摘要
目的根据颈动脉粥样硬化的中医分型,探讨颈动脉粥样硬化中医证候的诊断规律。方法收集经颈部超声明确诊断的136例颈动脉粥样硬化患者,根据相关的中医诊断标准,将患者分别诊断为精髓亏虚证（33例）、气虚证（34例）、痰浊内阻证（32例）、血瘀证（23例）、气滞证（14例）5型。将临床症状分为轻度、中度、重度和严重4级,分别记为1-4分。根据患者中医证型对变量进行逐步判别分析。将有显著贡献的变量建立判别函数式,并使用逐一回代法和刀切法,对函数式的误判率进行检验。结果筛选出对区分5类中医证型有显著贡献的20个变量：头晕（x1）、失眠（x2）、耳鸣（x3）、健忘（x4）、气短（x5）、神疲（x6）、乏力（x7）、自汗（x8）、胸脘胀痛（x9）、太息（x10）、局部刺痛（x11）、唇紫（x12）、腰酸（x13）、头脑空痛（x14）、口中黏腻（x15）、腹满（x16）、呃逆（x17）、嗳气（x18）、舌暗（x19）、腻苔（x20）。通过这些变量建立颈动脉粥样硬化中医证型判别函数为：精髓亏虚证=-15.861＋9.453x1-2.768x2＋8.646x3＋9.087x4＋0.167x5-0.955x6-2.112x7-2.537x8-1.163x9-2.822x10-1.542x11＋6.707x12＋0.557x13-4.364x14＋4.565x15＋3.869x16-2.536x17-9.246x18＋9.504x19＋7.799x20;气虚证=-33.048＋5.117x1-0.931x2-2.349x3＋4.728x4-1.156x5＋2.841x6＋13.925x7＋9.017x8-0.449x9-4.317x10＋1.584x11＋3.837x12＋5.542x13＋6.725x14＋0.247x15＋12.491x16＋5.931x17-12.760x18-4.784x19＋9.001x20;痰浊内阻证=-37.974＋11.015x1-1.329x2＋2.241x3＋7.237x4-0.134x5-1.698x6＋8.497x7＋6.564x8-4.911x9-3.109x10＋11.532x11＋8.453x12-4.027x13＋5.732x14＋26.727x15＋6.255x16＋7.139x17-12.138x18＋3.385x19＋27.468x20;血瘀证=-23.812＋13.170x1＋3.721x2＋10.207x3＋7.599x4＋2.031x5-6.033x6＋6.102x7＋1.308x8-7.105x9＋4.188x10＋14.892x11＋2.842x12-8.401x13-8.497x14＋9.879x15＋7.875x16-2.309x17-10.913x18＋7.481x19＋4.487x20;气滞证=-18.531＋8.330x1＋3.733x2＋3.663x3＋0.281x4＋1.459x5＋1.569x6＋8.453x7＋1.006x8-1.590x9＋2.412x10-0.529x11-2.795x12-0.105x13-4.891x14-0.149x15＋11.966x16-1.885x17-3.726x18＋8.558x19＋1.896x20。逐一回代法判别总误判率为0.00%;刀切法计算误判率为16.87%。结论颈动脉粥样硬化中医证型判别函数与临床诊断吻合良好,能提高颈动脉粥样硬化中医诊断的客观性和准确性。
Objective To investigate the diagnostic law of symptom complex of traditional Chinese medicine （TCM） according to TCM typing of carotid arteriosclerosis.Methods One hundred and thirty-six patients with carotid arteriosclerosis diagnosed with ultrasound were collected. According to the related TCM diagnostic criteria, the patients were dignosed as 5 types including marrow deficiency syndrome （n=33）, Qi deficiency syndrome （n=34）, phlegm turbid retention syndrome （n=32）, blood stasis syndrome（n=23）, and Qi stagnation syndrome （n=14）. The clinical symptoms were divided into 4 grades including mild, moderate, severe, and very severe, and they were recorded as scores 1, 2, 3 and 4. Then the variables were analysed with a stepwise discriminant analysis according to TCM syndromes of patients.Results On the basis of the TCM syndromes of carotid arteriosclerosis, the variables were treated with the stepwise discriminant analysis, and 20 variables with significant contributions in identifying 5 TCM syndromes were selected： dizziness （x1）, insomnia （x2）, tinnitus （x3）, amnesia （x4）, shortness of breath （x5）, poor spirit （x6）, fatigue （x7）, spontaneous perspiration （x8）, distending pain in the chest-epigastrium （x9）, sighing （x10）, local stabbing pain （x11）, purple lib （x12）, soreness of loins （x13）, empty headache （x14）, sticky and greasy in mouth （x15）, abdominal fullness （x16）, vomiting and regurgitation （x17）, belching （x18）, dark tongue （x19）, and greasy fur （x20）. Then the discriminant functions of TCM syndromes in patients with carotid arteriosclerosis were established with these variables： marrow deficiency syndrome=-15.861＋9.453 x1-2.768x2＋8.646x3＋9.087x4＋0.167x5-0.955x6-2.112x7-2.537x8-1.163x9-2.822x10-1.542x11＋6.707x12＋0.557x13-4.364x14＋4.565x15＋3.869x16-2.536x17-9.246x18＋9.504x19＋7.799x20; Qi deficiency syndrome =-33.048＋5.117x1-0.931x2-2.349x3＋4.728x4-1.156x5＋2.841x6＋13.925x7＋9.017x8-0.449x9-4.317x10＋1.584x11＋3.837x12＋5.542x13＋6.725x14＋0.247x15＋12.491x16＋5.931x17-12.760x18-4.784x19＋9.001x20; phlegm turbid retention syndrome=-37.974＋11.015x1-1.329x2＋2.241x3＋7.237x4-0.134x5-1.698x6＋8.497x7＋6.564x8-4.911x9-3.109x10＋11.532x11＋8.453x12-4.027x13＋5.732x14＋26.727x15＋6.255x16＋7.139x17-12.138x18＋3.385x19＋27.468x20; blood stasis syndrome =-23.812＋13.170x1＋3.721x2＋10.207x3＋7.599x4＋2.031x5-6.033x6＋6.102x7＋1.308x8-7.105x9＋4.188x10＋14.892x11＋2.842x12-8.401x13-8.497x14＋9.879x15＋7.875x16-2.309x17-10.913x18＋7.481x19＋4.487x20; and Qi stagnation syndrome =-18.531＋8.330x1＋3.733x2＋3.663x3＋0.281x4＋1.459x5＋1.569x6＋8.453x7＋1.006x8-1.590x9＋2.412x10-0.529x11-2.795x12-0.105x13-4.891x14-0.149x15＋11.966x16-1.885x17-3.726x18＋8.558x19＋1.896x20. These functions had very significant discriminant effect.Conclusion The TCM syndromes discriminant function of carotid arteriosclerosis is well in accordance with clinical practice. It may improve the objectivity and accuracy in diagnosis and differential diagnosis of carotid arteriosclerosis with TCM, and will have a better application prospect.
出处
《中国脑血管病杂志》
CAS
2007年第11期496-500,共5页
Chinese Journal of Cerebrovascular Diseases
基金
北京中医药科技发展基金项目(京中重VI26)
关键词
颈动脉疾病
判别分析
中医证型
Carotid artery diseases
Discriminant analysis
Traditional Chinese medicine syndromes
