【作者】 王雁南；

【导师】 侯玉芬；

【作者基本信息】 山东中医药大学 ， 中医外科学， 2009， 博士

【摘要】 目的:探讨下肢深静脉血栓形成的证候内涵、影响因素及其变化规律,初步制定基本证候的诊断方案,探寻影响证候要素的理化指标。方法:借鉴循证医学概念,运用聚类分析、因子分析、Logistic回归等现代数据挖掘方法,对下肢深静脉血栓形成近28年证候研究文献和山东中医药大学附属医院周围血管病科近13年的临床病例进行整理,构建相关数据系统,对其证候及影响因素进行研究。结果:①下肢深静脉血栓形成的常见证候为湿热证、血瘀湿重、血瘀证、脾肾阳虚,其中前两者为基本证候;常见证候要素为湿、热、血瘀、脾阳虚、肾阳虚,其中前三者为基本证候要素。②下肢深静脉血栓形成的病机是以湿瘀互结为基础,多因素影响、虚实错杂的复杂过程。湿瘀互结是其病理基础,贯穿于该病的始终。其病机特点为虚实错杂,其虚为脾阳虚、肾阳虚、气虚等,其实为湿、血瘀、热。急性期以邪实为主,兼有正虚;非急性期以诸虚为主,兼有邪实。③提出下肢深静脉血栓形成基本证候的初步诊断方案,并筛选出与其基本证候要素密切相关的理化指标。结论:证候研究中,简化成证候要素的形式具有更强的可操作性,但是证候要素研究最终不应离开“应证组合”。下肢深静脉血栓形成的病机变化是以湿瘀互结为基础,并受多因素影响、虚实错杂的复杂过程。更多还原

【Abstract】 Objective: To investigate the syndrome connotation, the impact of factors and change rules of lower extremity deep venous thrombosis (LEDVT). Then to attempt to preliminary maping out the diagnosis scheme of basic syndrome and exploring the physicochemical indexs influenced syndrome factors in LEDVT.Methods: Reference for the evidence-based medicine concept, to analyze the literature of LEDVT about Traditional Chinese medicine(TCM) syndrome in nearly 28 years and the clinical data from 1106 cases which hospitalization in the peripheral vascular department in the affiliated hospital of the TCM of Shandong University within nearly 13 years by using clustering analysis and factor analysis, Logistic regression and other modern data mining methods. Then data system was constructed for the study of syndrome and influence factors.Results:①Syndrome of dampness-heat, blood stasis with predominant dampness, blood stasis, yang deficiency of spleen and kidney are the common syndromes of LEDVT and the first two were basic syndromes; Dampness, heat, blood stasis, deficiency of spleen yang, deficiency of kidney yang were the common factors of syndrome and the first three were basic syndrome factors.②The variation pathogenesis of LEDVT was a complex process which influenced by multifactorial intervention and included interlacement of asthenia and sthenia factors. Its main pathological basis was damp-stasis accumulation which run through the process from beginning to end in LEDVT. Its pathogenesis was inclusion of asthenia and sthenia, the syndrome of asthenia manifested in deficiency of spleen yang , kidney yang and qi, the syndrome of sthenia manifested in dampness, blood stasis as well as heat. The acute phase of LEDVT was mainly sthenia of evil and minorly weakened body resistance, the non-acute phase was vice versa.③The diagnosis scheme of basic syndrome of LEDVT were constructed, and physicochemical indexs which was closely related to syndrome factors of LEDVT were screened . Conclusions: In the study of TCM syndrome, the form which simplified syndrome factors of LEDVT are more feasible, but the research of syndrome factors should not depart from corresponding syndromes. The variation pathogenesis of LEDVT is a complex process which influenced by multifactorial intervention and included interlacement of asthenia and sthenia factors. Its main pathological basis is damp-stasis accumulation.更多还原