过敏性鼻炎中医常见证型的定量诊断研究
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摘要
过敏性鼻炎(allergic rhinitis, AR),又称变应性鼻炎,是常见的耳鼻咽喉科疾病,也是常见的呼吸道变应性疾病。该病是发生于鼻粘膜的变应性疾病,以鼻痒、喷嚏、鼻溢清涕、鼻粘膜肿胀为主要特点。
在中医理论及临床研究中,开展定量诊断研究有非常重要的意义：从临床的角度,中医辨证存在着一定程度的模糊性,采用定量诊断的方法就可以比较准确地把握辨证标准,更全面更客观地把握患者的病情变化,提高诊断水平。从中医科研的角度看,由于在中医理论与临床中往往存在定量指标不足的问题,采用定量诊断的方法可提高对疗效、新药、新疗法等方面的评估客观化、准确度与成果的论证力,有助于发现新问题,突破思维方式。
关于过敏性鼻炎中医证型研究量化的问题,迄今为止,建立在流行病学调查基础上,以现代医学诊断为基础、以中医证型定量诊断为目的研究尚未见到。我们认为,在借鉴现代医学疾病、现代计量学及相关数理统计方法的基础上,编制反映常年性过敏性鼻炎中医常见证相关项目的调查表,通过本流行病学调查,用数理统计的方法找到其有意义、有价值的项目及其常见证型,在诊断上做到计量化,不但可行,而且该研究可为常年性过敏性鼻炎进一步研究、预防、治疗以及治疗后评价打好坚实的基础而有着深远的社会实践意义。
目的：
本研究旨在注意学科交融,发挥中医自身优势,用科学的方法探索过敏性鼻炎常见中医证型的诊断模式,以过敏性鼻炎人群为研究对象,运用流行病学的方法,从中医证候入手,进行一定样本量的调查。在对该人群症状、体征等进行频数分布等统计分析的基础上对该人群中医证型以多元数理统计方式进行定量研究。初步建立起过敏性鼻炎的中医常见证型本底资料库,并初步揭示过敏性鼻炎常见中医证型中症状、体征间的相关关系,寻找在多种数理统计方法下过敏性鼻炎常见中医证型的诊断模型或公式,从而为今后过敏性鼻炎中医辨证的标准化、规范化研究提供依据,进而提高临床用药的准确性,为临床疗效评估发挥功用,以为中医病证结合的定量诊断提供参考启示。
方法：
设定常年性过敏性鼻炎中医证候调查表,调查表设计参考等文献。限于研究时间,本研究初拟先研究过敏性鼻炎最常见的肺气虚证及风热犯肺证定量诊断,将两证型所含的症征纳入,制成问卷。将收集到的研究资料转为统计数据,建立数据库,对每份中医证候量表进行初始数据的统计学处理。
对筛选出的阳性量表中的症状、体征等作如下的数据整理及分析：
以症状因子在各组间频率对照探求症状因子与证的关系。在各证筛选出常见症状因子后,进一步分析这些症状因子与证是否有关系,以探讨其在临床中的意义。本研究把症状因子作为研究要素,运用了病例一对照的研究方法,目的在于平衡研究因子以外的因素。
以OR值探求症状因子与证的联系强度。在探讨了症状因子与证联系的基础上,进一步探讨症状因子与证的联系强度,以了解症状因子在证中的诊断意义。引入了比值比(OR值)。OR值是一个联系强度指标,是一个点估计值,用来评估研究因子与证的联系强度。OR值的范围是0～+∞。当OR值>1时,表明研究因子与证存在正相关,OR值越大,症状与证的联系强度越大。根据OR值,可以得出症状因子与证联系强度的大小排序,以明确症状因子在诊断中的意义。
对回收的调查表用Epidata3.0建立数据库,将录入的数据逐项核对,不统一的项目与原问卷进行核对纠正。用EXCEL对核对无误的数据进行整理、归类。将两组110例调查资料输入Mathlab数据分析软件,采用基于熵的复杂系统分划方法对数据进行处理分析,提取过敏性鼻炎的症状因子信息,归纳基本证型,分析、计算基本证型中症状因子的贡献度。
根据症状赋分对110例患者症状进行打分,计算基本证型中症状总积分,将数据输入SPSS统计软件,采用诊断性试验中的ROC曲线分析方法,参考不同诊断界点的灵敏度和特异度,建立各基本证型的诊断阈值。
结果：
1.通过频率统计法,对肺气虚型常年性过敏性鼻炎各症状因子出现的频率进行统计、对照,发现各个症状因子出现的频率是不同的：鼻痒：93.8%,喷嚏：89.2%,流清涕：90.2%,鼻塞：92.7%,神疲乏力：86.4%,少气懒言：84.7%,自汗：70.5%,咳嗽痰白：68.1%。其中鼻痒出现的机率最高。通过本研究发现,在诸多症状之中,鼻痒在全部症状因子中出现的比例是最高的,在统计学上说明肺气虚型常年过敏性鼻炎中鼻痒出现的机率是最大的。
2.通过症状因子频率统计,对风热犯肺型常年性过敏性鼻炎各症状因子出现的频率进行统计、对照,发现各个症状因子出现的频率是不同的：鼻痒：92.7%,喷嚏：94.8%,鼻塞：91.6%,恶风身热：90.1%,头痛肢楚：88.5%,鼻流黄涕：86.4%,口渴：69.3%。其中喷嚏出现的机率最高。
3.在本研究的结果部分,我们借用OR值来说明主要研究的四个症状因子在不同研究对象中的差异。两组研究对象(肺气虚型和风热犯肺型)鼻塞和鼻痒症状因子的OR值分别是1.19和1.16,说明症状的发生在两组人群中发生的机率是有差异的,而喷嚏和流涕的症状因子的OR值分别是0.45和0.98,说明症状的发生在两组人群中发生的机率是无差异的。
4.证候是不同症状因子依其内在规律有机组合而成,不同症状因子对证候具有不同的特异性贡献,这也是产生症状因子之间非线性复杂关系的原因。为充分反映症状之间复杂的相互作用,基于熵的复杂系统分划方法以症状因子对症状因子集合(证候)的关联度,反映症状对症状集合的贡献度,对肺气虚证来讲,症状因子原始贡献度排序为鼻痒、鼻塞、流涕、喷嚏、神疲乏力、少气懒言、自汗、咳嗽痰白,对气虚具有较高诊断价值的鼻痒、鼻塞、流涕、喷嚏等症状的贡献度均显著高于其他症状,与临床实际相符。对风热犯肺证来讲,症状因子原始贡献度排序为鼻痒、喷嚏、流涕、鼻塞、恶风身热、头痛肢楚、咽干、口渴,对风热犯肺证具有较高诊断价值的鼻痒、喷嚏、流涕、鼻塞等症状的贡献度均显著高于其他症状,与临床实际相符。
结论：
通过结果分析,基于熵的复杂系统分划等方法可实现无监督的中医证候相关症状提取及症状的定量运算,其分析结果较处理线性相关的多元统计方法更具说服力。以基于熵的复杂系统分划方法对常年性过敏性鼻炎临床数据分析结果显示,其基本证候(肺气虚证、风热犯肺证等)的试验结果与此前文献的研究结论认识基本一致。
在对该人群症状、体征等进行频数分布等统计分析的基础上对该人群中医证型以多元数理统计方式进行定量研究。初步建立起了过敏性鼻炎的中医常见证型本底资料库,并初步揭示过敏性鼻炎常见中医证型中症状、体征间的相关关系,寻找出了在多种数理统计方法下过敏性鼻炎常见中医证型的诊断模型或公式,从而为今后过敏性鼻炎中医辨证的标准化、规范化研究提供依据,进而提高临床用药的准确性,为临床疗效评估发挥功用,以为中医病证结合的定量诊断提供参考启示。
Allergic rhinitis (allergic rhinitis, AR), also known as allergic rhinitis, is a common ENT diseases, is a common respiratory allergic diseases. The disease occurred in the nasal mucosa of allergic disease by nasal itching, sneezing, rhinorrhea clear tears, nasal swelling as the main features. In TCM theory and clinical studies, quantitative diagnostic study carried out a very important meaning:From the clinical point of view, TCM there is a certain degree of ambiguity, quantitative diagnostic methods can be more accurately grasp the dialectical standard, a more comprehensive and objectively grasp the patient's condition changes, improve the diagnostic level. From the perspective of traditional Chinese medicine research, due to traditional Chinese medicine theory and quantitative indicators that often exist in the clinical problem of insufficient use of quantitative diagnostic methods may increase the efficacy of new drugs, new therapies and other aspects of our assessment of objective-oriented, accuracy and results of the demonstration power contribute to the discovery of new problems, a breakthrough way of thinking. With regard to allergic rhinitis TCM Syndrome Research to quantify the problem, to date, based on epidemiological investigations, based on modern medical diagnosis based on Chinese medicine diagnosis of syndromes for the purpose of quantitative studies have not been seen. In our view, drawing on modern medicine, diseases, modern metrology and related mathematical statistical methods, based on the establishment of perennial allergic rhinitis reflects the common certificate-related projects TCM questionnaire, through the epidemiological investigation, using the method of mathematical statistics to find it is meaningful and valuable items and their common card type, in the diagnosis of been able to measure not only feasible, but also the research for perennial allergic rhinitis further research, prevention, treatment, and treatment evaluation of laying a solid foundation for The society has far-reaching practical significance. Objective: This study aimed to note that Interdiscipline play traditional Chinese medicine to its own advantages, using scientific methods to explore allergic rhinitis, the diagnosis of syndromes of traditional Chinese medicine model to allergic rhinitis population as the research object, using epidemiological methods, from the TCM waiting to start to carry out a certain sample size investigated. In this population symptoms, signs and other conduct statistical analysis of the frequency distribution of the population on the basis of traditional Chinese medicine syndromes in multiple ways mathematical statistics, quantitative research, diagnostic model or formula, and thus for the next allergic rhinitis TCM standardization, standardization of research provide the basis for, and to improve the accuracy of clinical medicine, in order to assess the clinical efficacy to perform their functions, that the combination of TCM Syndrome quantitative diagnostic reference inspiration.
Methods:Set Perennial allergic rhinitis TCM questionnaire, questionnaire design reference and other documents. Limited to research time, the beginning of this study was intended to first study the allergic rhinitis the most common hot-Fan Fei Qi Deficiency and wind permit quantitative diagnosis, two disease syndromes contained in the levy incorporated, made the questionnaire. The research data will be collected into statistical data, creating databases, for each TCM scale initial diagnosis. Screened positive on the scale of the symptoms and signs such as the following data collation and analysis of:The symptoms of factor in the frequency control among the three groups to explore the relationship between symptom factors and permits. In each card, after filtering out common symptom factor, further analysis of whether these symptoms are related factors and permits in order to explore its clinical significance. This study, the symptom factors as elements of the study, the use of a case-control study aimed at balancing factors other than the study factor. OR value of symptoms in order to explore the link strength factor and permits. In exploring the symptom factors associated with the permit, based on the symptoms to further explore the link strength factor and permits in order to understand the symptoms factor in the diagnosis of cards. The introduction of odds ratio (OR value). OR value is a link strength index, is a point estimate study of factors used to assess the strength of the link with the card. OR values range from 0~+∞. When the OR value is "1, the study shows that there is a positive correlation factor and certificate, OR the value the greater the intensity of symptoms and the greater the contact card. According to OR values, the symptoms can be drawn strength factor and the size of the contact card sort in order to identify factors in the diagnosis of symptoms of significance. Data processing and analysis. Questionnaire on the recovery of a database with Epidata3.0 will input the data one by one check, not a unified project and check to correct the original questionnaire. Using EXCEL on the check and correct the data collation, classification. Two groups of 110 cases of survey data will be entered Mathlab data analysis software, using entropy-based partition of a complex system of data processing and analysis methods to extract the symptoms of allergic rhinitis factor information, summarized the basic card type, analysis, computation of the basic Syndrome Symptoms the contribution factor. According to the symptoms Fufen symptoms of 110 patients scoring to calculate the basic card types in the total symptom score, to enter data into SPSS statistical software, using diagnostic test in the ROC curve analysis method, reference points of different diagnostic sector, sensitivity and specificity to establish the diagnosis of various fundamental Syndromes threshold.
Results:1. Through the frequency statistics law, the lung Qi-type perennial allergic rhinitis, the frequency of each symptom factor statistics, control and found that the frequency of each symptom factor is different:the nose itch:93.8%, sneezing:89.2%, stream-Qing tears:90.2%, nasal obstruction: 92.7%, Shenpi fatigue:86.4%, less gas lazy Introduction:84.7%, spontaneous perspiration:70.5%, cough, sputum White:68.1%. In which the highest incidence of nasal itching occurs. Through this study found that among the many symptoms, nasal itch factor in all the symptoms appear in the ratio is the highest, statistically explain the lung Qi-type perennial allergic rhinitis in nasal itching appears likely to be the greatest.2. Through the symptoms factor frequency statistics for wind-heat Fan Fei-type perennial symptoms of allergic rhinitis, the frequency of factors emerged statistics, control and found that the frequency of various symptoms of different factors: the nose itch:92.7%, sneezing:94.8%, nasal obstruction:91.6%, the evil wind fever:90.1%, headache and limb Chu:88.5%, nasal flow of yellow tears: 86.4%, thirst:69.3%. One sneeze occurs at the highest risk.3. In this study, the results section, we borrow OR values to illustrate the four symptoms of major research study on different factors in the differences. Two groups of subjects (Lung Qi Fan Fei-type wind heat type) symptoms of nasal congestion and nasal itch factor OR values were 1.19 and 1.16, indicating the occurrence of symptoms occurred in the two populations there is a difference in the probability, while sneezing and streaming tears of the symptoms of factor OR values were 0.45 and 0.98, indicating the occurrence of symptoms in the two groups in the incidence is no different.4. Is different from the symptoms of syndrome factors in accordance with its inherent laws of the organic combination of the different symptom factors cross-checks with different specificity designate the contribution, which is produced non-linear complex relationships between the symptom factors causes. In order to fully reflect the complex interactions between the symptoms, based on the complexity of the system partition entropy approach to symptom factors on the symptom factor collection (syndrome) in correlation, reflecting the contribution of a collection of symptoms to the degree of symptoms of lung deficiency is concerned, factors contribute to symptoms of the original order of degree of nasal itching, nasal congestion, runny nose, sneezing, Shenpi fatigue, less gas lazy statement, spontaneous perspiration, cough, phlegm white, right Qi has high diagnostic value of nasal itching, nasal congestion, runny nose, sneezing the contribution of other symptoms were significantly higher than the other symptoms consistent with clinical practice. Certificate of wind-heat Fanfei concerned, the original symptoms of Factor Contribution to sort of nasal itching, sneezing, runny nose, stuffy nose, bad wind or fever, headache and limb Chu, throat, thirst, for wind-heat Fanfei permit higher Diagnostic value of nasal itching, sneezing, runny nose, stuffy nose and other symptoms of the contribution degree were significantly higher than the other symptoms consistent with clinical practice.
Conclusion:The results of analysis of complex systems based on entropy partition method can be achieved without supervision of TCM-related symptoms and symptoms of quantitative extraction operation, the results of their analysis than dealing with the multi-linear statistical methods more convincing. Entropy-based partition method of complex systems of perennial allergic rhinitis clinical data analysis showed that the basic syndrome (Qi Deficiency, wind-heat Fanfei certificate, etc.) test results with current literature and research findings understanding of basically the same. In this population symptoms, signs and other conduct statistical analysis of the frequency distribution of the population on the basis of traditional Chinese medicine syndromes in multiple ways mathematical statistics, quantitative research, card type diagnostic model or formula, which for the next allergic rhinitis TCM standardization, standardization of research provide the basis for, and to improve the accuracy of clinical medicine, in order to assess the clinical efficacy to perform their functions, that the combination of TCM Syndrome provide reference for the quantitative diagnosis of Enlightenment
在中医理论及临床研究中,开展定量诊断研究有非常重要的意义：从临床的角度,中医辨证存在着一定程度的模糊性,采用定量诊断的方法就可以比较准确地把握辨证标准,更全面更客观地把握患者的病情变化,提高诊断水平。从中医科研的角度看,由于在中医理论与临床中往往存在定量指标不足的问题,采用定量诊断的方法可提高对疗效、新药、新疗法等方面的评估客观化、准确度与成果的论证力,有助于发现新问题,突破思维方式。
关于过敏性鼻炎中医证型研究量化的问题,迄今为止,建立在流行病学调查基础上,以现代医学诊断为基础、以中医证型定量诊断为目的研究尚未见到。我们认为,在借鉴现代医学疾病、现代计量学及相关数理统计方法的基础上,编制反映常年性过敏性鼻炎中医常见证相关项目的调查表,通过本流行病学调查,用数理统计的方法找到其有意义、有价值的项目及其常见证型,在诊断上做到计量化,不但可行,而且该研究可为常年性过敏性鼻炎进一步研究、预防、治疗以及治疗后评价打好坚实的基础而有着深远的社会实践意义。
目的：
本研究旨在注意学科交融,发挥中医自身优势,用科学的方法探索过敏性鼻炎常见中医证型的诊断模式,以过敏性鼻炎人群为研究对象,运用流行病学的方法,从中医证候入手,进行一定样本量的调查。在对该人群症状、体征等进行频数分布等统计分析的基础上对该人群中医证型以多元数理统计方式进行定量研究。初步建立起过敏性鼻炎的中医常见证型本底资料库,并初步揭示过敏性鼻炎常见中医证型中症状、体征间的相关关系,寻找在多种数理统计方法下过敏性鼻炎常见中医证型的诊断模型或公式,从而为今后过敏性鼻炎中医辨证的标准化、规范化研究提供依据,进而提高临床用药的准确性,为临床疗效评估发挥功用,以为中医病证结合的定量诊断提供参考启示。
方法：
设定常年性过敏性鼻炎中医证候调查表,调查表设计参考等文献。限于研究时间,本研究初拟先研究过敏性鼻炎最常见的肺气虚证及风热犯肺证定量诊断,将两证型所含的症征纳入,制成问卷。将收集到的研究资料转为统计数据,建立数据库,对每份中医证候量表进行初始数据的统计学处理。
对筛选出的阳性量表中的症状、体征等作如下的数据整理及分析：
以症状因子在各组间频率对照探求症状因子与证的关系。在各证筛选出常见症状因子后,进一步分析这些症状因子与证是否有关系,以探讨其在临床中的意义。本研究把症状因子作为研究要素,运用了病例一对照的研究方法,目的在于平衡研究因子以外的因素。
以OR值探求症状因子与证的联系强度。在探讨了症状因子与证联系的基础上,进一步探讨症状因子与证的联系强度,以了解症状因子在证中的诊断意义。引入了比值比(OR值)。OR值是一个联系强度指标,是一个点估计值,用来评估研究因子与证的联系强度。OR值的范围是0～+∞。当OR值>1时,表明研究因子与证存在正相关,OR值越大,症状与证的联系强度越大。根据OR值,可以得出症状因子与证联系强度的大小排序,以明确症状因子在诊断中的意义。
对回收的调查表用Epidata3.0建立数据库,将录入的数据逐项核对,不统一的项目与原问卷进行核对纠正。用EXCEL对核对无误的数据进行整理、归类。将两组110例调查资料输入Mathlab数据分析软件,采用基于熵的复杂系统分划方法对数据进行处理分析,提取过敏性鼻炎的症状因子信息,归纳基本证型,分析、计算基本证型中症状因子的贡献度。
根据症状赋分对110例患者症状进行打分,计算基本证型中症状总积分,将数据输入SPSS统计软件,采用诊断性试验中的ROC曲线分析方法,参考不同诊断界点的灵敏度和特异度,建立各基本证型的诊断阈值。
结果：
1.通过频率统计法,对肺气虚型常年性过敏性鼻炎各症状因子出现的频率进行统计、对照,发现各个症状因子出现的频率是不同的：鼻痒：93.8%,喷嚏：89.2%,流清涕：90.2%,鼻塞：92.7%,神疲乏力：86.4%,少气懒言：84.7%,自汗：70.5%,咳嗽痰白：68.1%。其中鼻痒出现的机率最高。通过本研究发现,在诸多症状之中,鼻痒在全部症状因子中出现的比例是最高的,在统计学上说明肺气虚型常年过敏性鼻炎中鼻痒出现的机率是最大的。
2.通过症状因子频率统计,对风热犯肺型常年性过敏性鼻炎各症状因子出现的频率进行统计、对照,发现各个症状因子出现的频率是不同的：鼻痒：92.7%,喷嚏：94.8%,鼻塞：91.6%,恶风身热：90.1%,头痛肢楚：88.5%,鼻流黄涕：86.4%,口渴：69.3%。其中喷嚏出现的机率最高。
3.在本研究的结果部分,我们借用OR值来说明主要研究的四个症状因子在不同研究对象中的差异。两组研究对象(肺气虚型和风热犯肺型)鼻塞和鼻痒症状因子的OR值分别是1.19和1.16,说明症状的发生在两组人群中发生的机率是有差异的,而喷嚏和流涕的症状因子的OR值分别是0.45和0.98,说明症状的发生在两组人群中发生的机率是无差异的。
4.证候是不同症状因子依其内在规律有机组合而成,不同症状因子对证候具有不同的特异性贡献,这也是产生症状因子之间非线性复杂关系的原因。为充分反映症状之间复杂的相互作用,基于熵的复杂系统分划方法以症状因子对症状因子集合(证候)的关联度,反映症状对症状集合的贡献度,对肺气虚证来讲,症状因子原始贡献度排序为鼻痒、鼻塞、流涕、喷嚏、神疲乏力、少气懒言、自汗、咳嗽痰白,对气虚具有较高诊断价值的鼻痒、鼻塞、流涕、喷嚏等症状的贡献度均显著高于其他症状,与临床实际相符。对风热犯肺证来讲,症状因子原始贡献度排序为鼻痒、喷嚏、流涕、鼻塞、恶风身热、头痛肢楚、咽干、口渴,对风热犯肺证具有较高诊断价值的鼻痒、喷嚏、流涕、鼻塞等症状的贡献度均显著高于其他症状,与临床实际相符。
结论：
通过结果分析,基于熵的复杂系统分划等方法可实现无监督的中医证候相关症状提取及症状的定量运算,其分析结果较处理线性相关的多元统计方法更具说服力。以基于熵的复杂系统分划方法对常年性过敏性鼻炎临床数据分析结果显示,其基本证候(肺气虚证、风热犯肺证等)的试验结果与此前文献的研究结论认识基本一致。
在对该人群症状、体征等进行频数分布等统计分析的基础上对该人群中医证型以多元数理统计方式进行定量研究。初步建立起了过敏性鼻炎的中医常见证型本底资料库,并初步揭示过敏性鼻炎常见中医证型中症状、体征间的相关关系,寻找出了在多种数理统计方法下过敏性鼻炎常见中医证型的诊断模型或公式,从而为今后过敏性鼻炎中医辨证的标准化、规范化研究提供依据,进而提高临床用药的准确性,为临床疗效评估发挥功用,以为中医病证结合的定量诊断提供参考启示。
Allergic rhinitis (allergic rhinitis, AR), also known as allergic rhinitis, is a common ENT diseases, is a common respiratory allergic diseases. The disease occurred in the nasal mucosa of allergic disease by nasal itching, sneezing, rhinorrhea clear tears, nasal swelling as the main features. In TCM theory and clinical studies, quantitative diagnostic study carried out a very important meaning:From the clinical point of view, TCM there is a certain degree of ambiguity, quantitative diagnostic methods can be more accurately grasp the dialectical standard, a more comprehensive and objectively grasp the patient's condition changes, improve the diagnostic level. From the perspective of traditional Chinese medicine research, due to traditional Chinese medicine theory and quantitative indicators that often exist in the clinical problem of insufficient use of quantitative diagnostic methods may increase the efficacy of new drugs, new therapies and other aspects of our assessment of objective-oriented, accuracy and results of the demonstration power contribute to the discovery of new problems, a breakthrough way of thinking. With regard to allergic rhinitis TCM Syndrome Research to quantify the problem, to date, based on epidemiological investigations, based on modern medical diagnosis based on Chinese medicine diagnosis of syndromes for the purpose of quantitative studies have not been seen. In our view, drawing on modern medicine, diseases, modern metrology and related mathematical statistical methods, based on the establishment of perennial allergic rhinitis reflects the common certificate-related projects TCM questionnaire, through the epidemiological investigation, using the method of mathematical statistics to find it is meaningful and valuable items and their common card type, in the diagnosis of been able to measure not only feasible, but also the research for perennial allergic rhinitis further research, prevention, treatment, and treatment evaluation of laying a solid foundation for The society has far-reaching practical significance. Objective: This study aimed to note that Interdiscipline play traditional Chinese medicine to its own advantages, using scientific methods to explore allergic rhinitis, the diagnosis of syndromes of traditional Chinese medicine model to allergic rhinitis population as the research object, using epidemiological methods, from the TCM waiting to start to carry out a certain sample size investigated. In this population symptoms, signs and other conduct statistical analysis of the frequency distribution of the population on the basis of traditional Chinese medicine syndromes in multiple ways mathematical statistics, quantitative research, diagnostic model or formula, and thus for the next allergic rhinitis TCM standardization, standardization of research provide the basis for, and to improve the accuracy of clinical medicine, in order to assess the clinical efficacy to perform their functions, that the combination of TCM Syndrome quantitative diagnostic reference inspiration.
Methods:Set Perennial allergic rhinitis TCM questionnaire, questionnaire design reference and other documents. Limited to research time, the beginning of this study was intended to first study the allergic rhinitis the most common hot-Fan Fei Qi Deficiency and wind permit quantitative diagnosis, two disease syndromes contained in the levy incorporated, made the questionnaire. The research data will be collected into statistical data, creating databases, for each TCM scale initial diagnosis. Screened positive on the scale of the symptoms and signs such as the following data collation and analysis of:The symptoms of factor in the frequency control among the three groups to explore the relationship between symptom factors and permits. In each card, after filtering out common symptom factor, further analysis of whether these symptoms are related factors and permits in order to explore its clinical significance. This study, the symptom factors as elements of the study, the use of a case-control study aimed at balancing factors other than the study factor. OR value of symptoms in order to explore the link strength factor and permits. In exploring the symptom factors associated with the permit, based on the symptoms to further explore the link strength factor and permits in order to understand the symptoms factor in the diagnosis of cards. The introduction of odds ratio (OR value). OR value is a link strength index, is a point estimate study of factors used to assess the strength of the link with the card. OR values range from 0~+∞. When the OR value is "1, the study shows that there is a positive correlation factor and certificate, OR the value the greater the intensity of symptoms and the greater the contact card. According to OR values, the symptoms can be drawn strength factor and the size of the contact card sort in order to identify factors in the diagnosis of symptoms of significance. Data processing and analysis. Questionnaire on the recovery of a database with Epidata3.0 will input the data one by one check, not a unified project and check to correct the original questionnaire. Using EXCEL on the check and correct the data collation, classification. Two groups of 110 cases of survey data will be entered Mathlab data analysis software, using entropy-based partition of a complex system of data processing and analysis methods to extract the symptoms of allergic rhinitis factor information, summarized the basic card type, analysis, computation of the basic Syndrome Symptoms the contribution factor. According to the symptoms Fufen symptoms of 110 patients scoring to calculate the basic card types in the total symptom score, to enter data into SPSS statistical software, using diagnostic test in the ROC curve analysis method, reference points of different diagnostic sector, sensitivity and specificity to establish the diagnosis of various fundamental Syndromes threshold.
Results:1. Through the frequency statistics law, the lung Qi-type perennial allergic rhinitis, the frequency of each symptom factor statistics, control and found that the frequency of each symptom factor is different:the nose itch:93.8%, sneezing:89.2%, stream-Qing tears:90.2%, nasal obstruction: 92.7%, Shenpi fatigue:86.4%, less gas lazy Introduction:84.7%, spontaneous perspiration:70.5%, cough, sputum White:68.1%. In which the highest incidence of nasal itching occurs. Through this study found that among the many symptoms, nasal itch factor in all the symptoms appear in the ratio is the highest, statistically explain the lung Qi-type perennial allergic rhinitis in nasal itching appears likely to be the greatest.2. Through the symptoms factor frequency statistics for wind-heat Fan Fei-type perennial symptoms of allergic rhinitis, the frequency of factors emerged statistics, control and found that the frequency of various symptoms of different factors: the nose itch:92.7%, sneezing:94.8%, nasal obstruction:91.6%, the evil wind fever:90.1%, headache and limb Chu:88.5%, nasal flow of yellow tears: 86.4%, thirst:69.3%. One sneeze occurs at the highest risk.3. In this study, the results section, we borrow OR values to illustrate the four symptoms of major research study on different factors in the differences. Two groups of subjects (Lung Qi Fan Fei-type wind heat type) symptoms of nasal congestion and nasal itch factor OR values were 1.19 and 1.16, indicating the occurrence of symptoms occurred in the two populations there is a difference in the probability, while sneezing and streaming tears of the symptoms of factor OR values were 0.45 and 0.98, indicating the occurrence of symptoms in the two groups in the incidence is no different.4. Is different from the symptoms of syndrome factors in accordance with its inherent laws of the organic combination of the different symptom factors cross-checks with different specificity designate the contribution, which is produced non-linear complex relationships between the symptom factors causes. In order to fully reflect the complex interactions between the symptoms, based on the complexity of the system partition entropy approach to symptom factors on the symptom factor collection (syndrome) in correlation, reflecting the contribution of a collection of symptoms to the degree of symptoms of lung deficiency is concerned, factors contribute to symptoms of the original order of degree of nasal itching, nasal congestion, runny nose, sneezing, Shenpi fatigue, less gas lazy statement, spontaneous perspiration, cough, phlegm white, right Qi has high diagnostic value of nasal itching, nasal congestion, runny nose, sneezing the contribution of other symptoms were significantly higher than the other symptoms consistent with clinical practice. Certificate of wind-heat Fanfei concerned, the original symptoms of Factor Contribution to sort of nasal itching, sneezing, runny nose, stuffy nose, bad wind or fever, headache and limb Chu, throat, thirst, for wind-heat Fanfei permit higher Diagnostic value of nasal itching, sneezing, runny nose, stuffy nose and other symptoms of the contribution degree were significantly higher than the other symptoms consistent with clinical practice.
Conclusion:The results of analysis of complex systems based on entropy partition method can be achieved without supervision of TCM-related symptoms and symptoms of quantitative extraction operation, the results of their analysis than dealing with the multi-linear statistical methods more convincing. Entropy-based partition method of complex systems of perennial allergic rhinitis clinical data analysis showed that the basic syndrome (Qi Deficiency, wind-heat Fanfei certificate, etc.) test results with current literature and research findings understanding of basically the same. In this population symptoms, signs and other conduct statistical analysis of the frequency distribution of the population on the basis of traditional Chinese medicine syndromes in multiple ways mathematical statistics, quantitative research, card type diagnostic model or formula, which for the next allergic rhinitis TCM standardization, standardization of research provide the basis for, and to improve the accuracy of clinical medicine, in order to assess the clinical efficacy to perform their functions, that the combination of TCM Syndrome provide reference for the quantitative diagnosis of Enlightenment
引文
[1]农辉图.耳鼻咽喉科学实用教程.北京,人民卫生出版社,2004年4月第1版,28,30,31
[2]顾之燕.韩子刚.刘志连编.耳鼻咽喉变应性和免疫性疾病.天津,天津科学技术出版社,1999年8月第1版,1
[3]中华医学会耳鼻咽喉科学分会、中华耳鼻咽喉科杂志编辑委员会.过敏性鼻炎诊断标准及疗效评定标准(1997年修订,海口).中华耳鼻咽喉科杂志,1998,33(3)：134-135.
[4]国家中医药管理局.中医病证诊断疗效标准.南京,南京大学出版社,1994年7月第1版,124
[5]王德鉴主编.中医耳鼻咽喉口腔科学.人民卫生出版社,1994年1月第1版347-357
[6]王士贞主编.中医耳鼻咽喉口腔科学.北京,中国中医药出版社,2003年1月第1版,124-127
[7]顾之燕.耳鼻咽喉科变应性和免疫性疾病.天津：天津科学技术出版社,2000.1—13.
[8]陈黎明.过敏性鼻炎的中医辨治探讨,云南中医中药杂志,2001,22(5)：10.
[9]柴向斌.血瘀证与常年性过敏性鼻炎关系初探.中医药研究,2001,17(4)：24—25.
[10]吴成山.过敏性鼻炎以痰饮论治初探.陕西中医,1996,17(12)：544 545.
[11]李明.浅谈中医药治疗过敏性鼻炎的基本思路.国医论坛,2001,16(3)：44—45.
[12]苑利敏.乌梅止敏鼻炎汤治疗过敏性鼻炎疗效观察.河北医药,2002,24(4)：295.
[13]徐秋云.过敏性鼻炎的中医治疗.中国中医药信息杂志,1996,3(5)：28—29.
[14]金慧鸣.鼻鼽汤治疗过敏性鼻炎疗效观察.北京中医药大学学报,2002,30：2.
[15]黄森潮.补中益气汤合苍耳子散治疗过敏性鼻炎35例观察.实用中西医结合杂志,1996,9(3)：177.
[16]卫淑华.温阳益气法为主治疗过敏性鼻炎.河南中医,2000,20(6)：17.
[17]马江.益气抗敏冲剂治疗常年性过敏性鼻炎疗效观察.南京中医大学学报,1999,(6)：341 342.
[18]王学斌.小青龙汤合玉屏风散加减治疗过敏性鼻炎.河南中医,2000,20(6)：19.
[19]李明.玉屏风散加味治疗过敏性鼻炎100例.实用中医药杂志,2002,18(5)：22.291
[20]牟淑兰.补气固表治疗过敏性鼻炎488例.新疆中医药,1994,(3)：38—39.
[21]郑斌.桂枝脱敏汤治疗过敏性鼻炎100例.新中医,2002,34(10)：49—50.
[22]伊春有.麻黄附子细辛汤加味治疗过敏性鼻炎100例.吉林中医药,2003,(4)： 29.
[23]苏宗海.黄芪细辛汤加减治疗过敏性鼻炎123例.新中医,2002,34(11)：57.
[24]林伟霖.益肾苍耳散治疗过敏性鼻炎50例疗效观察.新中医,2000,32(4)：29.
[25]臧朝平.扶正止鼽汤治疗常年性过敏性鼻炎60例.中医文献杂志,2003,21(1)：52.
[26]张风琴.复方丹参注射液治疗过敏性鼻炎效果观察.齐齐哈尔医学院学报,1996,17(3)：195—196.
[27]潘迎萍.固本通窍汤治疗过敏性鼻炎的体会.河北中西医结合杂志,1996,5(2)：89.
[28]韩静.益气活血法治疗过敏性鼻炎32例.陕西中医,2002,23(9)：794—795.
[29]黄兆坤.复方鼽灵汤治疗过敏性鼻炎72例.黑龙江中医药,1996,(1)：12—13.
[30]朱瑞群.疏风通窍汤治疗小儿“鼻鼽”.辽宁中医杂志,1995,22(10)：460.
[31]严试.调气化利水毒治疗过敏性鼻炎。河南中医,2000,20(6)：16—17。
[32]潘风军.小青龙汤加味治疗过敏性鼻炎30例。包头医学,1999,23(2)：77。
[33]孙晓峰.牵正散加味治疗过敏性鼻炎体会。实用中医药杂志,2001,17(1)：38。
[34]Bousquet J, van Cauwenberge P, Bachert C, et aL Alhrgic rhinitisand its impact on asthm& J Allergy Clin Immunol。2001。108(5 Suppl):147-334。
[35]Laf orce CF, Corren J, Wheeler WJ, et aL Efficacy of azelastinenasal spray in seasonal allergic rhinjtis patients who remain symptomatic after treatment with fexofenadine。Ann M lergy Asthma Immunol,2004,93:154-159。
[36]Storms Pharmacologic approaches to daytime and nighttime symptoms of allergic rhinitis. J Allergy Clin Immunol,2004,114(5 Suppl):146-153.
[37]张罗.周兵.韩德民.等.过敏性鼻炎研究进展(三)：鼻用皮质类固醇的药理作用.中国耳鼻咽喉头颈外科,2004,11：67-72.
[38]Golden S. Teets SJ. lehman EB, et al. E&ct of topical nasalazelastine on the sym ptoms of rhinitis, sleep, and daytimesomnolence in perennial allergic rhinitis. Ann Mleigy Asthma Immunol,2000,85:53-57.
[39]张罗.周兵.韩德民.等.过敏性鼻炎研究进展(二)：药物治疗.耳鼻咽喉头颈外科,2003,10：368-374.
[40]Norman PS. Immunotherapy:1999-2004. J AHergy Clin Immunol,2004,113: 1013-1023.
[41]Powel NB. Riley RW. Troel RJ, et al. Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest,1997,11,1:1348-1355.
[42]Sapci T. Sahin B. Karavus A. et al. Comparison of the efects of radiofrequency tissue ablation, CO2 laser ablation, and partialturbinectomy applications on hasal mucociliary functions. Laryngoscope,20o3,113:514-519.
[43]陈群.多元分析在冠心病脉图计量诊断中的应用.广州中医学院学报,1989；6(1)：31-35
[44]刘士敬.杨维益.朱倚.中医妇科病证脾气虚证型定量诊断标准研究.辽宁中医杂志,1997,24(6)：246—247
[45]黄益兴.任占利.王顺道.等.头风病证候诊断标准的研究.脑与神经疾病杂志,1997,5(3)：144.147.
[46]肖代齐.陈寿康.施美芬等.多动综合征的中医计量诊断.湖北中医杂志,1991；13(4)：28-29
[47]陈东汉,陈文发.脉图在高血压病和冠心病的计量诊断中的应用.福建中医药,1987,18(4)：24—26
[48]赖世隆,曹桂婵.梁伟雄.等.中医证候的数理统计基础及血瘀证宏观辨证计量化初探.中国医药学报,1988,3(6)：27—32
[49]李学中.等.计量诊断法中医四诊中的应用.吉林中医药1984；3(2)：17-18
[50]邱向红.脾虚证计量诊断的探讨.广州中医学院学报,1990,7(1)；25-27
[51]潘毅.心气虚的计量诊断初探.广州中医药学院学报,1990；7(2)：78-83
[52]赵玉秋,陈国林,陈泽奇.等.肝郁脾虚证临床流行病学调查.中国现代医学杂志,1998,8(12)：35.37.
[53]周小青.刘建新.浅析证的等级计量诊断.辽宁中医杂志,1992；(6)：11-12
[54]柯清林.张德舜.模糊综合评判法在慢性胃肠病中医辨证分型分级中的应用.中国中西医结合脾胃杂志,1997；5(2)：69-72
[55]梁俊雄.吴永毅.罗丹峰.脾虚证计算机定量诊断的探索.广州中医药大学学报,1997,14(4)：229.232.
[56]吴大嵘.梁伟雄.温泽淮.等.建立中风病血瘀证宏观辨证定量标准的方法探讨.广州中医药大学学报,1999,16(4)：249-252.
[57]王奇.谭芬来.梁伟雄等.中医证候定量的临床流行病学说研究初探.广州中医学院学报,1992；9(4)：224-228
[58]梁茂新.洪治平.中医症状定量的方法初探.中国医药学报,1994；9(3)：37-39
[59]陈泽奇.陈国林.潘其民等.肝火上炎症与肝胆湿热证临床辨证标准的研究.黑龙江中医药,1992；(4)：12-14
[60]严石林.张连文.王米渠等.肾虚证辨证因子等级评判操作标准的研究.成都中医药大学学报,2001；24(1)：56-57
[2]顾之燕.韩子刚.刘志连编.耳鼻咽喉变应性和免疫性疾病.天津,天津科学技术出版社,1999年8月第1版,1
[3]中华医学会耳鼻咽喉科学分会、中华耳鼻咽喉科杂志编辑委员会.过敏性鼻炎诊断标准及疗效评定标准(1997年修订,海口).中华耳鼻咽喉科杂志,1998,33(3)：134-135.
[4]国家中医药管理局.中医病证诊断疗效标准.南京,南京大学出版社,1994年7月第1版,124
[5]王德鉴主编.中医耳鼻咽喉口腔科学.人民卫生出版社,1994年1月第1版347-357
[6]王士贞主编.中医耳鼻咽喉口腔科学.北京,中国中医药出版社,2003年1月第1版,124-127
[7]顾之燕.耳鼻咽喉科变应性和免疫性疾病.天津：天津科学技术出版社,2000.1—13.
[8]陈黎明.过敏性鼻炎的中医辨治探讨,云南中医中药杂志,2001,22(5)：10.
[9]柴向斌.血瘀证与常年性过敏性鼻炎关系初探.中医药研究,2001,17(4)：24—25.
[10]吴成山.过敏性鼻炎以痰饮论治初探.陕西中医,1996,17(12)：544 545.
[11]李明.浅谈中医药治疗过敏性鼻炎的基本思路.国医论坛,2001,16(3)：44—45.
[12]苑利敏.乌梅止敏鼻炎汤治疗过敏性鼻炎疗效观察.河北医药,2002,24(4)：295.
[13]徐秋云.过敏性鼻炎的中医治疗.中国中医药信息杂志,1996,3(5)：28—29.
[14]金慧鸣.鼻鼽汤治疗过敏性鼻炎疗效观察.北京中医药大学学报,2002,30：2.
[15]黄森潮.补中益气汤合苍耳子散治疗过敏性鼻炎35例观察.实用中西医结合杂志,1996,9(3)：177.
[16]卫淑华.温阳益气法为主治疗过敏性鼻炎.河南中医,2000,20(6)：17.
[17]马江.益气抗敏冲剂治疗常年性过敏性鼻炎疗效观察.南京中医大学学报,1999,(6)：341 342.
[18]王学斌.小青龙汤合玉屏风散加减治疗过敏性鼻炎.河南中医,2000,20(6)：19.
[19]李明.玉屏风散加味治疗过敏性鼻炎100例.实用中医药杂志,2002,18(5)：22.291
[20]牟淑兰.补气固表治疗过敏性鼻炎488例.新疆中医药,1994,(3)：38—39.
[21]郑斌.桂枝脱敏汤治疗过敏性鼻炎100例.新中医,2002,34(10)：49—50.
[22]伊春有.麻黄附子细辛汤加味治疗过敏性鼻炎100例.吉林中医药,2003,(4)： 29.
[23]苏宗海.黄芪细辛汤加减治疗过敏性鼻炎123例.新中医,2002,34(11)：57.
[24]林伟霖.益肾苍耳散治疗过敏性鼻炎50例疗效观察.新中医,2000,32(4)：29.
[25]臧朝平.扶正止鼽汤治疗常年性过敏性鼻炎60例.中医文献杂志,2003,21(1)：52.
[26]张风琴.复方丹参注射液治疗过敏性鼻炎效果观察.齐齐哈尔医学院学报,1996,17(3)：195—196.
[27]潘迎萍.固本通窍汤治疗过敏性鼻炎的体会.河北中西医结合杂志,1996,5(2)：89.
[28]韩静.益气活血法治疗过敏性鼻炎32例.陕西中医,2002,23(9)：794—795.
[29]黄兆坤.复方鼽灵汤治疗过敏性鼻炎72例.黑龙江中医药,1996,(1)：12—13.
[30]朱瑞群.疏风通窍汤治疗小儿“鼻鼽”.辽宁中医杂志,1995,22(10)：460.
[31]严试.调气化利水毒治疗过敏性鼻炎。河南中医,2000,20(6)：16—17。
[32]潘风军.小青龙汤加味治疗过敏性鼻炎30例。包头医学,1999,23(2)：77。
[33]孙晓峰.牵正散加味治疗过敏性鼻炎体会。实用中医药杂志,2001,17(1)：38。
[34]Bousquet J, van Cauwenberge P, Bachert C, et aL Alhrgic rhinitisand its impact on asthm& J Allergy Clin Immunol。2001。108(5 Suppl):147-334。
[35]Laf orce CF, Corren J, Wheeler WJ, et aL Efficacy of azelastinenasal spray in seasonal allergic rhinjtis patients who remain symptomatic after treatment with fexofenadine。Ann M lergy Asthma Immunol,2004,93:154-159。
[36]Storms Pharmacologic approaches to daytime and nighttime symptoms of allergic rhinitis. J Allergy Clin Immunol,2004,114(5 Suppl):146-153.
[37]张罗.周兵.韩德民.等.过敏性鼻炎研究进展(三)：鼻用皮质类固醇的药理作用.中国耳鼻咽喉头颈外科,2004,11：67-72.
[38]Golden S. Teets SJ. lehman EB, et al. E&ct of topical nasalazelastine on the sym ptoms of rhinitis, sleep, and daytimesomnolence in perennial allergic rhinitis. Ann Mleigy Asthma Immunol,2000,85:53-57.
[39]张罗.周兵.韩德民.等.过敏性鼻炎研究进展(二)：药物治疗.耳鼻咽喉头颈外科,2003,10：368-374.
[40]Norman PS. Immunotherapy:1999-2004. J AHergy Clin Immunol,2004,113: 1013-1023.
[41]Powel NB. Riley RW. Troel RJ, et al. Radiofrequency volumetric reduction of the tongue. A porcine pilot study for the treatment of obstructive sleep apnea syndrome. Chest,1997,11,1:1348-1355.
[42]Sapci T. Sahin B. Karavus A. et al. Comparison of the efects of radiofrequency tissue ablation, CO2 laser ablation, and partialturbinectomy applications on hasal mucociliary functions. Laryngoscope,20o3,113:514-519.
[43]陈群.多元分析在冠心病脉图计量诊断中的应用.广州中医学院学报,1989；6(1)：31-35
[44]刘士敬.杨维益.朱倚.中医妇科病证脾气虚证型定量诊断标准研究.辽宁中医杂志,1997,24(6)：246—247
[45]黄益兴.任占利.王顺道.等.头风病证候诊断标准的研究.脑与神经疾病杂志,1997,5(3)：144.147.
[46]肖代齐.陈寿康.施美芬等.多动综合征的中医计量诊断.湖北中医杂志,1991；13(4)：28-29
[47]陈东汉,陈文发.脉图在高血压病和冠心病的计量诊断中的应用.福建中医药,1987,18(4)：24—26
[48]赖世隆,曹桂婵.梁伟雄.等.中医证候的数理统计基础及血瘀证宏观辨证计量化初探.中国医药学报,1988,3(6)：27—32
[49]李学中.等.计量诊断法中医四诊中的应用.吉林中医药1984；3(2)：17-18
[50]邱向红.脾虚证计量诊断的探讨.广州中医学院学报,1990,7(1)；25-27
[51]潘毅.心气虚的计量诊断初探.广州中医药学院学报,1990；7(2)：78-83
[52]赵玉秋,陈国林,陈泽奇.等.肝郁脾虚证临床流行病学调查.中国现代医学杂志,1998,8(12)：35.37.
[53]周小青.刘建新.浅析证的等级计量诊断.辽宁中医杂志,1992；(6)：11-12
[54]柯清林.张德舜.模糊综合评判法在慢性胃肠病中医辨证分型分级中的应用.中国中西医结合脾胃杂志,1997；5(2)：69-72
[55]梁俊雄.吴永毅.罗丹峰.脾虚证计算机定量诊断的探索.广州中医药大学学报,1997,14(4)：229.232.
[56]吴大嵘.梁伟雄.温泽淮.等.建立中风病血瘀证宏观辨证定量标准的方法探讨.广州中医药大学学报,1999,16(4)：249-252.
[57]王奇.谭芬来.梁伟雄等.中医证候定量的临床流行病学说研究初探.广州中医学院学报,1992；9(4)：224-228
[58]梁茂新.洪治平.中医症状定量的方法初探.中国医药学报,1994；9(3)：37-39
[59]陈泽奇.陈国林.潘其民等.肝火上炎症与肝胆湿热证临床辨证标准的研究.黑龙江中医药,1992；(4)：12-14
[60]严石林.张连文.王米渠等.肾虚证辨证因子等级评判操作标准的研究.成都中医药大学学报,2001；24(1)：56-57