基于多元统计方法非动脉炎性前部缺血性视神经病变中医证候学研究

发布时间：2018-01-06 02:19

本文关键词：基于多元统计方法非动脉炎性前部缺血性视神经病变中医证候学研究　出处：《北京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：非动脉炎性前部缺血性视神经病变是一种严重危害中老年人视功能的常见视神经疾病,祖国医学中没有该病相对应的病名。根据患者的病因病机以及症状体征,临床医家多将之归于“暴盲”、“目系暴盲”等疾病范畴。到目前为止,该病的病因和发病机制尚不明确,而且尚无公认有效的治疗方法。通过文献调研以及临床经验总结得知,中医药辨证论治该病可取得较好的疗效。但现有的研究对于该病的证候分型以及治疗方法多从主观的个人经验出发,或者采用简单的数理统计方法进行,因此得出的结论缺乏科学性和代表性,极大地限制了中医药治疗本病优势的发挥。在中医辨证论治体系中,证候是联系理、法、方、药的中心环节,因此非动脉炎性前部缺血性视神经病变的证候规律研究是首先应当解决的瓶颈问题。基于此认识,导师周剑教授认为对该病的中医证候规范化研究已势在必行。本课题在数据挖掘方法的理论指导下,横断面、前瞻性地调查收集符合纳入标准的非动脉炎性前部缺血性视神经病变患者的临床流行病学和中医证候学资料,并采用聚类分析、主成分分析、探索性因子分析等多元统计方法初步归纳并总结其中医证型分布规律,为进一步开展该病的中医证候学研究和临床规范化研究奠定基础。论文包括文献综述和临床观察两部分。文献综述主要包括：《非动脉炎性前部缺血性视神经病变的现代研究进展》和《非动脉炎性前部缺血性视神经病变的中医研究进展》两部分。在《非动脉炎性前部缺血性视神经病变的现代研究进展》中,主要对该病的定义、分类、病因、危险因素、临床特征、辅助检查、治疗等方面进行了简要评述。在《非动脉炎性前部缺血性视神经病变的中医研究进展》中,则对该病的中医学病名及历史沿革、病证溯源、病因病机、辨证论治以及现代中医对目系暴盲的认识进行了简要回顾。临床研究部分目的：本研究在综述了国内外对非动脉炎性前部缺血性视神经病变的中西医研究进展的基础上,运用临床流行病学调查研究和多元统计分析方法探讨非动脉炎性前部缺血性视神经病变的中医证候类型。方法：首先通过反复文献调研和专家咨询后制定非动脉炎性前部缺血性视神经病变中医证候学调查表,然后采用前瞻性中医证候学横断面调查的方法,对于2014年1月至2015年12月就诊于北京中医药大学东方医院眼科、北京中医药大学第三附属医院眼科和中国中医科学院眼科医院眼科的非动脉炎性前部缺血性视神经病变患者进行问卷调查,结果共得到254例符合研究标准的患者流行病学资料和中医四诊信息等。将所收集的资料输入数据库,然后对证候学资料进行传统证候学研究和聚类分析、主成分分析和探索性因子分析等多元统计分析,最后结合中医诊断学和临床专业知识初步归纳总结出非动脉炎性前部缺血性视神经病变的主要中医证候类型。结果：①本组254例NAION患者前10位临床常见的症状依次是：视力下降、眼前黑影遮挡、胸胁胀满、头晕、口苦、口干、烦躁易怒、胸闷、心悸、喜太息等。常见的舌质是舌淡、舌暗红有瘀斑、舌暗、舌红。常见的舌苔是舌苔薄白、苔少、苔白。常见的脉象是脉弦细、脉弦、脉细数、脉涩。②经聚类分析后254例非动脉炎性前部缺血性视神经病变患者主要症状被聚成类气虚血瘀证、类肝郁气滞证、类阴虚阳亢证、类气滞血瘀证等四类证候。③经主成分分析后总结出九个主成分,经合并后归为类阴虚火旺证、类气虚血瘀证、类肝郁气滞证、类气滞血瘀证等四类证候。④经因子分析后归纳出类阴虚火旺证、类气虚血瘀证、类肝郁气滞证、类气滞血瘀证等四类证候。结论：非动脉炎性前部缺血性视神经病变患者临床多见血瘀证、气滞证、气虚证、肝郁证和阴虚证等单证表现。类阴虚火旺证、类气虚血瘀证、类肝郁气滞证、类气滞血瘀证是非动脉炎性前部缺血性视神经病变的中医常见基本证候类型。
[Abstract]:Nonarteritic anterior ischemic optic neuropathy is a common disease of serious harm in the optic nerve visual function in the elderly, the corresponding disease not in Chinese medicine. According to the patient's etiology and pathogenesis, symptoms and signs, clinical doctors to "blind violence", the category of "eye blind violence" other diseases. So far, the etiology and pathogenesis of this disease is not clear, and there is no effective therapy. Through literature research and clinical experience that Chinese medicine in the treatment of the disease can achieve good effect. But the existing research for the symptoms of the disease classification and treatment method from personal experience, or by using simple mathematical statistics, so the conclusion of the lack of scientific and representative, greatly limits the Chinese medicine treatment of this disease. In the play of the advantages of TCM. System, the syndrome is linked, law, medicine, central link, the syndrome research arteritic anterior ischemic optic neuropathy is should first solve the bottleneck problem. Based on this understanding, Professor Zhou Jian believes that the standardization of TCM Syndrome Research on this disease is imperative. Theoretical guidance for mining in this paper the method of data, cross-sectional, prospective survey data collected in accordance with the inclusion criteria of patients with non arteritic anterior ischemic optic neuropathy clinical epidemiology and TCM syndrome, and using cluster analysis, principal component analysis, exploratory factor analysis of multivariate statistical methods is summarized and summed up its TCM syndrome type distribution, lay the foundation of research and clinical practice of TCM syndrome for further development of the disease. This paper includes literature review and clinical observation of two parts. The literature review mainly includes: " Nonarteritic anterior ischemic optic neuropathy and modern research progress "and" Chinese medicine research progress of non arteritic anterior ischemic optic neuropathy > two parts. Modern research progress in < nonarteritic anterior ischemic optic neuropathy ", mainly on the definition, classification of disease, etiology, risk factors, clinical the characteristics, auxiliary examination, treatment and other aspects are briefly reviewed. Research progress in traditional Chinese medicine" in nonarteritic anterior ischemic optic neuropathy ", the disease of TCM disease and history of disease origin, etiology and pathogenesis, syndrome differentiation and understanding of modern Chinese medicine for eye blindness a brief review of the clinical research. Objective: in this study, summarized the Chinese and Western medicine research at home and abroad of nonarteritic anterior ischemic optic neuropathy on the clinical epidemiological research and multiple TCM syndrome type of statistical analysis method of nonarteritic anterior ischemic optic neuropathy. Methods: first, through literature research and expert consultation for nonarteritic anterior ischemic optic neurological lesions of TCM syndromes questionnaire, then a prospective TCM methodology for cross-sectional survey, from January 2014 to December 2015 in Beijing University of Chinese Medicine Hospital East Hospital of Ophthalmology, ophthalmology and ophthalmic hospital of the Third Affiliated Hospital of Beijing University of Chinese Medicine China Academy of traditional Chinese medicine in the patients with non arteritic anterior ischemic optic neuropathy questionnaire survey results of the 254 patients who met study criteria and epidemiological data were obtained. Four diagnostic information data input database will be collected, and then the data of the traditional syndrome the analysis of syndromes research and clustering, principal component analysis and exploration Multivariate statistical analysis of factor analysis, combined with TCM diagnosis and clinical expertise preliminarily summarized the TCM syndrome types of non arteritic anterior ischemic optic neuropathy. Results: the group of 254 NAION patients before 10 common clinical symptoms are: visual acuity, eyes shadow occlusion, fullness, chest hypochondriac dizziness, irritability, mouth pain, dry mouth, chest tightness, heart palpitations, heave a deep sigh is common. The tongue is pale tongue, dark red tongue with ecchymosis, dark tongue, red tongue. Common tongue is thin white tongue, less moss, moss white. The common pulse is a pulse string, string pulse, pulse counting and the unsmooth pulse. Optic neuropathy patients 254 cases of nonarteritic anterior ischemic symptoms after cluster analysis were clustered into the type of qi deficiency and blood stasis syndrome, liver qi stagnation type, type of yin deficiency and yang hyperactivity type, qi stagnation and blood stasis syndrome in four. The principal component analysis, summed up the nine main a After the merger, the return to hyperactivity of fire due to yin deficiency, Qi deficiency and blood stasis type, type of liver qi stagnation, qi stagnation and blood stasis type four syndrome. 4. After factor analysis summed up the type of hyperactivity of fire due to yin deficiency type, Qi deficiency and blood stasis type, liver Qi stagnation, qi stagnation and blood stasis type four the syndrome. Conclusion: nonarteritic anterior ischemic optic neuropathy patients clinical rare blood stasis, qi stagnation, Qi deficiency, stagnation of the liver qi and yin deficiency and other documents. The Yin Syndrome of hyperactivity of fire, type of qi deficiency and blood stasis syndrome, type of liver Qi stagnation, qi stagnation and blood stasis type is nonarteritic anterior ischemic optic neuropathy common TCM basic syndromes.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R276.7

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