冠心病证候要素研究—论心阳虚、痰饮、瘀血在冠心病发病中的作用

【作者】 吴东宁；

【导师】 张明雪；

【作者基本信息】 辽宁中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 目的:本实验旨在运用频数、决策树和神经网络等多种数理统计方法对冠心病证候要素、证候特征、证候病机演变规律临床专家调查问卷三维结构化关联数据库进行统计分析,明确证候要素的判断标准,证实心阳虚、痰饮、血瘀是冠心病的主要证候要素,并明晰其在冠心病发病各个阶段的作用和与不同证候的应证关系。材料与方法:根据国家颁布的标准,查阅文献,进行专家咨询,从现代心理测量理论出发并引入结构化的决策方式,应用量表学方法,并运用德尔菲法,研制冠心病证候要素、证候特征、证候病机演变规律临床专家调查问卷,其信度、效度的考评优良后,对全国东北、华北、西北、东南、西南、华南六个地区,共41家医院进行问卷调查,共收集1218份合格问卷,利用电脑设备建立Access问卷数据库,进行问卷录入并二次核查,最终建立冠心病证候要素、证候特征、证候病机演变规律临床专家调查问卷三维结构化关联数据库,使用SAS统计分析软件,运用频数、决策树和神经网络等多种数理统计方法进行统计分析。结果:1.冠心病主要证候要素在四个阶段的频数结果:心阳虚证候要素在四个阶段(发病早期、发作期、缓解期、恢复期)的频数分布依次为:61%,90%,71%,41%;痰饮为:78%,96%,76%,61%;血瘀为:58%,83%,66%,51%。即在发病早期和发作期频次逐渐增高,至缓解期和恢复期呈总体均衡下降,显示病情变化由盛至衰的发展趋势。2.冠心病主要证候要素与证候应证统计结果:心阳虚、痰饮、血瘀证候要素在发病早期的气阴两虚证、气滞心胸证,在发作期的心阳不振证、寒凝心脉证、瘀血阳微证、气滞心胸证,在缓解期的心肺气虚证、肝脾不调证、心肾阳虚证,在恢复期心气不足证、气阴两虚证、阳虚气滞证中的频数分布在9.94%—99.53%之间;反之,各期的证候在心阳虚、痰饮、血瘀证候要素中的频数分布在9.42%—66.51%之间。即在发病早期和发作期频次逐渐增高,至缓解期和恢复期呈总体均衡下降,显示病情变化由盛至衰的发展趋势。3.决策树结果显示出冠心病主要证候要素心阳虚、痰饮、血瘀在冠心病四个阶段(发病早期、发作期、缓解期、恢复期)的判断规则,经神经网络训练显示,预测效果比较一致,无论是训练集还是验证集、评估集的正确率均达到了58%—94%之间。结论:1.问卷研制。以中医理论为指导,结合冠心病的发病特点,从现代心理测量理论出发并引入结构化的决策方式,研制了冠心病证候要素、证候特征、证候病机演变规律临床专家调查问卷。比较全面、客观的还原冠心病的整个病变过程,真实地描述各阶段冠心病的症状、体征,同时运用德尔菲法重新修订问卷结构和内容,对冠心病的症状维度及辨证维度进行了有益的探索和尝试,旨在分析、总结冠心病证候要素、证候特征及其演变规律。这将对融人文哲学与自然科学于一体的中医学理论的现代化研究,提供可借鉴的模版和方法学内容。2.问卷调研。本课题采用循证医学及临床流行病学的方法,信度、效度优,并较容易实施,是一个有价值的研究方法;下一步还可以考虑纵向观察方法。3.证候要素。频数分布的分析结果显示,冠心病的主要证候要素包括心阳虚、痰饮、血瘀,在发病早期和发作期频次逐渐增加,至缓解期和恢复期呈总体均衡下降趋势。决策树和神经网络在本次证候要素探讨中起到了重要的作用。4.症状分布。对冠心病问卷中所有变量运用频数分布的统计方法,绘制了四个阶段全部条目的频数分布直方图,并运用中医学病机理论,分析每个变量在发病早期、发作期、缓解期、恢复期的动态变化,结果显示大多数变量集中在发病早期和发作期,其中发作期程度加重;缓解期至恢复期变量逐渐减少,且程度减轻,基本符合冠心病病变的临床表现,为归纳证候要素提供了数据支持并奠定了理论基础。更多还原

【Abstract】 Purpose: This experiment to use frequency, the decision tree and neural networketc. various mathematical statistic method to analysis clinical expert questionnaire 3d structural correlation database of coronary heart disease syndrome factor、syndrome features、syndrome pathology evolution rule, judge the standard of the syndrome factor, Yang heart、phlegm retention、blood stasis are the major coronary syndrome factor, clear its actions in incidence of coronary heart disease with different phases and the relationship of coronary syndromes.Material and method: According to the national standards, the literature,expert consultation, from modern psychological measurement theory and the method of structured decision-making, application of the Scale learn, have Delphi methods, develop the clinical expert questionnaire of coronary heart disease syndrome factor、syndrome features、syndrome pathology evolution rule,its reliability and validity of the evaluation of excellent, survey the northeast, north, northwest, southwest, southeast China, six areas, 41 hospitals, collect 1218 questionnaires, using a qualified computer equipment, established the questionnaire survey database of Access, input and second check input, established clinical expert questionnaire 3d structural correlation database of coronary heart disease syndrome factor、syndrome features、syndrome pathology evolution rule, using SAS software, use frequency, the decision tree and neural network etc. Various mathematical statistical analysis method.Results:1.Main coronary heart disease syndrome factors in the four stages of frequency results:Yang heart syndrome factor in four phases (early onset period, paroxysm period, remission period, recovery period)frequency distribution as follows: 61%, 90%, 71%, 41%;Phlegm retention for:78%, 96%, 76%, 61%;Blood stasis:58%, 83%, 66%, 51%. Gradually increased frequency in early and paroxysm period, and general equilibrium decline in remission and recovery period, show the changes the development trend from vigorous to failure.2. Relationship of major coronary heart disease syndrome and syndrome factor by statistic result shows:Syndrome factor of the Yang heart、phlegm retention、blood stasis, in the early onset period of Qi and Yin deficiency syndrome、Qi open-minded syndrome, in the paroxysm period of Yang malaise heart syndrome、Cold coagulation heart vessel syndrome、Blood stasis Yang syndrome、Qi open-minded syndrome, in the remission period of cardiopulmonary Qi deficiency syndrome、Liver and spleen no coordination syndrome、Heart renal Yang syndrome, in the recovery period of Heart Qi difficiency syndrome、Qi and Yin deficiency syndrome、Yang Qi syndrome, the frequency distribution in 9. 94% -99. 53% between; Conversely, the syndromes in stages of Yang Heart、phlegm retention、blood stasis syndrome factors of frequency distribution in 9. 42% -66. 51% between. Gradually increased frequency in early and paroxysm period, and general equilibrium decline in remission and recovery period, show the changes the development trend from vigorous to failure.3. The decision tree results show:The judgment rules of Coronary heart syndrome main factors of Yang heart、phlegm retention、blood stasis in the four stages of coronary heart disease (early onset period, paroxysm period, remission period, recovery period), neural network training, the forecast effect is consistent with that, whether training sets or set of evaluation、test sets accuracy reached 58 %-94% between.Conclusion:1. Questionnaire research. Chinese medicine theory as the guide, combining the characteristics of coronary heart disease pathogenesis, from theory and modern psychological measurement into a structured decision-making, developed the clinical expert questionnaire of coronary heart disease syndrome factor、syndrome features、syndrome pathology evolution rule. In a comprehensive, objective comparison of the whole process of lesion reduction of coronary heart disease, to describe the different stages of symptoms、signs and using Delphi method revision of questionnaire, structure and content of coronary heart disease symptoms dimensions and the dialectical dimension beneficial exploration and try to analysis and summary coronary heart disease syndrome factor、syndrome features、syndrome pathology evolution rule. It will be on humanism philosophy and science in the modernization of TCM theory research, provide reference templates and methodology.2. Questionnaire survey. This subject adopts evidence-based medicine and clinical epidemiological methods, reliability and validity good, and easier to implement, and is a valuable research methods, The longitudinal observation method can be considered.3. Syndrome factor. Frequency distribution of the analysis results show that the main coronary heart syndrome factor including Yang heart、phlegm retention、blood stasis, gradually increased frequency in early and paroxysm period, and general equilibrium decline in remission and recovery period. The decision tree and the neural network is discussed in this syndrome factor plays an important role.4. Symptoms distribution. All variables in the questionnaire for coronary heart disease by statistical methods of frequency distribution, rendering the four stages of all items, and frequency distribution histogram analysis theory of TCM pathogenesis, each variable in early onset period, paroxysm period, remission period, recovery period,the results show that the dynamic changes of the most concentrated in early onset period and paroxysm period, including paroxysm period general intensified, gradually reduce variable extent lighter in remission and recovery period, comply with the clinical manifestations of the disease, coronary syndrome factor for induction provides data to support and laid a foundation.更多还原