“减权法”在肝炎后肝硬化中医证候量化中的应用
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摘要
目的基于中医证候复杂、多态的特点,借鉴证素辨证方法,对收集到的79个肝炎后肝硬化患者的临床表征信息进行证素拆分,并根据权重赋予不同分值进行计算,实现中医对肝炎后肝硬化中医证候的定量分析,从而达到中医证候分类诊断的客观化与规范化目的。
方法运用课题组先期研制的肝炎后肝硬化中医证候量表,在沈阳市第六人民医院采集符合本研究纳入标准的肝炎后肝硬化患者的临床信息(包括一般资料及中医四诊信息)。根据证素辨证原理,将患者的每个四诊信息分解成证素,利用自行研究的“减权法”为每个证素赋值,计算出每个患者症状中各个证素所占的百分比。依据前期临床调查发现的肝炎后肝硬化常见的肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、湿热内蕴证及瘀热蕴结证五个证候的各自辨证特点,结合证素的百分比情况判定患者的证候。再利用《证素辨证学》中提供的“双层频权剪叉算法”,对相同的病例资料进行辨证并得出证候诊断结果。最终,以专家辨证结果为标准,使用SPSS 16.0软件,对“减权法”和“双层频权剪叉算法”所得出的辨证结果进行McNemar检验和Kappa检验,检验二者之间的优势性和一致性。
结果79例病倒中,专家辨证示;肝肾阴虚证12例;脾肾阳虚证2例;瘀热内蕴证5例;湿热内蕴证26例;肝郁脾虚证28例,气虚血瘀证6例;根据减权法计算,肝肾阴虚证的证素百分比权值结果中以阴虚、热、气虚三者为主。脾肾阳虚证的以阳虚、寒、湿、气虚四者为主。瘀热内蕴证的以热、血瘀、气滞三者为主。湿热内蕴证以湿、热、气滞三者为主。肝郁脾虚证以气滞、气虚、湿三者为主。而证素百分比权值结果不符合上述五种证型的为气虚血瘀证。以其对全部病倒进行辨证,结果与专家辨证完全一致的41例,部分一致12例,错误26例;运用“双层频权剪叉算法”判定结果与专家辨证完全一致的42例,部分一致11例,错误26例;二者间优势性检验(McNemar)结果示无显著性差异(P>0.05)一致性(Kappa)检验的结果示二者存在显著性差异(P<0.01)。
结论
1.通过对79例病例资料辨证分析证实,在对肝炎后肝硬化中医证候的量化诊断中,“减权法”与“双层频权剪叉算法”具有相同的优势性及极高的一致性。
2.“减权法”可根据实际相关证素的数量来动态计算证素的权值,不用查询和记忆证素的权值,较“双层频权剪叉算法”简便且易于操作。
3.本研究提出的量化诊断方法能够有效地避免医生辨证过程中的主观臆测,从而为中医临床诊治肝炎后肝硬化提供客观、有效的工具。
Objective Based on the syndromes complex, polymorphism characteristic, Reference syndrome factor dialectical method,split the cases of collected data to syndrome factor and endow the different weights score. For patients with posthepatitic cirrhosis by the clinical manifestations of the calculation and analysis of information, realization of posthepatitic cirrhosis TCM quantitative analysis of syndromes, so as to achieve the diagnosis of syndromes classification objectivated with standardized purpose.
Method Use the scale of TCM symptomatic of earlier research group, acquisition and record the infectious disease hospital for a period of time in a certain number, aged between 18 and 65, between the compliance with this study included patients with liver cirrhosis medical standards general data, including medical history, TCM symptoms, signs results material. Using the method of the syndrome factor dialectical, each of the four diagnostic positive information will be decomposed into syndrome factor, use "reduce weight method" for every syndrome factor assignment, and then calculate each patient the percentage of each syndrome factor. According to five syndrome differentiation characteristics of their parting, combined with the percentage of the syndrome factor situation obtains the corresponding parting diagnosis. Using the syndrome factor differentiation method of learning provide, get parting diagnosis of the control group. Use SPSS16.0 software, the results for the standard with expert syndrome differentiation, use the McNemar test and Kappa test with the results of discriminate and the control group, test the dominance and consistency.
Results
1.This study proposed diagnosis methods and control results ,the of McNemar test and Kappa test has Statistically significant.
2.The inspection results of "Reduce weight method" and "double frequency power cut fork algorithm" dominance test——McNemar test is P>0.05 .
3. The inspection results of "Reduce weight method" and "double frequency power cut fork algorithm" consistency test——Kappa test is P<0.01.
Conclusion
1. Of all the quantitative diagnosis experiment case data results, "decrease weight method" and "double frequency power cut fork algorithm" has no dominance compared.
2. Of all the quantitative diagnosis experiment case data results, "decrease weight method" and "double frequency power cut fork algorithm" has high compared consistency.
3. Compare with "double frequency power cut fork algorithm", "Reduce weight method" involving the syndrome factor weights is according to the actual number of relevant syndrome factor to dynamic calculation, need not query and memory syndrome factor metric.
4.This study proposed the quantitative diagnosis method can effectively reduce the doctor subjective speculation, reducing misdiagnosis, for TCM clinical diagnosis and treatment posthepatitic cirrhosis to provide effective and objective tools, and thus promote the quantification and standardization of TCM syndrome
方法运用课题组先期研制的肝炎后肝硬化中医证候量表,在沈阳市第六人民医院采集符合本研究纳入标准的肝炎后肝硬化患者的临床信息(包括一般资料及中医四诊信息)。根据证素辨证原理,将患者的每个四诊信息分解成证素,利用自行研究的“减权法”为每个证素赋值,计算出每个患者症状中各个证素所占的百分比。依据前期临床调查发现的肝炎后肝硬化常见的肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、湿热内蕴证及瘀热蕴结证五个证候的各自辨证特点,结合证素的百分比情况判定患者的证候。再利用《证素辨证学》中提供的“双层频权剪叉算法”,对相同的病例资料进行辨证并得出证候诊断结果。最终,以专家辨证结果为标准,使用SPSS 16.0软件,对“减权法”和“双层频权剪叉算法”所得出的辨证结果进行McNemar检验和Kappa检验,检验二者之间的优势性和一致性。
结果79例病倒中,专家辨证示;肝肾阴虚证12例;脾肾阳虚证2例;瘀热内蕴证5例;湿热内蕴证26例;肝郁脾虚证28例,气虚血瘀证6例;根据减权法计算,肝肾阴虚证的证素百分比权值结果中以阴虚、热、气虚三者为主。脾肾阳虚证的以阳虚、寒、湿、气虚四者为主。瘀热内蕴证的以热、血瘀、气滞三者为主。湿热内蕴证以湿、热、气滞三者为主。肝郁脾虚证以气滞、气虚、湿三者为主。而证素百分比权值结果不符合上述五种证型的为气虚血瘀证。以其对全部病倒进行辨证,结果与专家辨证完全一致的41例,部分一致12例,错误26例;运用“双层频权剪叉算法”判定结果与专家辨证完全一致的42例,部分一致11例,错误26例;二者间优势性检验(McNemar)结果示无显著性差异(P>0.05)一致性(Kappa)检验的结果示二者存在显著性差异(P<0.01)。
结论
1.通过对79例病例资料辨证分析证实,在对肝炎后肝硬化中医证候的量化诊断中,“减权法”与“双层频权剪叉算法”具有相同的优势性及极高的一致性。
2.“减权法”可根据实际相关证素的数量来动态计算证素的权值,不用查询和记忆证素的权值,较“双层频权剪叉算法”简便且易于操作。
3.本研究提出的量化诊断方法能够有效地避免医生辨证过程中的主观臆测,从而为中医临床诊治肝炎后肝硬化提供客观、有效的工具。
Objective Based on the syndromes complex, polymorphism characteristic, Reference syndrome factor dialectical method,split the cases of collected data to syndrome factor and endow the different weights score. For patients with posthepatitic cirrhosis by the clinical manifestations of the calculation and analysis of information, realization of posthepatitic cirrhosis TCM quantitative analysis of syndromes, so as to achieve the diagnosis of syndromes classification objectivated with standardized purpose.
Method Use the scale of TCM symptomatic of earlier research group, acquisition and record the infectious disease hospital for a period of time in a certain number, aged between 18 and 65, between the compliance with this study included patients with liver cirrhosis medical standards general data, including medical history, TCM symptoms, signs results material. Using the method of the syndrome factor dialectical, each of the four diagnostic positive information will be decomposed into syndrome factor, use "reduce weight method" for every syndrome factor assignment, and then calculate each patient the percentage of each syndrome factor. According to five syndrome differentiation characteristics of their parting, combined with the percentage of the syndrome factor situation obtains the corresponding parting diagnosis. Using the syndrome factor differentiation method of learning provide, get parting diagnosis of the control group. Use SPSS16.0 software, the results for the standard with expert syndrome differentiation, use the McNemar test and Kappa test with the results of discriminate and the control group, test the dominance and consistency.
Results
1.This study proposed diagnosis methods and control results ,the of McNemar test and Kappa test has Statistically significant.
2.The inspection results of "Reduce weight method" and "double frequency power cut fork algorithm" dominance test——McNemar test is P>0.05 .
3. The inspection results of "Reduce weight method" and "double frequency power cut fork algorithm" consistency test——Kappa test is P<0.01.
Conclusion
1. Of all the quantitative diagnosis experiment case data results, "decrease weight method" and "double frequency power cut fork algorithm" has no dominance compared.
2. Of all the quantitative diagnosis experiment case data results, "decrease weight method" and "double frequency power cut fork algorithm" has high compared consistency.
3. Compare with "double frequency power cut fork algorithm", "Reduce weight method" involving the syndrome factor weights is according to the actual number of relevant syndrome factor to dynamic calculation, need not query and memory syndrome factor metric.
4.This study proposed the quantitative diagnosis method can effectively reduce the doctor subjective speculation, reducing misdiagnosis, for TCM clinical diagnosis and treatment posthepatitic cirrhosis to provide effective and objective tools, and thus promote the quantification and standardization of TCM syndrome
引文
[1]张华,刘平.中医证候量化研究的思路与方法探析[J].中国中医基础医学杂志, 2009,15(8):574-576.
[2]郭蕾,王永炎,张志斌,等.证候动态时空特征的复杂性及相应的研究思路.中医研究,2006,19(3):1-3.
[3]钟波,肖智,周家启.组合预测中基于粗糙集理论的权值确定方法[J].重庆大学学报,2002,25(7):127-130.
[4]宴俊峰,朱文峰.粗糙集理论在中医证素辨证研究中的应用[J].中国中医基础医学杂志,2006,12(2):90-93.
[5]李联社,曹贵民,赵广刚,等.中医症状定量化方法初步研究.中医药学刊,2005,11(23):2046.
[6]粱俊雄.中医辨证定量化的思路.广州中医药大学学报,1997,14(1):5.
[7]王学伟,瞿海斌,王阶.一种基于数据挖掘的中医定量诊断方法.北京中医药大学学报,2005,28(1):4.
[8]吴芸,周昌乐,张志枫.中医舌诊八纲辨证神经网络知识库构建.计算机应用研究,2006,(6):188.
[9]孟家眉.脑血管病临床辨证规范化定量化初探.中西医结合杂志.1988,8(3):47.
[10]朱文锋.制定全病域中医方面辨证量表的设汁思路.辽宁中医杂志。2005,32(6):521.
[11]由松.中医症状及证候的量化方法探讨.北京中医药大学学报。2002,25(2):13.
[12]李利清.证的量化初探.上海中医药杂志,2004,38(10):42.
[13]王天芳,薛晓琳,王庆围.量表在中医药研究中的应用现状与展望.北京中医药大学学报,2O06,29(5):293.
[14]李国春,陈文垲,梅晓云,等.中医宏观辨证指标量化方法研究探讨.中国中医基础医学杂志,2005,11(9):650.
[15]林松,波连棋,岗庞明,等.急性脑梗塞中医辨证分型血管内皮细胞活性因子检测证的指标探讨.中国中西医结合杂志,2000,20(12):911.
[16]谌剑飞,马雅玲,丁萍,等.急性脑梗死患者血浆内皮素胰岛激素水平及与中医证候量值的关系研究.中围中西医结合急救杂志,2002,9(2):108.
[17]梁健芬,刘泰,胡跃强.急性脑梗死中医辨证分型与血浆同半胱氨酸水平的卡甘关性.辽宁中医杂志,2006,33(12):1527.
[18]吴大嵘,梁伟雄,温泽淮,等.建立中风病血瘀证宏观辨证量化标准的方法探讨.广州中医药大学学报1999,16(4):249.
[19]陈国林,潘其民,赵玉秋,等.中医肝病证候临床辨证标准的研究.中国医药学报,1990,5(1):66.2
[20]陈启光,申春悌,张华强,等.结构方程模型在中医证候规范标准研究中的应用.中国卫生统计,2005,22(1):4.
[21]李国春,李春婷,黄蓝平,等.结构方程模型探讨慢性萎缩性胃炎证候分型规律.南京中医药大学学报,2006,22(1):217.
[22]郦水平,陈启光,张菊萍,等.脑梗死中医“证”的结构方程.四川中医,20o6,24(8):27.
[23]海霞.朱文锋教授谈证素辨证新体系.中国中医药报,2004,4,5
[24]郭蕾,王永炎,张志斌,等.证候动态时空特征的复杂性及相应的研究思路.中医研究,2006,19(3):1-3.
[25]王永炎.关于中医学学科建设目标的探讨.天津中医药,2003,20(2:)1-3.
[26]朱文锋.证素辨证学[M].北京:人民卫生出版社,2008: 91-161.
[27]苏越,王磊,张华,等.肝炎后肝硬化中医证候与疾病信息相似度分析[J].中国中西医结合杂志,2009,29(5):398-402.
[2]郭蕾,王永炎,张志斌,等.证候动态时空特征的复杂性及相应的研究思路.中医研究,2006,19(3):1-3.
[3]钟波,肖智,周家启.组合预测中基于粗糙集理论的权值确定方法[J].重庆大学学报,2002,25(7):127-130.
[4]宴俊峰,朱文峰.粗糙集理论在中医证素辨证研究中的应用[J].中国中医基础医学杂志,2006,12(2):90-93.
[5]李联社,曹贵民,赵广刚,等.中医症状定量化方法初步研究.中医药学刊,2005,11(23):2046.
[6]粱俊雄.中医辨证定量化的思路.广州中医药大学学报,1997,14(1):5.
[7]王学伟,瞿海斌,王阶.一种基于数据挖掘的中医定量诊断方法.北京中医药大学学报,2005,28(1):4.
[8]吴芸,周昌乐,张志枫.中医舌诊八纲辨证神经网络知识库构建.计算机应用研究,2006,(6):188.
[9]孟家眉.脑血管病临床辨证规范化定量化初探.中西医结合杂志.1988,8(3):47.
[10]朱文锋.制定全病域中医方面辨证量表的设汁思路.辽宁中医杂志。2005,32(6):521.
[11]由松.中医症状及证候的量化方法探讨.北京中医药大学学报。2002,25(2):13.
[12]李利清.证的量化初探.上海中医药杂志,2004,38(10):42.
[13]王天芳,薛晓琳,王庆围.量表在中医药研究中的应用现状与展望.北京中医药大学学报,2O06,29(5):293.
[14]李国春,陈文垲,梅晓云,等.中医宏观辨证指标量化方法研究探讨.中国中医基础医学杂志,2005,11(9):650.
[15]林松,波连棋,岗庞明,等.急性脑梗塞中医辨证分型血管内皮细胞活性因子检测证的指标探讨.中国中西医结合杂志,2000,20(12):911.
[16]谌剑飞,马雅玲,丁萍,等.急性脑梗死患者血浆内皮素胰岛激素水平及与中医证候量值的关系研究.中围中西医结合急救杂志,2002,9(2):108.
[17]梁健芬,刘泰,胡跃强.急性脑梗死中医辨证分型与血浆同半胱氨酸水平的卡甘关性.辽宁中医杂志,2006,33(12):1527.
[18]吴大嵘,梁伟雄,温泽淮,等.建立中风病血瘀证宏观辨证量化标准的方法探讨.广州中医药大学学报1999,16(4):249.
[19]陈国林,潘其民,赵玉秋,等.中医肝病证候临床辨证标准的研究.中国医药学报,1990,5(1):66.2
[20]陈启光,申春悌,张华强,等.结构方程模型在中医证候规范标准研究中的应用.中国卫生统计,2005,22(1):4.
[21]李国春,李春婷,黄蓝平,等.结构方程模型探讨慢性萎缩性胃炎证候分型规律.南京中医药大学学报,2006,22(1):217.
[22]郦水平,陈启光,张菊萍,等.脑梗死中医“证”的结构方程.四川中医,20o6,24(8):27.
[23]海霞.朱文锋教授谈证素辨证新体系.中国中医药报,2004,4,5
[24]郭蕾,王永炎,张志斌,等.证候动态时空特征的复杂性及相应的研究思路.中医研究,2006,19(3):1-3.
[25]王永炎.关于中医学学科建设目标的探讨.天津中医药,2003,20(2:)1-3.
[26]朱文锋.证素辨证学[M].北京:人民卫生出版社,2008: 91-161.
[27]苏越,王磊,张华,等.肝炎后肝硬化中医证候与疾病信息相似度分析[J].中国中西医结合杂志,2009,29(5):398-402.