor analysis combined with syndrome differentiation of traditional Chinese medicine, we obtained the TCM syndrome type of each patient, compared with the characteristics of syndromes And the clinical type of Western medicine. Results: The proportions of different syndromes in TCM syndrome types in 470 cases of occupational chronic lead poisoning were descending spleen and stomach (27.45%), deficiency of both spleen and stomach (22.34%), phlegm and fire disturbance (14.47%), colonic fever (12.98%), phlegm blocking (10.85%), kidney yang deficiency (7.02%), kidney yin deficiency (4.47%) and phlegm blindness (0.43%). From the actual situation, 61.28% of the patients were mainly deficiency syndromes (the first, second, fourth and fifth syndromes), and 38.72% were mainly empirical evidences. Different age groups of different types of TCM syndrome, the difference was statistically significant (P <0.01). Gender distribution of TCM syndromes: The ratio of spleen and stomach Deficiency was the highest in both men and women, followed by heart and spleen, the lowest was phlegm-blindness, there was no significant difference between men and women (P> 0.05). Western medicine diagnosis and classification of the relationship between TCM syndromes: Lead absorption in this group there are five main TCM syndromes, the apparent rate from high to low spleen and stomach Deficiency (50%), heart and spleen deficiency (18.55%), , Colorectal fever (16.94%), kidney yang deficiency (8.06%) and phlegm disruption (6.45%). Mild poisoning followed by heart and spleen deficiency (24.16% (20.13%), phlegm and fire disturbance (6.7%), kidney yin deficiency (6.7%), moderate poisoning followed by phlegm (26.15%), heart and spleen (23.59%), spleen and stomach Deficiency (15.9%), phlegm disruption (15.38%), kidney yin deficiency (7.18%), kidney yang deficiency (6.67%) and colitis (5.13% Phlegm-blind type of lead encephalopathy in 2 cases, yet to collect cases of lead numbness. Conclusion: The results preliminarily reveal the distribution characteristics of traditional Chinese medicine syndromes of occupational chronic lead poisoning and provide evidence for differentiation of symptoms and signs of traditional Chinese medicine.