基于聚类分析和对应分析的1019例血脂异常患者的中医证候研究

发布时间：2018-06-25 19:03

本文选题：血脂异常 + 证候　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:探讨血脂异常的中医证候及证候要素组合规律,并初步建立证候诊断标准。方法:多中心收集1019例血脂异常患者,采用聚类分析和对应分析对其四诊信息进行中医证候及证候要素的非线性降维和相关性研究。结果:①在1019例血脂异常患者中,排名前10的临床症状、体征分别是胸闷584例(占57.3%)、眩晕476例(占46.7%)、失眠432例(占42.4%)、倦怠乏力391例(占38.4%)、心悸 378 例(占 37.1%)、口干 331 例(占 32.5%)、咳嗽 319 例(占 31.3%)、喘憋304例(占29.8%)、咳痰272例(占26.7%)、胸前区胀痛268例(占26.3%)。排名前3的舌象是舌质紫暗590例(57.9%)、苔白497例(48.8%)、苔腻453例(44.5%),排名前三的脉象是脉弦531例(52.1%)、脉滑375例(36.8%)、脉细334例(32.8%)。②基于聚类分析发现,血脂异常的中医证候可分为6类:气滞证、痰瘀互阻证、痰浊阻滞证、脾肾阳虚证、脾气虚证、肾阳虚衰证。③并且初步建立了血脂异常基本证候(气滞证、痰瘀互阻证、痰浊阻滞证、脾肾阳虚证、脾气虚证、肾阳虚衰证)的诊断标准:一是气滞证,主要症状是口干(0.5229)、口苦(0.4011)、急躁易怒(0.1525),次要症状为耳鸣(0.0983)、腹满(0.0804)、胸前区胀痛(0.0359)、善太息(0.0568)、舌瘀斑瘀点(0.0555)、健忘(0.0500);二是痰瘀互阻证,主要症状是脉滑(0.4641)、脉弦(0.3485)、脉沉(0.1750)、苔腻(0.2033)、舌紫暗(0.0661),次要症状为痛有定处(0.0127)、呕吐痰涎(0.0044)、肥胖(0.0027)、肢体困重(0.0025);三是痰浊阻滞证,主要症状是咳嗽(0.7320)、咳痰(0.7256)、喘憋(0.2432),次要症状为胸闷(0.0968)、气短(0.0731)、头-重如裹(0.0165);四是脾肾阳虚证,主要症状是苔白(0.6284)、畏寒肢冷(0.2343)、舌淡(0.2489),次要症状为齿痕舌(0.1243)、走窜疼痛(0.0355)、舌胖(0.0190)、肢体麻木(0.0112);五是脾气虚证,主要症状是纳差(0.2863)、脘腹胀闷(0.2582),次要症状为呃逆(0.1457)、呕恶(0.1373)、反酸烧心(0.1437)、便秘(0.1543)、腹痛(0.1850)、失眠(0.1702)、眩晕(0.1800);六是肾阳虚衰证,主要症状是尿频(0.4877)、尿急(0.6120)、尿痛(0.2989),次要症状为面肢浮肿(0.0454)。并发现血脂异常的气滞证与脾气虚证的关系最为密切(相关距离0.23415)。④基于对应分析发现,关系最密切的证候要素是气虚和血瘀(直线距离为0.060066796),脾虚和血瘀(直线距离为0.060372262),脾虚和气滞(直线距离为0.068734416),痰浊和气滞(直线距离为0.074379097)。血脂异常的核心证候要素是气滞(直线距离为0.028738824)、津亏(直线距离为0.073979795)、痰浊(直线距离为0.085363283)、脾虚(直线距离为0.083952010)。结论:血脂异常可分为气滞证、痰瘀互阻证、痰浊阻滞证、脾肾阳虚证、脾气虚证、肾阳虚衰证6个基本证候,且常见的证候要素组合为气虚和血瘀,脾虚和血瘀,脾虚和气滞,痰浊和气滞,治疗上当用运脾化浊法(包括运脾理气、运脾益气、活血和化痰),同时还提示聚类分析和对应分析能够帮助进行中医证候的分类及证候要素组合规律的研究。
[Abstract]:Objective: to explore the rule of syndromes and syndromes combination of dyslipidemia, and to establish the diagnostic criteria of syndromes. Methods: 1019 patients with dyslipidemia were collected from 1019 patients with hyperlipidemia. Cluster analysis and correspondence analysis were used to study the nonlinear reduction and correlation of TCM syndromes and syndromes. Results among 1019 patients with dyslipidemia, the first 10 clinical symptoms, The signs were chest tightness in 584 cases (57.3%), vertigo in 476 cases (46.7%), insomnia in 432 cases (42.4%), fatigue in 391 cases (38.4%), palpitation in 378 cases (37.1%), dry mouth in 331 cases (32.5%), cough in 319 cases (31.3%), dyspnea in 304 cases (29.8%). 272 cases (26.7%) were phlegm, 268 cases (26.3%) were pain in chest area. In the top 3 cases, 590 cases (57.9%) of purple dark tongue, 497 cases (48.8%) of white fur, 453 cases (44.5%) of greasy fur, 531 cases (52.1%) of pulse string, 375 cases (36.8%) of silky veins, 334 cases (32.8%) of fine veins were found to have six types of TCM syndromes of dyslipidemia based on cluster analysis. Syndrome of phlegm and blood stasis, stagnation of phlegm and turbidity, syndrome of deficiency of spleen and kidney yang, syndrome of deficiency of spleen qi, syndrome of deficiency of kidney yang, and establishment of basic syndromes of abnormal blood lipids (Qi stagnation, phlegm and blood stasis mutual obstruction, phlegm and turbid block, spleen and kidney yang deficiency, spleen qi deficiency), The diagnostic criteria of kidney yang deficiency and failure syndrome are as follows: one is Qi stagnation, the main symptoms are dry mouth (0.5229), bitter mouth (0.4011), irritability and irritability (0.1525), secondary symptoms are tinnitus (0.0983), abdominal fullness (0.0804), distending pain (0.0359) in anterior chest area, good breath (0.0568), stasis spot in tongue (0.0555), forgetfulness (0.0500), and phlegm and stasis obstruction syndrome (0.0500). The main symptoms were pulse slip (0.4641), pulse string (0.3485), pulse sink (0.1750), greasy fur (0.2033), tongue purple dark (0.0661). The secondary symptoms were pain, sputum (0.0127), vomiting sputum (0.0044), obesity (0.0027), and limb distress (0.0025). The main symptoms were cough (0.7320), expectoration (0.7256), dyspnea (0.2432), secondary symptoms were chest tightness (0.0968), shortness of breath (0.0731), head-heavy as wrapped (0.0165), fourth, deficiency of spleen and kidney yang, The main symptoms were white fur (0.6284), chills of cold limbs (0.2343), thin tongue (0.2489), secondary symptoms of tooth mark tongue (0.1243), walking pain (0.0355), fat tongue (0.0190), limb numbness (0.0112), and syndrome of deficiency of spleen qi. The main symptoms were anorexia (0.2863), abdominal distention (0.2582), hiccup (0.1457), nausea (0.1373), acid resuscitation (0.1437), constipation (0.1543), abdominal pain (0.1850), insomnia (0.1702), vertigo (0.1800); It was also found that the relationship between qi stagnation syndrome with abnormal blood lipid and spleen qi deficiency syndrome was the most close (correlation distance 0.23415). 4. 4 based on corresponding analysis. The most closely related syndromes are qi deficiency and blood stasis (linear distance is 0.060066796), spleen deficiency and blood stasis (straight line distance is 0.060372262), spleen deficiency and qi stagnation (linear distance is 0.068734416), phlegm turbidity and qi stagnation (straight line distance is 0.074379097). The key syndromes of dyslipidemia were Qi stagnation (linear distance was 0.028738824), deficiency of Jin (linear distance was 0.073979795), phlegm turbidity (linear distance was 0.085363283), spleen deficiency (linear distance was 0.083952010). Conclusion: the abnormal blood lipid can be divided into six basic syndromes: Qi stagnation syndrome, phlegm and blood stasis mutual obstruction syndrome, phlegm turbid block syndrome, spleen and kidney yang deficiency syndrome, spleen qi deficiency syndrome and kidney yang deficiency failure syndrome, and the common syndromes are qi deficiency and blood stasis, spleen deficiency and blood stasis, and the common syndromes are qi deficiency and blood stasis, spleen deficiency and blood stasis. Spleen deficiency and qi stagnation, phlegm turbidity and qi stagnation, the treatment was done with the method of transferring spleen to remove turbidity (including the transfer of spleen to regulate qi, to transfer spleen to replenish qi, to transfer spleen to invigorate qi, At the same time, cluster analysis and correspondence analysis can help to study the classification of TCM syndromes and the combination of syndromes.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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