缺血性中风证候组合规律及方证相应的初步研究

【作者】 徐俊峰；

【导师】 高颖；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2006， 博士

【摘要】 辨证论治是中医理论的核心内容之一,中医临床过程中讲究辨证立法,以法统方,以方遣药,也就是理、法、方、药要完整统一,实现“方证相应”。过去许多方证相应的研究都集中在理论方面的探讨,随着现代方法学的发展、交叉学科的渗入,探索数据仓库与数据挖掘技术在医学方面的应用就具有更重要的使用价值和广阔的发展前景。本研究在结构化、标准化的临床数据采集平台的支持下,在严格质量控制下,采集423例急性缺血性中风患者的临床诊疗数据,采用数据挖掘理念和技术来探索、验证证候和治法之间的关系,为进一步方证相应的研究奠定基础。以往研究均应用《中风病辨证诊断标准》(简称《标准》)进行证候成立的判断和证候轻重程度的划分,在临床应用时发现有不足之处。此次研究与以往研究不同之处在于未采用《标准》的证候成立和轻重程度的划分标准,而是采用聚类分析的结果对证候轻重程度进行划分,并在此基础上进行证候组合、治法和证候关联规则挖掘的研究。研究共分五部分进行。第一部分,NIHSS和证候轻重程度的聚类分析采用k-means方法将所有患者所有时段证候的分值按照轻、中、重聚为三类。通过聚类分析的结果进行NIHSS和中风病证候轻重程度边界值的划分。NIHSS的结果:0-5分为轻度、6-13分为中度、≥14分为重度;中医证候轻、中、重的结果分别为:①风证:0-4分、5-10分、≥11分;②火热证:0-3分、4-10分、≥11分;③痰证:0-5分、6-13分、≥14分;④血瘀证:0-2分、3-7分、≥8分;⑤气虚证:0-2分、3-7分、≥8分;⑥阴虚阳亢证:0-3分、4-9分、≥10分。这种研究方法将为《标准》的完善和改进提供思路。同时,我们针对四个时段(0-1天、2-3天、6-8天、12-16天)数据均全的患者进行不同时段轻中重的聚类,以期了解在急性期入院的患者随着时间的推移,神经功能缺损程度和证候分值演变的规律。第二部分,证候在不同时间段的组合规律根据第一部分聚类的结果,在对证候组合的研究时,我们首先对证候进行轻重程度的划分,优先选择较重的证候进行证候组合研究,当轻重程度一致时,选择分值高的证候进行研究。两证、三证、四证的研究均遵循以上原则进行排列组合。通过研究在不同时段两证、三证和四证的证候组合规律,发现在发病0-1天、2-3天证候组合形式以风+痰、风+火+痰、风+火+痰+瘀为主;发病6-8天证候组合形式以痰+瘀(火+痰)、风+火+痰、风+火+痰+瘀为主;发病12-16天证候组合形式以痰+瘀、风+火+痰、风+火+痰+瘀为主。总体上来看,证候组合以实证的组合为主。第三部分,证候组合随时间推移的动态演变规律我们将第二部分的结果(各种证候组合所占的比例)描记在时间轴上,做出证候组更多还原

【Abstract】 Syndrome differentiation and treatment is one of the core theories of Traditional Chinese Medicine (TCM). In the clinical process of the Traditional Chinese Medicine, the correspondence of the prescription and the syndrome should be implemented. Many foregone researches on the correspondence of the prescription and the syndrome mainly focused on the academic discuss. With the development of modern methodology and the infiltration of the cross-subject, the approach to medical application of the data warehouse and the data mining is of great use value and has broad perspective. Supported by the structured and standardized platform of clinical data gathering, under the strict quality control, we gathered the clinical data of diagnoses and treatment of 423 cases with ischemic stroke. Then we explored and validated the relationship between the syndrome and the treatment method with the conception and technique of data mining. This research will lay a foundation for further study of the correspondence of the prescription and the syndrome.In the previous researches, Criterion for Diagnose and Differentiation of Syndromes of Stroke (CDDSS) is always used to make the estimation of tenable syndrome and the differentiation of the degree of the syndrome. However, shortages of the CDDSS are found in the clinical use. The difference between this research and the previous ones is the criterion. Instead of using the CDDSS, we made use of the result of cluster analysis to differentiate the degree of the syndrome. Based on the result of cluster analysis, we did the research of syndrome combination, and explored the associated regulation between the treatment method and the syndrome. This research is divided into 5 parts as follows:Part 1: The differentiation of NIHSS and the degree of the syndrome.Part 2: The combination rule of the syndrome in different time periods.Part 3: The dynamic evolutive rule of the syndrome combination along with the time’s going by.Part 4: The using rule of the therapy in different time period.Part 5:The research of the associated regulation between the treatment method and the syndrome.The result of this research indicates that there is the deep-seated relationship between the treatment method and the syndrome, instead of the simple relationship. Hereby, we can infer that the relationship between the prescription and the syndrome will be the same as above. According to the correspondence of the prescription and the syndrome, we should not only implement the correspondence of the condition, characteristics, location, tendency of the illness, but also pay more attention to the dynamic change of the illness and the syndrome on更多还原