摘要
目的对临床研究中心绞痛的中医证候疗效评价指标进行分析,初步形成心绞痛中医证候疗效评价指标条目池,旨在为心绞痛中医证候疗效评价提供参考。方法通过检索中国知网(CNKI)、维普数据库(VIP)和万方数据库(WF)中自2008年1月1日至2023年12月31日发表的心绞痛临床疗效观察期刊文献,将符合要求的文献整理归纳,将证候类型、症状、体征等评价条目逐条记录到Excel中,建立数据库,应用SPSS Modeler 18.0对评价条目进行贝叶斯网络模型和关联规则分析。将同时满足贝叶斯网络模型及关联规则条件的条目进行组合,初步形成心绞痛中医疗效评价指标条目池。结果共纳入合格文献94篇,包含21种辨证分型,总频次为100次,除气虚血瘀证(28次,28%)、痰瘀互结证(14次,14%)、血脉瘀阻证(14次,14%)、气滞血瘀证(10次,10%)这四类证型外,其他证型出现频次较低,故仅针对前四种证型进行数据挖掘,临床疗效评价症状及体征条目共38种,总频次为599次。初步形成心绞痛四种证型的中医临床疗效评价条目池:①气虚血瘀证,主要条目为胸痛(贡献度0.96);次要条目为胸闷(贡献度0.93)、心悸(贡献度0.77)、舌质紫暗(淡紫)或有瘀点、瘀斑(贡献度0.77)、气短(贡献度0.83)。②痰瘀互结证,主要条目为胸痛(贡献度0.94);次要条目为胸闷(贡献度0.94)、心悸(贡献度0.69)。③血脉瘀阻证,主要条目为胸痛(贡献度0.94);次要条目为胸闷(贡献度0.81)、心悸(贡献度0.69)、舌质紫暗(淡紫)或有瘀点、瘀斑(贡献度0.94)、脉涩(贡献度0.81)、疼痛位置固定、拒按、夜间加重(贡献度0.81)。④气滞血瘀证,主要条目为胸痛(贡献度0.92);次要条目为胸闷(贡献度0.92)、心悸(贡献度0.83)、舌质紫暗(淡紫)或有瘀点、瘀斑(贡献度0.75)、脉涩(贡献度0.67)、胁肋胀痛(贡献度0.75)。结论所建立的冠心病心绞痛中医证候疗效评价指标条目池可为开展科学规范的中医证候疗效评价提供参考,为证候核心指标的遴选提供依据,为进一步构建核心指标集(COS)奠定基础。
Objuective To analyze the evaluation indicators of TCM syndrome efficacy in patients with angina pectoris at a clinical research center,and to preliminarily form a pool of items to evaluate the efficacy of TCM syndromes in angina pectoris,with the aim of providing a reference for evaluating the efficacy of TCM syndromes in angina pectoris.Metods By searching the literature on the clinical efficacy of angina pectoris published from January 1,2008,to December 31,2023,in the China National Knowledge Infrastructure(CNKI),VIP database(VIP),and Wanfang database(WF),the eligible literature was sorted and summarized,and items such as syndrome type,symptoms,and physical signs were recorded one by one in Excel to establish a database.SPSS Modeler 18.0 was used to perform Bayesian network model and association rule analysis on the evaluation items.The items that met both the Bayesian network model and association rule conditions were combined to preliminarily form a pool of items to evaluate the efficacy of TCM in angina pectoris.Results A total of 94 qualified articles were included,containing 21 types of differential diagnoses,with a total frequency of 100.Except for qi deficiency and blood stasis syndrome(28 times,28%),phlegm and blood stasis syndrome(14 times,14%),blood flow stasis obstruction syndrome(14 times,14%),and qi stagnation and blood stasis syndrome(10 times,10%),the frequency of other syndromes was relatively low,so only the first four syndromes were data mined.There were a total of 38 types of symptoms and physical signs for clinical efficacy evaluation,with a total frequency of 599 times.A preliminary pool of items for evaluating the efficacy of TCM in four types of angina pectoris was formed:①Qi deficiency and blood stasis syndrome main items included chest pain(contribution rate 0.96);secondary items included chest tightness(contribution rate 0.93),palpitations(contribution rate 0.77),dark purple(light purple)tongue or ecchymosis(contribution rate 0.77),and shortness of breath(contribution rate 0.83).②Phlegm and blood stasis syndrome main items included chest pain(contribution rate:0.94);secondary items included chest tightness(contribution rate:0.94)and palpitations(contribution rate:0.69).③Blood flow stasis obstruction syndrome,main items include chest pain(contribution rate 0.94);secondary items include chest tightness(contribution rate 0.81),palpitations(contribution rate 0.69),purple dark(light purple)tongue or ecchymosis(contribution rate 0.94),rough pulse(contribution rate 0.81),fixed pain location,refusal to press,and aggravation at night(contribution rate 0.81).④Qi stagnation and blood stasis syndrome,main items include chest pain(contribution rate 0.92);secondary items include chest tightness(contribution rate 0.92),palpitations(contribution rate 0.83),purple dark(light purple)tongue or ecchymosis(contribution rate 0.75),rough pulse(contribution rate 0.67),costal pain(contribution rate 0.75).Conclusion The pool of evaluation indicators for the efficacy of TCM syndromes in patients with angina pectoris can provide a reference for conducting scientific and standardized evaluations of the efficacy of TCM syndromes,provide a basis for selecting core indicators,and lay the foundation for further building a core indicator set(COS).
作者
王金浩
邵妍
陈智慧
张会永
WANG Jinhao;SHAO Yan;CHEN Zhihui;ZHANG Huiyong(The First Clinical College of Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110000,China;School of Integrated Traditional Chinese and Western Medicine,Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China;The Fourth Affiliated Hospital of China Medical University,Shenyang 110032,China)
出处
《世界科学技术-中医药现代化》
北大核心
2025年第10期3010-3020,共11页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
辽宁省教育厅2022年度高等学校基本科研项目(LJKMZ20221342):基于贝叶斯网络构建冠心病病证结合疗效评价量表“因证论效”动态评价体系,负责人:邵妍
沈阳市中青年科技创新人才培育专项(RC230077):基于CNN等多种机器学习算法的痰瘀互结证诊断量表及其量化诊断模型的研制与评价研究,负责人:陈智慧
国家自然科学基金委员会青年基金项目(81603504):基于最小重要差异值(MID)的冠心病病证结合疗效评价量表中医临床疗效判定阈值研究
负责人:陈智慧。
关键词
冠心病
心绞痛
贝叶斯网络
中医证候
疗效评价
Coronary heart disease
Angina pectoris
Bayesian network
TCM syndrome
Efficacy evaluation
