肾虚痰湿证PCOS患者肥胖中西医内涵辨析

发布时间：2018-05-07 18:09

本文选题：肾虚痰湿 + 肥胖　；参考：《山东中医药大学》2017年硕士论文

【摘要】：背景:中医是经验医学的产物,与西医学客观化的诊断方式不同,中医对于疾病的诊断界定常具有主观性,较为模糊。多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是育龄期妇女中广泛存在的疾病,肥胖是PCOS的常见症状,中医对肥胖的诊断界定方法主要以望诊为主,此方法具有一定的不确定性。中医的肥胖内涵尚需进行量化、客观化研究。目的:探究肾虚痰湿证PCOS患者的肥胖症状与西医学肥胖诊断标准的内涵差异,发掘肾虚痰湿证PCOS患者的肥胖症状与西医肥胖诊断标准间的异同,并总结出肾虚痰湿证PCOS肥胖的人体测量学特征,为中医辨证提供依据。方法:通过对就诊于山东中医药大学附属医院中西医结合生殖与遗传中心的133例(包含71例观察组与62例对照组)PCOS患者进行临床观察并收集其人体测量学指标,填写临床病例观察表及四诊评价表,将所有数据录入Microsoft Excel数据库,并使用SPSS 20.0进行统计学分析:对原始资料进行分类并进行描述性统计;使用kappa检验测试测量指标与肾虚痰湿证PCOS患者肥胖间的一致性;筛检试验检验各指标与望诊法的贴合度,并据此绘制ROC曲线;将出现频率超过60%的症状与各测量指标行二分类Logistic回归检验其与测量指标的相关性。结果:1.经Kappa一致性检验分析,腰围、腰身比诊断与中医望诊的肾虚痰湿证PCOS肥胖症状高度一致(kappa0.8),腰臀比与中医望诊的肾虚痰湿证PCOS肥胖症状的一致性尚可(kappa0.4),体重指数(Body Mass Index,BMI)与中医望诊的肾虚痰湿证PCOS肥胖症状的一致性则较差(kappa0.4)(P0.05)。2.筛检试验中各指标与中医望诊的肾虚痰湿证PCOS肥胖症状的符合程度依次为:腰身比(96.99%)腰围(96.24%)腰臀比(70.94%)BMI(70.46%)。腰身比与腰围的检验灵敏度最高(94.37%)。3.对一致性较好的腰围、腰身比、腰臀比以望诊法为金标准,绘制ROC曲线,其中腰身比的符合度最高,腰围其次,腰臀比次之。4.在观察组患者的所有常见症状中,舌苔厚腻、脉滑与四个测量学指标无明显相关性(P0.05),舌胖有齿痕与腰臀比具有相关性(P=0.022),与其余三个指标无明显相关性(P0.05)。结论:1.腰身比、腰围对肥胖的诊断界值与肾虚痰湿证PCOS肥胖症状判断较为准确,推断肾虚痰湿证PCOS肥胖特点与西医学中心性肥胖较为吻合。2.经过筛检试验得知,腰身比与腰围作为肾虚痰湿证PCOS肥胖望诊的判定更有参考意义。3.ROC曲线下四个测量学指标对于肾虚痰湿证PCOS患者的风险预测值分别为:腰臀比=0.86,腰围=78.5cm,腰身比=0.478,BMI=21.29kg/m2。4.腰臀比与肾虚痰湿证PCOS患者舌胖有齿痕具有相关性。
[Abstract]:Background: Chinese medicine is the product of empirical medicine, which is different from the objective diagnosis of western medicine. Chinese medicine is often subjective and fuzzy in the diagnosis of diseases. Polycystic ovarian syndrome (PCOS) is a common disease in women of childbearing age. Obesity is a common symptom of PCOS. The connotation of obesity in traditional Chinese medicine still needs to be quantified and objectively studied. Objective: to explore the difference between the obesity symptoms of PCOS patients with kidney deficiency and phlegm dampness syndrome and the diagnostic criteria of obesity in western medicine, and to explore the similarities and differences between the obesity symptoms of PCOS patients with kidney deficiency and phlegm dampness syndrome and the diagnostic standards of obesity in western medicine. The anthropometric characteristics of PCOS obesity with kidney deficiency and phlegm dampness syndrome were summarized, which provided basis for TCM syndrome differentiation. Methods: a total of 133 patients with PCOS (71 cases in observation group and 62 cases in control group) in the Center of Reproductive and genetic Integration of traditional Chinese Medicine and Western Medicine, affiliated to Shandong University of traditional Chinese Medicine, were studied and their anthropometric indexes were collected. Filling out the clinical case observation form and the evaluation form of four diagnoses, entering all the data into the Microsoft Excel database, and using SPSS 20.0 for statistical analysis: classifying the original data and carrying out descriptive statistics; Kappa test was used to test the consistency between the measurement index and obesity in PCOS patients with kidney deficiency and phlegm dampness syndrome, and screening test was used to test the adherence degree of each index to the inspection method, and to draw the ROC curve accordingly. The correlation between symptoms with more than 60% frequency and each measurement index was tested by two classification Logistic regression. The result is 1: 1. By Kappa consistency analysis, waist circumference, The obese symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) diagnosed by waist to body ratio are highly consistent with those of traditional Chinese medicine (TCM). The obesity symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) with waist-to-hip ratio are consistent with those of traditional Chinese medicine (TCM). The body Mass index (BMI) and the visceral syndrome of kidney deficiency and phlegm dampness in traditional Chinese medicine (TCM) are similar to those of traditional Chinese medicine. The consistency of obesity symptoms in PCOS was less than that in kappa 0.4 and P0.05. 2. In the screening test, the degree of conformance between the indexes and the obesity symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) was as follows: waist to body ratio was 96.99) waist circumference was 96.24.4) waist to hip ratio was 70.94 and BMI70.46. Waist ratio and waist circumference of the highest sensitivity of 94.37. 3. For the waist circumference, waist-to-waist ratio and waist-to-hip ratio with good consistency, the ROC curve was drawn according to the method of inspection, in which the waistline ratio was the highest, the waist circumference was the second, and the waist-to-hip ratio was the second. 4. In all the common symptoms of the observation group, the tongue coating was thick and greasy, there was no significant correlation between the vein slip and the four measuring indexes (P 0.05), the tongue fat with teeth mark and the waist hip ratio (WHR) were correlated with P0. 022, and there was no significant correlation with the other three indexes (P 0. 05). Conclusion 1. The ratio of waist to body, waist circumference in the diagnosis of obesity and kidney deficiency phlegm dampness syndrome (PCOS) were more accurate. The characteristics of PCOS obesity in kidney deficiency and phlegm dampness syndrome were consistent with the central obesity in western medicine. 2. The screening test shows that, The ratio of waist to body and waist circumference are more important for the diagnosis of PCOS obesity with kidney deficiency and phlegm dampness syndrome. 3. The risk prediction values under the ROC curve for PCOS patients with kidney deficiency and phlegm dampness syndrome are: waist to hip ratio 0.86, waist circumference 78.5 cm, waist to body ratio 0.478BMI21.29kgm2.4. There was a correlation between waist-hip ratio and tongue and fat teeth mark in PCOS patients with kidney deficiency and phlegm dampness syndrome.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

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