脾虚痰湿证PCOS患者肥胖中西医内涵辨析

发布时间：2018-06-25 08:06

本文选题：肥胖 + 脾虚痰湿证　；参考：《山东中医药大学》2017年硕士论文

【摘要】：背景:囿于历史条件限定,中医对症状的判定偏于主观、模糊,肥胖即是其中的症状之一,并为中西医公认的多囊卵巢综合征(polycystic ovarian syndrome,PCOS)的常见症状。中医辨证将肥胖责之于痰湿,脾虚及肾虚均是导致痰湿的常见病机。临床上,中医对肥胖的判定以目测望诊为主,带有不确定性,如何将传统中医目测法的评价标准转变为量化可观的指标是亟待解决的问题。而以往大多研究在涉及这一领域时,多以西医诊断中体质量指数(Body Mass Index,BMI)为标准,并将其简单的移植进中医辨证依据中。中西医肥胖内涵有“置换”之嫌,有必要对中西医肥胖概念内涵进行辨析。目的:通过研究脾虚痰湿证PCOS肥胖症状的客观量化指标,为临床诊断提供新的思路,并为中西医肥胖症状内涵的辨析提供客观的参考依据。方法:收集95例脾虚痰湿证PCOS患者及80例非肥胖PCOS患者的基本信息、中医四诊信息及相关测量结果,填写病例观察表,建立数据库,录入收集数据,然后通过SPSS软件进行Kappa一致性检验、筛检试验、受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)统计分析,从而得出结论。结果:1、经Kappa一致性统计,结果显示腰围(waist circumference,WC)、腰身比(waist-to-height ratio,WHtR)与脾虚痰湿证望诊判定的肥胖一致性较好。2、经筛检试验分析,WC的灵敏度及阳性预测率最高,分别为94.74%、100%,表明经WC筛检为肥胖的患者中,患脾虚痰湿证PCOS的概率为94.74%,WHtR、BMI、腰臀比(waist-to-hip ratio,WHpR)未表现出明显优势。3、对于脾虚痰湿证PCOS患者,ROC曲线分析所得各测量指标的曲线下面积分别为:BMI(0.997)WHtR(0.995)WC(0.990)体重(0.972)WHpR(0.762)。其中BMI、WHtR、WC的ROC曲线下面积均大于0.99,统计学方面没有明显差异,皆能较好的预测中医肥胖,其适宜切点分别为22.39、0.485、78.5cm,临床可以此作为诊断脾虚痰湿证PCOS肥胖的界值。4、所研究对象育龄期妇女为主,职业以企业职工为主,文化程度初中及以下最多,其次为本科及以上,月经延迟情况以2年内为主,症状除肥胖外以月经后期最为常见。结论:1、对于中西医肥胖症状的辨别而言,西医WC、WHtR诊断下的肥胖与脾虚痰湿证PCOS肥胖一致。可见脾虚痰湿证PCOS的肥胖更偏向于以WC、WHtR增大为突出特征的中心型肥胖。2、筛检试验分析得出,经WC筛检为肥胖的患者中,患脾虚痰湿证PCOS的概率最高,因此WC可能更适用于脾虚痰湿证PCOS患者的筛检。另外,WHtR、BMI、WHpR未表现出明显优势。3、因ROC分析得出的BMI、WHtR、WC曲线下面积均0.99,统计学方面没有明显差异,所以此三项指标对于脾虚痰湿证PCOS的肥胖在适宜切点下皆有较好的风险预测。此结果亦说明脾虚痰湿证PCOS肥胖以人体中下部肥胖为特点,与西医学中心型肥胖特征较为贴合。在诊断切点方面,以WC78.5cm,WHtR0.485,BMI22.39为灵敏度和特异度较适宜的界值。可为今后临床中进行客观量化的诊断指标提供参考。
[Abstract]:Background: due to the limitation of historical conditions, the judgment of TCM symptoms is subjective and fuzzy. Obesity is one of the symptoms, and it is a common symptom of polycystic ovary syndrome (polycystic ovarian) recognized by Chinese and western medicine. TCM syndrome differentiation will be responsible for obesity phlegm dampness, spleen deficiency and kidney deficiency are common causes of phlegm dampness. In clinic, the judgment of obesity in TCM is based on visual diagnosis, with uncertainty, how to change the evaluation standard of traditional Chinese medicine visual test into a significant quantitative index is an urgent problem to be solved. In the past, most of the researches in this field were based on the standard of body Mass Index BMI (BMI) in western medicine diagnosis, and transplanted it into TCM syndrome differentiation. The connotation of obesity in Chinese and western medicine has the suspicion of "replacement", it is necessary to differentiate the connotation of obesity in traditional Chinese and western medicine. Objective: to study the objective quantitative indexes of obesity symptoms of PCOS with spleen deficiency and phlegm dampness syndrome, to provide a new idea for clinical diagnosis, and to provide an objective reference for the analysis of the connotation of obesity symptoms in traditional Chinese and western medicine. Methods: the basic information of 95 PCOS patients with spleen deficiency and phlegm dampness syndrome and 80 non-obese PCOS patients were collected. Then the statistical analysis of Kappa consistency test, screening test and (receiver operating characteristic curve is carried out by SPSS software, and the conclusion is drawn. Results: 1. According to Kappa consistency statistics, the results showed that waist circumference WC, waist-to-height ratio and phlegm dampness syndrome had better consistency of obesity. The sensitivity and positive predictive rate of WC were the highest by screening test. 94.74 and 100, respectively, indicating that those who were screened by WC as obese, The probability of PCOS with spleen deficiency and phlegm dampness syndrome was 94.74 and the WHR did not show obvious superiority. The area under the curve of each measure index was: waist-to-hip: (0.997) WHTR (0.995) WC (0.990) BW (0.972) WHPR (0.762) for PCOS patients with spleen deficiency and phlegm dampness syndrome. The area under ROC curve of BMIA WHtRX WC is larger than 0.99, there is no significant difference in statistics, all of them can predict obesity in TCM. The suitable cutting point was 22.39 ~ 0.485 ~ 78.5 cm, which could be used as the cutoff value of PCOS in diagnosis of spleen deficiency and phlegm dampness syndrome. The subjects of study were mainly women of childbearing age, the occupation was mainly enterprise workers, the education level was the most in junior middle school and below, the next was undergraduate course and above. Menstrual delay occurred mainly within 2 years, and the symptoms were most common in late menstruation except obesity. Conclusion: 1, for the differentiation of obesity symptoms of traditional Chinese and western medicine, the obesity diagnosed by WCU WHtR is consistent with PCOS of spleen deficiency and phlegm dampness syndrome. It can be seen that the obesity of PCOS with spleen deficiency and phlegm dampness is more inclined to the central obesity, which is characterized by the increase of WCU WHtR. The screening test shows that the probability of PCOS with spleen deficiency and phlegm dampness syndrome is the highest among those who are obese by WC screening. Therefore, WC may be more suitable for screening PCOS patients with spleen deficiency and phlegm dampness syndrome. In addition, WHT RV BMIP WHpR did not show obvious advantage. Because the area of BMIT RV WC curve obtained by ROC analysis was 0.99, there was no significant difference in statistics, so these three indexes could predict the risk of obesity of PCOS with spleen deficiency and phlegm dampness syndrome under the appropriate cutting point. The results also showed that the obesity of spleen deficiency and phlegm dampness syndrome PCOS was characterized by obesity in the middle and lower part of human body, which was close to the characteristics of central obesity in western medicine. The sensitivity and specificity of WC78.5 cm-1 WHtR0.485 BMI22.39 were suitable for the diagnosis of cutoff point. It can be used as a reference for the objective quantitative diagnosis in the future.
【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】：R711.75

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