基于真实世界的膝骨性关节炎中医证候规律研究

发布时间：2018-04-23 13:57

本文选题：膝骨性关节炎 + 证候　；参考：《中国中医科学院》2017年硕士论文

【摘要】：研究目的:基于“真实世界”的临床研究方法,在采集膝骨性关节炎(knee osteoarthritis,KOA)临床症状、体征及中医四诊等信息的基础上,运用SPSS24.0软件和复杂网络Liquorice软件进行分析、归纳、总结,明确其证候特点,为研究KOA临床证候标准奠定基础,以期为中医临床辨证论治KOA提供基于“真实世界”的循证医学支持。研究方法:基于“真实世界”的临床研究方法,在文献调研的基础上,系统总结KOA证候的研究方法和思路,根据国家中医药管理局“十一五”重点专科协作组膝痹病(膝骨性关节炎)的中医临床路径,以及中华人民共和国中医药行业标准(中医内科、中医骨伤科病证诊断疗效标准ZY/T001.1-94),以中国中医科学院望京医院骨科临床实际运行病历信息采集为基础,通过临床专家“头脑风暴法”,筛选出有关KOA证候分析需要采集的临床信息,制成KOA门诊电子病历模板信息采集点问卷统计表,并经过具有高级职称的30位中医证候学领域专家论证达成专家共识,确定临床信息采集点。运用临床科研共享系统客观、真实、实时采集2014年9月18日至2016年4月26日,经中国中医科学院望京医院骨关节一科、骨关节二科、骨关节三科、骨关节四科和骨伤综合科的高年资医生诊疗且符合纳入标准的门诊或住院病例。将收集的病例信息建成数据库,运用Excel软件进行数据清洗和逻辑核查,形成证候信息矩阵。基于中国中医科学院广安门医院数据挖掘平台进行数据统计分析,计算出各症的分布频率(各症分布频率=每个症的定量分总和/样本量,*100%),取分布频率高于或等于5%的中医症状,运用SPSS24.0软件系统聚类分析总结其证候特点,并运用Liquorice复杂网络分析各症之间的关联性,形成证候信息分类群,对其主症和兼症进行归纳总结,依据中医病证分类与代码(GB/T15657-1995)、中医基础理论术语(GB/T20348-2006)、中医病证诊断疗效标准(ZY/T001.1.94),结合中医骨科学领域和中医证候学领域专家论证,达成专家共识,形成证候的判定和描述,进而形成KOA的证候特点,为本病的证候分类、辨证治疗提供基于循证医学的科学、统一的参考依据。研究结果:1纳入门诊或住院病例803例,根据剔除标准,剔除病例27例,纳入分析776例,男性166例,女性610例,男女比例为1:3.67,最小年龄22岁,最大年龄92岁,平均年龄61.26± 11.53岁。2运用SPSS24.0聚类分析和主成分分析得出三大类证候信息群:G1组(瘀血闭阻):双下肢肌肉萎缩,舌底脉络色红,可见迂曲,劳累后发热,苔黄白相兼,舌红,头晕眼花,脉涩,苔腻。G2组(寒湿凝滞):下肢酸楚,下肢畏寒,腰膝酸软,下肢无力,胀痛,酸痛,畏寒,脉滑,脉濡,胖大。G3组(肝肾亏虚):盗汗,苔白,舌淡红,苔薄。3运用频数统计方法根据所包含的三大类证候信息权重对入组病例进行分类:以G1组证候信息为主的G1组(482例);以G2组证候信息为主的G2组(208例);以G3组证候信息为主的G3组(11例)。统计分析发现入组病例多为证候相兼,将各组证候信息权重相等的归为G4组(75例)。4运用Liquorice复杂网络分析,结合聚类分析结果,形成各组主症、兼症分类群,经中医骨科学领域和中医证候学领域专家论证,根据G4组的主要症状、体征及舌脉象并结合临床,将其归入G3组,最后判定证候:776例KOA患者中医证候多为证候相兼,其主要证候分类情况为:以瘀血闭阻为主的为最多,占62.11%;以寒湿凝滞为主的占26.80%;以肝肾亏虚为主的占11.08%。研究结论:1膝骨性关节炎证候主要分为瘀血闭阻、寒湿凝滞、肝肾亏虚三种。其中瘀血闭阻类型最为常见。2膝骨性关节炎患者多为证候相兼,以主证为主,兼见他证。3膝骨性关节炎三类主要证候的判定描述:瘀血闭阻型:患膝刺痛,关节僵硬,痛有定处。舌暗红,苔薄,舌底脉络可见迂曲,脉涩或脉弦。寒湿凝滞型:患膝酸痛或胀痛,屈伸不利,下肢酸楚,或肿胀,下肢沉重,遇风寒湿后加重,畏寒,腰膝酸软,舌淡红,苔白腻,脉濡滑或脉沉迟。肝肾亏虚型:患膝隐隐作痛,屈伸不利,腰膝酸软,头晕眼花,耳鸣,或盗汗,或劳累后加重,舌淡红,苔薄,脉细。形成的各组证候判定描述能够更好的为临床医生在诊疗过程中判断KOA患者证候类型提供理论上的参考依据。
[Abstract]:Research objective: Based on the "real world" clinical research method, on the basis of collecting the information of knee osteoarthritis (KOA) clinical symptoms, signs and four diagnosis of traditional Chinese medicine, SPSS24.0 software and complex network Liquorice software are used to analyze, summarize, make clear the characteristics of the syndrome, and lay a foundation for the study of the standard of the clinical syndrome of KOA. In order to provide evidence based evidence-based medical support based on "real world" for clinical syndrome differentiation and treatment of KOA in traditional Chinese medicine. Research methods: Based on the "real world" clinical research method, the research methods and ideas of KOA syndrome are systematically summarized on the basis of literature research. According to the "11th Five-Year" key specialist cooperative group of the State Administration of traditional Chinese medicine (TCM) The clinical path of traditional Chinese medicine of knee arthralgia (knee osteoarthritis), as well as the standard of People's Republic of China traditional Chinese medicine (traditional Chinese medicine, ZY/T001.1-94), based on the collection of medical records in the Department of orthopedics, Wangjing Hospital of the Chinese Academy of science of traditional Chinese medicine, is based on the "brainstorming method" by clinical experts. The clinical information needed to be collected for the KOA syndrome analysis was selected, and the questionnaire statistics table of the information collection point of the KOA outpatient medical record template was made, and the expert consensus was reached through the expert argument of 30 TCM syndromes with advanced titles, and the clinical information collection system was determined by the clinical science and research sharing system. The real time collection of 2014 9 From 18 to April 26, 2016, the data of the collected case information were completed and the data were cleaned and logically carried out by Excel software through the medical department of the bones and joints of the Wangjing Hospital, the two families of the bone joints, the three families of bone joints, the four families of bone joints and the integrated orthopedics department of the Chinese Academy of Chinese medicine. Verification, form the syndrome information matrix. Based on the data mining platform of the Guanganmen Hospital of Chinese Academy of science of traditional Chinese medicine (Chinese Academy of Chinese Medicine) data analysis and analysis, the distribution frequency of each disease is calculated (the frequency of each disease = the quantitive sum / sample amount of each disease, *100%), taking the traditional Chinese medicine symptoms higher than or equal to 5% of the distribution frequency, and using the SPSS24.0 software system to cluster analysis The characteristics of syndromes are summarized, and Liquorice complex network is used to analyze the association between the syndromes, form the classification group of syndrome information, summarize the main symptoms and concurrent symptoms, according to the classification and code of the TCM syndrome and the code (GB/T15657-1995), the basic theory of traditional Chinese medicine (GB/ T20348-2006), the standard of TCM syndrome diagnosis effect (ZY/T001.1.94), and the combination of traditional Chinese medicine (TCM), and the TCM syndrome diagnosis effect standard (ZY/T001.1.94). Expert argument in the field of Department of orthopedics and TCM syndrome, reach the consensus of experts, form the judgement and description of syndrome, and then form the syndrome characteristics of KOA, classify the syndromes of the disease, and provide the science based on evidence-based medicine and a unified reference basis. The results are: 1 included in 803 cases of outpatient or hospitalized cases, and eliminated according to the elimination standard. 27 cases were included, including 776 cases, 166 male and 610 female. The ratio of male and female was 1:3.67, the minimum age was 22 years, the maximum age was 92 years old. The average age was 61.26 + 11.53 years old, and the average age was 61.26 + 11.53 years old. SPSS24.0 cluster analysis and principal component analysis were used to get three groups of syndrome information groups: G1 group (blood stasis blocking): double lower limbs muscle atrophy, tongue bottom vein color red, tortuous and labor. After tired fever, white and white, tongue red, dizziness, pulse, and greasy.G2 group (cold dampness stagnation): lower extremities, lower limbs cold, low back and knee soft, weakness of the lower limbs, pain, pain, cold, pulse, pulse, fat and big.G3 group (liver and kidney deficiency): night sweats, moss white, lingual red,.3 use frequency statistics method based on the weight of the three major syndrome information weights included Group cases were classified as group G1 (482 cases) based on G1 syndrome information, G2 group with G2 syndrome information as the main group (208 cases) and group G3 (11 cases) based on G3 group syndrome information. Statistical analysis found that the group cases were mostly syndromes, and the weight phase of each group of syndromes were classified as G4 group (75 cases) with Liquorice complex network analysis. According to the results of cluster analysis, the main symptoms and syndromes of each group were formed by experts in the field of bone science of traditional Chinese medicine and TCM syndrome. According to the main symptoms, signs, tongue and pulse images of group G4 and combined with clinical, it was classified into group G3, and the syndromes of 776 cases of KOA patients were diagnosed as syndromes and the main syndromes were classified as blood stasis. The main blood closed obstruction was the most, accounting for 62.11%, 26.80% of the cold dampness stagnation, with the liver and kidney deficiency mainly in 11.08%. research conclusion: 1 knee osteoarthritis syndromes were mainly divided into blood stasis closure, cold dampness stagnation and three kinds of liver and kidney deficiency, among which the most common type of.2 knee osteoarthritis was syndrome phase and the main syndrome was main syndrome. And see his identification of the three main syndromes of.3 knee osteoarthritis: stagnation of the knee, stiff joints and pain. The tongue is dark red, the tongue is thin, and the bottom of the tongue is tortuous, pulse or pulse. The cold dampness and stagnation: knee pain or distending pain, bad flexion and extension, poor lower limb, heavy lower limbs, aggravation after wind and cold dampness, cold, waist The knee is soft, the tongue is pale and greasy, the vein is moistening or the pulse is late. The liver and kidney deficiency type: the knee is hidden pain, the flexion and extension are unfavorable, the waist and the knees are soft, the dizziness, the tinnitus, or the sweating, the tongue light red, the thin tongue and the vein. The symptoms of the KOA patients can be judged better by the clinicians in the process of diagnosis and treatment. A theoretical basis for reference.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

【参考文献】