基于贝叶斯（Bayes）网络技术的抑郁症中医证候规律研究

【作者】 包祖晓；

【导师】 唐启盛；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2008， 博士

【摘要】 抑郁症是目前临床上常见病和多发病,具有发病率高、危害性大、复发率高的特点,严重危害人们的心身健康。目前现代医学采用的各类诊断标准对于该病各亚型的诊断尚不完备;在治疗方面,现代医学以药物治疗为主,常用的几类药物具有不良反应大、价格昂贵、依从性差的特点。中医药治疗抑郁症虽具有一定优势,但中医对抑郁症的认识尚不统一,各医家提出的病因病机、临床分型、治疗方法多系个人经验,受主观因素影响较大,缺乏循证医学证据。部分以临床流行病学调查为基础研究出的证型,由于研究方法学上存在不足,导致研究出的各类分型标准与抑郁症的临床实际存在一定偏差。在中医辨治体系中,证候是关键。因此,在深入开展抑郁症中医研究之前,开展抑郁症的证候规律研究具有重要意义。本项研究在全面整理抑郁症相关文献的基础上,遵循临床流行病学研究思路,以首发、原发的抑郁症患者为研究对象,并排除其他躯体和精神疾病、药物等对证候观察的干扰,在北京市内共7家单位对611例研究对象进行中医证候学调查和精神科量表观察。在此基础上,借助数据挖掘技术中的贝叶斯(Bayes)网络技术,结合中医理论、专家经验及其它各种统计方法来研究抑郁症的中医证候规律;分析不同抑郁程度、中医证型在抑郁症人群中的分布规律;分析抑郁症中医证候(证候要素、证型)与HAMD抑郁量表7个因子及抑郁程度之间的内在联系,揭示中医辨证与西医诊断之间的内在联系;分析患者个人情况(如年龄、性别、出生季节等)与中医证候(证候要素、证型)、HAMD抑郁量表因子之间的内在联系。本项研究的主要研究结果与结论包括:(1)提取了抑郁症9个病机要素:精亏、气虚、血虚、阴虚、阳虚、气郁(滞)、血瘀、痰湿、火热;4个病位要素:心、肾、肝、脾;8个中医证型:肾虚肝郁证、肝郁脾虚证、脾肾两虚证、心肾不交证、气血两虚证、痰瘀互结证、气虚血瘀证、心肝火旺证。(2)抑郁症与患者个人情况具有相关性:①抑郁症在不同人群中的分布是不同的,其中30～50岁为抑郁症的高发年龄,平均年龄为40.21±13.16岁;抑郁症以女性发病为多,男女比例约为1:1.9;中学(专)和大学(专)文化、干部和职员、平时社会交往和兴趣爱好偏少、在职人员、居住在城区、冬季出生者抑郁症发病率较高;②不同抑郁程度在抑郁症人群中的分布是不同的,其中不同抑郁程度在不同经济状况、兴趣爱好、家庭关系、是否需照料他人、住房条件等人群中的构成比具统计学差异;③部分抑郁症HAMD量表的因子与患者部分个人情况具有相关性,其中焦躯化因子与住房条件相关,住房条件充裕者焦躯化程度较轻;平时兴趣爱好与认知障碍因子相关,平时兴趣爱好广泛者认知障碍程度较轻,无兴趣爱好者认知障碍程度较重;年龄与睡眠障碍因子相关,18～30岁年龄段睡眠障碍程度较轻,≥50岁者睡眠障碍程度较重,睡眠障碍与年龄之间存在正相关关系;平时兴趣爱好与阻滞因子相关,兴趣爱好广泛者阻滞程度较轻。(3)抑郁症中医证候与患者个人情况具有相关性:①抑郁症各中医证型在抑郁症人群中的分布是不同的。其中抑郁症各中医证型在不同年龄段、是否需照料他人中的构成比具有统计学差异;②部分抑郁症证候要素与患者部分个人情况具有相关性。其中平时的兴趣爱好与精亏相关,无兴趣爱好者精亏程度较重;平时的兴趣爱好与阳虚相关,平时兴趣爱好广泛者阳虚程度较轻,无兴趣爱好者阳虚程度较重;③部分抑郁症中医证型与患者部分个人情况具有相关性。其中平时的兴趣爱好与肾虚肝郁程度相关,平时兴趣爱好广泛者肾虚肝郁程度较轻,无兴趣爱好者较重;平时的兴趣爱好与肝郁脾虚程度相关,平时兴趣爱好广泛者肝郁脾虚程度较轻,无兴趣爱好者较重;年龄与气血两虚程度、痰瘀互结程度、心肾不交程度均相关,≥50岁者各型的程度较重,18～30岁者较轻,且任两个年龄段间的差异均有统计学意义,年龄与各型的程度呈正相关关系。(4)抑郁症中医证候与HAMD因子具有相关性:①部分抑郁症中医证候要素与部分HAMD因子具有相关性。其中病位肝和病位心与焦虑躯体化因子相关,相关性较高的是病位心;病位脾与体重因子相关;病机阳虚、气虚、火热、气郁及病位肝与认知障碍因子相关,相关性较高的是病机气郁;病机精亏、阳虚、气虚、血虚及病位肝、脾与阻滞因子相关,相关性较高的是病机精亏;病机阴虚、血虚、痰湿、血瘀与睡眠障碍因子相关,其中相关性较高的是病机血瘀;②部分抑郁症中医证型与部分HAMD因子具有相关性。其中肝郁脾虚型、心肝火旺型与焦虑躯体化因子相关,相关性较高的是肝郁脾虚型;脾肾两虚型、痰瘀互结型与体重因子相关;肾虚肝郁型、肝郁脾虚型、心肝火旺型与认知障碍因子相关,相关性较高的是心肝火旺型;所有证型均与阻滞因子相关,相关性最高的是肾虚肝郁型;心肾不交型、气虚血瘀型、气血两虚型、痰瘀互结型与睡眠障碍因子相关,相关性较高的是痰瘀互结型。(5)抑郁症中医证候与抑郁程度具有相关性:①部分抑郁症中医证候要素与抑郁程度具有相关性。其中抑郁程度与精亏相关性最高;②肾虚肝郁型在抑郁症中所占比例最大,为29.1%;抑郁程度在各型中的构成比较无统计学差异;抑郁程度与心肝火旺型间存在正相关关系。(6)发现肾精亏虚是抑郁症的主要病机,但抑郁症也涉及其它的病机和脏腑。更多还原

【Abstract】 Depression is a common and frequently encountered disease with high incidence rate and high recurrence rate which seriously jeopardizes our health. The current diagnostic criteria are not perfect for its subtypes yet. Drug treatment is the main method to treat depression. However, the commonly used drugs have many side effects and are very expensive. It is hard for the patients to comply with the prescription. So when dealing with depression, Chinese medicine has an advantage over western medicine. But unanimous opinion has not been reached yet on its etiology, mechanism, syndrome patterns and treatment. Many doctors put forward their opinion from their own clinical experience. There is a discrepancy between syndrome patterns derived from clinical investigation and clinical practice due to the limitation of these methods. In determining treatment by pattern identified system of Chinese medicine, syndrome pattern is the key point. So, study of the syndrome characteristics of depression is of great importance before further research is conducted.On the basis of an overall sort of the pertinent literatures of depression, the study investigated primary depression patients who were diagnosed for the first time in order to exclude the intervention of somatic diseases, other mental disorders and drugs. The study was conducted in 7 units in Beijing and 611 patients meeting the criteria were enrolled. The study adopts the method of Bayesian network and other statistical methods to: 1. study the syndrome characteristics of depression; 2.analyze the distribution characteristics of the degree of depression and syndrome patterns in different people; 3. analyze the relationship between the syndrome of depression(syndrome elements and patterns), the seven factors of HAMD Depression Measuring Scale and the degree of depression so as to reveal the internal relationship between differentiation of symptoms and signs of Chinese medicine and the diagnosis of western medicine; 4. analyze the relationship between personal information (age, gender, birth season, etc), syndrome patterns and the factors of HAMD Depression Measuring Scale.The main results and conclusion:1. The pathomechanism elements, sites of the disease and syndrome patterns were picked up. Nine pathomechanism elements are jing deficiency, qi deficiency, blood deficiency, yin deficiency, yang deficiency, stagnation of qi, blood stasis, phlegm dampness and fire heat. Four sites of the disease are the heart, kidney, liver and spleen. Eight syndrome patterns are syndrome of kidney deficiency and stagnation of liver-qi, syndrome of stagnation of liver-qi and spleen deficiency, syndrome of kidney and spleen deficiency, syndrome of breakdown of heart-kidney interaction, syndrome of deficiency of qi and blood, syndrome of phlegm and blood stasis biding together, syndrome of qi deficiency and blood stasis and syndrome of exuberant fire in the heart and liver. 2.The relationship between depression and personal information are as follows: (1)The distribution of depression varies in different people. People who are 30 to 50 most probably suffer from depression with the mean age 40.21±13.16 years old. Female is more likely to have depression and the ratio between male and female is 1:1.9. The incidence rate is higher in officials, office clerks, those who have received secondary and higher education, and who lack social communication and hobbies, live in the city and born in winter. (2) The degree of depression is related to the economic status, hobbies, family relation, self-care ability,housing condition, etc. (3) Some factors of HAMD Depression Measuring Scale are related to personal information. For instance, housing condition negatively correlates with anxiety/somatization factor, hobbies positively correlates with the degree of depression and years of age positively correlates with dyssomnia.3. The relation between syndrome patterns of Chinese medicine and personal information. (1)The distribution of syndrome patterns of depression differs according to people’s age and self-care ability. (2) Some syndrome elements of depression are related to personal information. In people who have wide hobbies, the degree of jing deficiency and yang deficiency are lower than those who have not. (3) Some syndrome patterns of depression also correlate with personal information. The degree of kidney deficiency and stagnation of liver-qi and that of stagnation of liver-qi and spleen deficiency are lower in people who have wide hobbies than those who have not. Years of age positively correlates with the degree of deficiency of qi and blood, phlegm and blood stasis biding together and breakdown of heart-kidney interaction.4. The relation between syndrome patterns of depression and factors of HAMD Depression Measuring Scale: (1) Some elements of syndrome correlate with the factors of HAMD Depression Measuring Scale. Liver and heart are related to anxiety/somatization factor. Spleen correlates with body weight. Yang deficiency, qi deficiency, fire heat, stagnation of qi, and the liver contribute to cognitive handicap. Jing deficiency, yang deficiency, qi deficiency, blood deficiency, and the liver and spleen contribute to retardation factor. And yin deficiency, blood deficiency, phlegm dampness and blood stasis contribute to dyssomnia. (2) Some syndrome patterns of depression correlate with the factors of HAMD Depression Measuring Scale. Syndrome of stagnation of liver-qi and spleen deficiency and syndrome of exuberant fire in the heart and liver correlate with anxiety/somatization factor. Syndrome of kidney and spleen deficiency and syndrome of phlegm and blood stasis biding together correlate with body weight. Syndrome of kidney deficiency and stagnation of liver-qi, syndrome of stagnation of liver-qi and spleen deficiency, and syndrome of exuberant fire in the heart and liver contribute to cognitive handicap. All of the patterns correlate with retardation factor. Syndrome of breakdown of heart-kidney interaction, syndrome of qi deficiency and blood stasis, syndrome of deficiency of qi and blood, and syndrome of phlegm and blood stasis biding together correlate with dyssomnia. 5. The relation between syndrome patterns of depression and the degree of depression: (1) Some elements of syndrome, especially jing deficiency, correlate with the degree of depression. (2) Syndrome of kidney deficiency and stagnation of liver-qi is the most common syndrome pattern of depression which accounts for 29.1% of the cases.6. It indicates that kidney-jing deficiency is the main pathomechanism of depression, in which other pathomechanisms and internal organs are also involved.更多还原