精神分裂症中医证候要素诊断量表初步研究
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摘要
目的建立精神分裂症中医证候要素诊断量表,促进精神分裂症中医证候标准化研究。方法制定精神分裂症中医证候要素调查表,收集302例精神分裂症患者的四诊信息,对中医四诊信息进行频数分析,保留出现频率> 10%的四诊信息条目,利用因子分析提取中医证候要素和四诊信息条目,运用二项Logistic回归方法进行进一步的条目筛选和确定条目权重系数,不同四诊信息权重系数不同,对302例患者进行重新打分,以专家辨证所得的证候要素为状态变量(Y),以重新打分所获得的证候要素分值作为检测变量(X)进行受试者工作特征(receiver operating characteristic,ROC)曲线分析,确定各证候要素的诊断阈值。结果精神分裂症中医证候要素诊断量表包含病位类证候要素6项,分别为:火热、气虚、气滞/气郁、阴虚、血瘀和阳虚,病位类的证候要素4项,分别为:心、肝、脾、胆,每一证候要素诊断量表的总分为100分,诊断域值为60分。结论精神分裂症中医证候要素诊断量表的研制将促进精神分裂症中医证候标准化工作的开展。
Objective To establish a traditional Chinese medicine( TCM) pattern element diagnostic scale of schizophrenia and promote the development of TCM syndrome standardization for schizophrenia. Methods The questionnaire of TCM pattern element of schizophrenia was designed,and TCM four diagnostic data from 302 schizophrenia cases were collected. The four diagnostic data were analyzed with occurrence frequency,the items of four diagnostic data with occurrence frequency > 10% were retained. TCM pattern elements and the items of four diagnostic data were extracted based on factor analysis. Binary Logistic regression analysis was used to identify the items with different weight coefficient. Totally 302 schizophrenia cases were scored with these items. Then,TCM pattern elements diagnosed by TCM experts were set as variables( Y),the scores of TCM pattern elements obtained with the above items with different weight were set as variables( X),and diagnostic threshold was determined with receiver operating characteristic( ROC) curve.Results The TCM pattern element diagnostic scale for schizophrenia was established based on 302 schizophrenia cases. There were 10 pattern elements in the scale,including 8 TCM pattern elements of disease nature( fire-heat,Qi-deficiency,Qi-stagnation,Yin-deficiency,blood stasis,and Yang-deficiency) and 4 TCM pattern elements of disease location( Heart,Liver,Spleen,and Gallbladder).The total scale of every TCM pattern element diagnostic scale was 100,with diagnostic threshold as 60. Conclusion The establishment of TCM pattern elements diagnostic scale for schizophrenia will promote the standardization of TCM syndrome of schizophrenia.
Objective To establish a traditional Chinese medicine( TCM) pattern element diagnostic scale of schizophrenia and promote the development of TCM syndrome standardization for schizophrenia. Methods The questionnaire of TCM pattern element of schizophrenia was designed,and TCM four diagnostic data from 302 schizophrenia cases were collected. The four diagnostic data were analyzed with occurrence frequency,the items of four diagnostic data with occurrence frequency > 10% were retained. TCM pattern elements and the items of four diagnostic data were extracted based on factor analysis. Binary Logistic regression analysis was used to identify the items with different weight coefficient. Totally 302 schizophrenia cases were scored with these items. Then,TCM pattern elements diagnosed by TCM experts were set as variables( Y),the scores of TCM pattern elements obtained with the above items with different weight were set as variables( X),and diagnostic threshold was determined with receiver operating characteristic( ROC) curve.Results The TCM pattern element diagnostic scale for schizophrenia was established based on 302 schizophrenia cases. There were 10 pattern elements in the scale,including 8 TCM pattern elements of disease nature( fire-heat,Qi-deficiency,Qi-stagnation,Yin-deficiency,blood stasis,and Yang-deficiency) and 4 TCM pattern elements of disease location( Heart,Liver,Spleen,and Gallbladder).The total scale of every TCM pattern element diagnostic scale was 100,with diagnostic threshold as 60. Conclusion The establishment of TCM pattern elements diagnostic scale for schizophrenia will promote the standardization of TCM syndrome of schizophrenia.
引文
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[12]杨思露,刘玥,陈爱萍,等.基于复杂系统熵聚堆方法的卒中后认知功能障碍患者证候要素提取[J].环球中医药,2017,10(10):1222-1225.
[13]王养忠,刘红芳,张先慧,等.基于聚类分析及主成分分析糖尿病肾病中医四诊信息特征临床研究[J].中华中医药杂志,2016,31(4):1416-1419.
[14]张志斌,王永炎,吕爱平,等.论证候要素与证候靶点应证组合辨证[J].中医杂志,2006,47(9):483-485.
[15]毕颖斐,毛静远.基于证候要素的病证结合辨治研究思路浅探[J].中华中医药杂志,2017,32(2):648-650.
[16]郭铭隆,陈家旭.中医学量表设计中的证候规范化思考[J].安徽中医学院学报,2008,27(6):8-10.
[17]沈渔邨.精神病学[M]. 5版.北京:人民卫生出版社,2009:936-939.
[18]赵晖,王筠,李纯,等.中医证候量表研制中的关键问题及其思考[J].中国中医药信息杂志,2017,24(6):6-9.
[19]李爽姿,王勤明,李志更.量表评价证候要素的基本原则[J].中华中医药杂志,2018,33(6):2444-2447.
[20]郭盛楠,刘强,王少卿,等.证候量表的诊断功能与评价功能[J].中华中医药杂志,2017,32(7):2894-2897.
[2]刘辉,刘珊珊,贾竑晓.首发精神分裂症未治疗时间的变化及相关因素[J].首都医科大学学报,2016,37(2):168-171.
[3]白冰,赵永厚.中医药治疗精神分裂症的临床研究进展[J].河北中医,2016,38(4):637-640.
[4]陈璇,张宏耕,宋炜熙.精神分裂症中医证候规律研究[J].湖南中医,2016,32(9):1-5.
[5]陈绍云,姚自强,陈锌郎,等.精神分裂症中医病因病机及证候分型探讨[J].深圳中西医结合杂志,2016,26(9):44-45.
[6]张宏耕,陈裕根,宋炜熙,等. 990例精神分裂症患者中医证候构成比分析[J].湖南中医药大学学报,2011,31(5):57-59.
[7]赵燕,王天芳,于春光,等.抑郁症中医证候及证候要素分布特点的文献研究[J].中医杂志,2006,47(9):691-693.
[8]世界卫生组织. ICD-10疾病和有关健康问题的国际统计分类[M].北京协和医院世界卫生组织疾病分类合作中心,编译.北京:人民卫生出版社,1996:28-33.
[9]国家技术监督局.中医临床诊疗术语证候部分[M].北京:中国标准出版社,1997:1-10.
[10]朱文锋.新世纪全国高等中医药院校规划教材:中医诊断学[M].北京:中国中医药出版社,2002:10-150.
[11]朱文锋.证素辨证学[M].北京:人民卫生出版社,2008:89-159.
[12]杨思露,刘玥,陈爱萍,等.基于复杂系统熵聚堆方法的卒中后认知功能障碍患者证候要素提取[J].环球中医药,2017,10(10):1222-1225.
[13]王养忠,刘红芳,张先慧,等.基于聚类分析及主成分分析糖尿病肾病中医四诊信息特征临床研究[J].中华中医药杂志,2016,31(4):1416-1419.
[14]张志斌,王永炎,吕爱平,等.论证候要素与证候靶点应证组合辨证[J].中医杂志,2006,47(9):483-485.
[15]毕颖斐,毛静远.基于证候要素的病证结合辨治研究思路浅探[J].中华中医药杂志,2017,32(2):648-650.
[16]郭铭隆,陈家旭.中医学量表设计中的证候规范化思考[J].安徽中医学院学报,2008,27(6):8-10.
[17]沈渔邨.精神病学[M]. 5版.北京:人民卫生出版社,2009:936-939.
[18]赵晖,王筠,李纯,等.中医证候量表研制中的关键问题及其思考[J].中国中医药信息杂志,2017,24(6):6-9.
[19]李爽姿,王勤明,李志更.量表评价证候要素的基本原则[J].中华中医药杂志,2018,33(6):2444-2447.
[20]郭盛楠,刘强,王少卿,等.证候量表的诊断功能与评价功能[J].中华中医药杂志,2017,32(7):2894-2897.