基于数据挖掘方法的慢性胃炎脾胃湿热证量化诊断标准研究

发布时间：2018-05-28 01:22

本文选题：慢性胃炎 + 脾胃湿热证　；参考：《湖北中医药大学》2016年博士论文

【摘要】：目的:通过对现代文献中慢性胃炎证型,慢性胃炎脾胃湿热证临床症状、舌象、脉象、方剂、药物、药物加减等资料的数据挖掘。研究慢性胃炎脾胃湿热证的证候特点,并以药测证、以方测证,探讨病证结合模式下脾胃湿热证的辨证规律。临床上通过对全国6所医院慢性胃炎流行病学(饮食偏好、诱发因素)、一般情况(病程、加重时间)和临床证候(症状加重时间、症状、舌质、舌苔),胃镜像、幽门螺旋杆菌等数据挖掘,为慢性胃炎脾胃湿热证量化诊断标准的研究提供佐证依据。方法:慢性胃炎包括慢性萎缩性胃炎、慢性浅表性胃炎、慢性糜烂性胃炎、胆汁反流性胃炎、慢性胃炎(胃痞)、幽门杆菌相关性胃炎。收集以“慢性胃炎”为关键词并包含“脾胃湿热证”的所有文献。收集文献资料中慢性胃炎的病例来源省份、研究病例数、男女病例数,辨证分型及相应的病例数;慢性胃炎脾胃湿热证的临床症状、舌象、脉象、方剂、药物、药物加减进行统计,并对以上指标的称谓进行统一。用Liquorice软件对其以上资料进行频次、节点度、紧密度统计,进行聚类分析、关联分析。临床上,采集2014年6月~2015年6月全国6所医院(武汉、北京、厦门、盐城、合肥、成都)消化内科门诊和住院的慢性胃炎患者600例。按照慢性胃炎西医诊断标准,中医脾胃湿热证辨证标准及临床纳入标准,随机选择病例纳入脾胃湿热证组,其余病例均归入非脾胃湿热病组。首先用Epi Data软件建立数据库,进行数据处理,并转换为SPSS数据库文件。用SPSS20.0软件对数据进行处理和分析,采用多重响应分析探究各数据间的频次、交叉相互关系;用多项多元logistic回归分析比较之间的拟合度,K均值聚类分析进行分类比较。结果:文献数据挖掘中,慢性胃炎中脾胃虚寒证出现频次最高,其次为肝胃郁热证和脾胃湿热证,明显较其他证型高。各证型中发病病例数,肝胃郁热证最高,为23%,脾胃虚弱证为22%,脾胃湿热证为16%,三证型总计61%。慢性胃炎脾胃湿热证症状,出现频次最高的为口苦。频次在100以上的症状由高到低依次为:口苦、胃脘痞满、尿黄、胃脘胀痛、口臭、恶心、胃脘灼热、纳呆、大便溏。频次在50~100之间的症状由高到低依次为:胃脘疼痛、呕吐、口渴少饮、口粘腻、肢体困重。慢性胃炎脾胃湿热证脉象中,脉滑频次最高,为97次,由高到低依次是脉滑数、脉濡数、脉弦、脉弦滑、脉濡缓、脉数。舌象上,总频度最高的为舌质红,为243次,舌苔黄腻为189次,舌苔黄厚为109次,舌苔腻为91次,舌边尖深红为63次。慢性胃炎脾胃湿热证选用方剂由高到低依次为:连朴饮、半夏泻心汤、黄连温胆汤、三仁汤、藿朴夏苓汤、清化饮。药物使用率最高的药物为黄连,频次为244次。频次在100以上的药物由高到低依次为半夏、厚朴、甘草、茯苓、黄芩、陈皮、蒲公英。频次在50~100之间由高到低依次为:薏苡仁、藿香、蔻仁、苍术、枳壳。清热化湿类药物在各慢性胃炎脾胃湿热证中大量选用,黄连、半夏、厚朴、茯苓、甘草、蒲公英均有较高的使用。瓦楞子、厚朴、薏苡仁、竹茹、蛇舌草、苍术、莱菔子、佩兰、陈皮、莪术、砂仁、代赭石、枳实、蒲公英、白术等药物在慢性胃炎脾胃湿热证药物加减上针对性强,使用率高,疗效好。瓦楞子针对反酸症状使用率最高,配合乌贼骨;延胡索针对疼痛选用率最高,常与川楝子配合;大便秘结时大黄使用最高,恶心呕吐竹茹、生姜配合;纳呆麦芽、鸡内金、神曲、谷芽使用率高,厚朴对胀满效果好。湿偏甚藿香、苍术、佩兰使用率高、热偏甚蒲公英、黄芩使用率高。各慢性胃炎脾胃湿热证发病率广东、北京、江苏、福建、山东高于全国其他地区,其频次均在35次以上。临床上,病程在2~5年的患者中多以脾胃湿热证为主,加重时间多在2周内。慢性胃炎脾胃湿热证的饮食偏好上,主要是以辛辣刺激食物最为常见,占74.4%,其次为油腻饮食、腌制食品,分别占73.4%和64.5%。饮酒、饭后症状明显加重,个案占比分别为68.2%、64.2%。下午症状更为明显,个案占比为61.7%。慢性胃炎脾胃湿热证症状频次中,脘腹胀满占75.9%,肢体困重占65.0%,口苦为58.1%。慢性胃炎脾胃湿热证舌色占比中,舌质红62.6%,舌尖红为49.8%;舌质形体上点刺舌为73.4%,舌体胖为37.4%,舌质老为30.0%。舌质红、舌尖红、点刺舌经卡方检验有显著的统计学意义(P0.05)。慢性胃炎脾胃湿热证舌苔颜色上,黄苔占63.0%,白苔为26.1%。舌苔分布部位个案占比上,舌根部为86.2%,舌质红为62.6%。舌苔的多项多元logistic回归分析,参数估计P0.05的有舌苔黄、苔腻。慢性胃炎脾胃湿热证组中热重于湿的证候个案占比大于50%以上的主要有点刺舌为73.4%,舌苔黄63.5%,舌质红62.6%,口苦为58.1%。慢性胃炎脾胃湿热证组中湿重于热的证候中,个案占比大于50%以上的主要有舌苔腻78.3%,点刺舌为73.4%,舌苔黄63.5%,肢体困重65.0%,便溏51.2%。慢性胃炎脾胃湿热证组中湿热并重的证候中,个案占比大于50%以上的主要有舌苔厚79.8%,舌苔腻78.3%,点刺舌为73.4%,舌苔黄63.0%,口苦58.1%。慢性胃炎脾胃湿热证组中,慢性浅表性胃炎占86.2%,伴糜烂占71.9%,粘膜红白相间,以红为主占86.2%。在各慢性胃炎脾胃湿热证,症状主要有口苦、胃脘痞满、尿黄、胃脘胀痛、口臭、恶心、胃脘灼热、纳呆、大便溏;脉象上主要有脉滑数、脉滑、脉濡数;舌象上表现为舌质红或舌边尖深红,苔黄腻或黄厚或腻。结论:文献研究中慢性胃炎各证型中肝胃不和证(肝郁气滞证和肝胃郁热证)脾胃虚弱证脾胃湿热证,以上证型的发病病例数占慢性胃炎中医证型的70%。慢性胃炎脾胃湿热证的症状由高到低依次为:口苦、胃脘痞满、尿黄、胃脘胀痛、口臭、恶心、胃脘灼热、纳呆、大便溏,胃脘疼痛、呕吐、口渴少饮、口粘腻、肢体困重。脉象由高到低依次为:脉滑、脉滑数、脉濡数、脉弦、脉弦滑、脉濡缓、脉数。舌象由高到低依次为:舌质红、舌苔黄腻、舌苔黄厚、舌苔腻、舌边尖深红。慢性胃炎脾胃湿热证临床常选用方剂由高到低依次为:连朴饮、半夏泻心汤、黄连温胆汤、三仁汤、藿朴夏苓汤、清化饮。药物使用由高到低依次为:黄连、半夏、厚朴、甘草、茯苓、黄芩、陈皮、蒲公英、薏苡仁、藿香、蔻仁、苍术、枳壳。药物加减中由高到低依次为:竹茹、瓦楞子、大黄、苍术、生姜、延胡索、佩兰、旋覆花、蒲公英。各慢性胃炎脾胃湿热证发病率广东、北京、江苏、福建、山东高于全国其他地区。临床研究中病程在2~5年的患者中多以脾胃湿热证为主,加重时间多在2周内。慢性胃炎脾胃湿热证的饮食偏好上主要是以辛辣刺激食物最为常见,其次为油腻饮食、腌制食品。饮酒、症状明显加重,下午症状更为明显。在慢性胃炎脾胃湿热证主要症状中,慢性胃炎中频次由高到低依次为:脘腹胀满胃脘疼痛嗳气烧心感食少纳呆便溏不爽肢体困重口苦睡眠差呃逆大便秘结反酸口臭口渴少饮胃中嘈杂恶心欲吐胸闷小便黄。最终筛选出百分率50%及具有统计学意义的条目作为慢性胃炎脾胃湿热证诊断量表内容,确定出:1脘腹胀满、2肢体困重、3口苦、4口渴少饮、5口臭、6便溏不爽、7嗳气、8睡眠差,以上8项症状为慢性胃炎脾胃湿热证的相关因素。综合文献和临床研究,制定以下慢性胃炎脾胃湿热证量化诊断内容,主要包括慢性胃炎的特异症状、慢性胃炎临床症状严重程度分级、脾胃湿热证证候的轻重程度量化。确定主要证候依次为:1胃脘胀满或胃脘胀痛或胃脘灼热疼痛或胃脘隐痛(特异症状),2肢体困重,3口苦,4口渴少饮,5口臭,6便溏不爽,7纳呆,8舌边尖红伴点刺、舌体胖;或舌边尖红伴点刺舌质老;9舌根部苔黄厚;或舌根部苔黄腻;或舌根部苔黄厚腻;或舌中后部苔黄厚;或舌中部、根部苔黄腻;或舌中后部苔黄厚腻10脉象上主要有脉滑数,或脉滑,或脉濡数。具备18910,即慢性胃炎特异性症状一项加舌象、脉象可诊断慢性胃炎脾胃湿热证。慢性胃炎临床症状严重程度分级(参考表2-1)。脾胃湿热证证候的轻重程度分级:1轻度为舌边尖红伴少许点刺,舌根部苔黄腻;2中度为舌边尖红伴点刺,舌根部苔黄厚腻,或舌中后部苔薄黄腻;或舌边尖红舌体胖,舌根部苔厚腻。3重度为舌边尖红绛伴明显点刺,舌质老,舌中后部苔黄厚腻;或舌边尖红绛伴明显点刺,舌质老,全舌苔燥厚腻;或舌边尖红,舌体胖,舌中后部苔厚腻;或舌边尖暗红,舌体胖,舌中后部苔厚腻。
[Abstract]:Objective: through the data mining of the clinical symptoms of chronic gastritis, chronic gastritis, spleen and stomach damp heat syndrome, tongue image, pulse image, prescription, medicine, drug addition and subtraction, the characteristics of syndrome of spleen and stomach damp heat syndrome of chronic gastritis were studied, and the syndrome differentiation law of spleen and stomach damp heat syndrome under the combination pattern of disease and syndrome was investigated by the drug test. On the basis of the epidemiology of chronic gastritis (diet preference, inducing factor), general condition (course of disease, aggravation time) and clinical syndrome (symptom aggravation time, symptom, tongue quality, tongue coating), gastric image, Helicobacter pylori and other data mining in 6 hospitals of the whole country, this paper provides evidence for the study of quantitative diagnosis standard for spleen and stomach damp heat syndrome of chronic gastritis. Chronic gastritis includes chronic atrophic gastritis, chronic superficial gastritis, chronic erosive gastritis, bile reflux gastritis, chronic gastritis (stomach ruffiffy), pylorus related gastritis. The collection of "chronic gastritis" as the key word and including "spleen and stomach damp heat syndrome". The number of cases, the number of men and women, the syndrome differentiation and the number of cases, the clinical symptoms of the spleen and stomach damp heat syndrome of the chronic gastritis, the tongue image, the pulse, the prescription, the medicine, the drug addition and subtraction are unified. The frequency, the node degree, the tightness statistics, the clustering analysis and the correlation of the above data are carried out by the Liquorice software. Analysis. Clinically, 600 cases of chronic gastritis in 6 hospitals (Wuhan, Beijing, Xiamen, Yancheng, Hefei, Chengdu) were collected from 6 hospitals of the whole country in June June 2014. According to the standard of Western medicine for chronic gastritis, the syndrome differentiation standard of spleen and stomach damp heat syndrome and the inclusion criteria were included, and the random selected cases were included in the spleen and stomach damp heat syndrome group. The remaining cases were all returned to the non spleen and stomach damp heat disease group. First, the database was established by Epi Data software, and the data were processed and converted into SPSS database files. The data were processed and analyzed with SPSS20.0 software. Multiple response analysis was used to explore the frequency of each data, intersecting with each other, and compared with a number of multiple logistic regression analysis. Results: in the literature data mining, the frequency of deficiency cold of spleen and stomach in chronic gastritis was the highest, followed by liver and stomach heat syndrome and spleen and stomach damp heat syndrome, which was higher than that of other syndromes. The number of cases in each type, the highest of liver and stomach heat syndrome, 22% of spleen and stomach weakness, 16% of spleen and stomach damp heat syndrome, 16%, three of spleen and stomach damp heat syndrome, were 16%, three. The symptoms of 61%. chronic gastritis with spleen and stomach damp heat syndrome were the most frequent. The symptoms from high to low were the following: stomachache, epigastric fullness, urine yellow, stomach distending pain, halitosis, nausea, heartburn, nausea and stool. The symptoms from high to low in 50~100 were as follows: stomachache, vomiting and thirst, and thirst. In the pulse image of the spleen and stomach damp heat syndrome of chronic gastritis, the frequency of pulse slipping is the highest, 97 times, from high to low is the number of veins, the number of veins, the veins, the veins, the veins and the veins. The highest frequency of the tongue is the red tongue, the 243 times, the yellow and greasy fur of the tongue 189 times, the tongue fur of 109 times, the tongue fur 91 times, and the deep red tongue edge of 63 times. The choice of prescription from high to low in chronic gastritis and spleen and stomach damp heat syndrome is: Lian Pu Yin, Banxia Xiexin soup, Huanglian Wendan soup, San Ren Tang, poupagari soup, Qinghua drink. The highest drug use rate is 244 times. The frequency of more than 100 of the drugs from high to low is the Pinellia ternata, Magnolia officinalis, licorice, Poria, Scutellaria, Chen peel, dandelion. 50~100 from high to low in turn: coix seed, patchouli, nutmeg, Atractylodes, Fructus aurantii, hot and humid drugs in the spleen and stomach of the chronic gastritis are widely used in the spleen and stomach damp and heat syndrome, and yellow Coptis, Pinellia ternata, Magnolia officinalis, licorice, dandelion all have high use. Ochre, ochre, ochre, Fructus aurantii trifoliate, dandelion, and Atractylodes on the spleen and stomach damp heat syndrome of chronic gastritis, the use rate is high, the curative effect is good. The use rate of corrugated on antiacid symptoms is the highest, with the cuttlefish bone; the Corydalis Corydalis has the highest selection rate for pain, often with the neem seed, and the use of the highest, nausea and vomiting and bamboo Ru when the constipation is conjecting. The use rate of malt, chicken inner gold, Divine Comedy and valley bud is high, and magnolia is good. The use rate of dampness is very high, the use rate of Perrin is high, the heat is dandelion, and the use rate of Scutellaria is high. The incidence of spleen and stomach damp heat syndrome in Guangdong, Beijing, Jiangsu, Fujian and Shandong is higher than the other regions of the country. The frequency of the syndrome is more than 35 times. In 2~5 years, most patients with spleen and stomach damp heat syndrome are mainly the spleen and stomach damp heat syndrome, and the time of aggravation is more than 2 weeks. The diet preference of chronic gastritis and spleen and stomach damp heat syndrome is the most common, accounting for 74.4%, followed by greasy food, pickled food, 73.4% and 64.5%. respectively, after meals, the symptoms are obviously aggravated, the case occupation ratio is 68.2% respectively. In the afternoon, the symptoms of 64.2%. were more obvious. The cases accounted for the frequency of spleen and stomach damp heat syndrome of 61.7%. chronic gastritis, the abdominal distention was 75.9%, the body weight was 65%, the oral pain was of 58.1%. chronic gastritis and spleen and stomach damp heat syndrome, the tongue color was 62.6%, the tongue tip red was 49.8%, the tongues were 73.4%, the tongue body fat was 37.4%, and the tongue was old 30.0%.. There are significant statistical significance (P0.05) in the tongue coating test of tongue quality red, tongue tip red and puncting tongue. The color of tongue coating of spleen and stomach damp heat syndrome of chronic gastritis, Huang Taizhan 63%, white moss for 26.1%. tongue fur distribution, 86.2% of tongue root, 62.6%. tongue fur with multiple multiple logistic regression analysis, parameter estimation of P0.05 with tongue coating yellow, In the group of spleen and stomach damp heat syndrome of chronic gastritis, the main points of hot and wet syndrome were 73.4%, 63.5% of tongue fur, 63.5% of tongue and 62.6% of tongue, and the pain in the group of 58.1%. chronic gastritis and spleen and stomach damp heat syndrome in the syndrome of damp and hot in the spleen and stomach damp heat syndrome, the cases accounted for 78.3% of the main tongue coating more than 50%, 73.4% of tongue tongue and tongue coating. Yellow 63.5%, limbs heavy 65%, loose stools of 51.2%. chronic gastritis and spleen and stomach damp heat syndrome in the syndrome of damp heat and weight, the proportion of cases accounted for more than 50% of the main tongue coating thickness 79.8%, tongue fur 78.3%, 73.4% tongue coating, tongue coating yellow 63%, chronic gastritis and spleen and stomach damp heat syndrome group, chronic superficial gastritis 86.2%, accompanied by erosion of 71.9%, mucous mucous membrane, 71.9%. Mucous mucosa is 71.9%, mucous mucous mucosa with 71.9%, mucous mucous mucosa with 71.9%, mucous mucous mucosa with 71.9%, mucous mucosa with 71.9%, mucous mucosa with 71.9%, mucous mucosa with erosion of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucous mucosa with 71.9% mucous mucous mucosa. Red and white, with red mainly 86.2%. in the spleen and stomach damp and hot syndrome of the chronic gastritis, the main symptoms are stomachache, epigastric fullness, urine yellow, stomachache distention and pain, bad breath, nausea, stomach burning, nausea and stool; the veins are mainly veins slippery, vein slippery, diulence and deep red, yellowish or yellow thick or greasy. Conclusion: literature research The syndromes of chronic gastritis in various syndromes (liver qi stagnation syndrome and liver and stomach depression) syndrome of spleen and stomach damp heat syndrome, the symptoms of the above syndrome type accounted for the symptoms of chronic gastritis 70%. chronic gastritis and spleen and stomach damp heat syndrome from high to low in turn: stomachache, stomach epigastric fullness, urine yellow, stomachache distention and pain, bad breath, nausea, heartburn heat. The pulse, the pulse number, the pulse number, the pulse string, the pulse string, the pulse and the pulse number. The tongue image is red, the tongue fur is yellow, the tongue fur is yellow, the tongue fur is yellow, the tongue fur is greasy, the tongue edge is deep red. The syndrome of chronic gastritis and spleen and stomach damp heat syndrome is often used clinically. The agent from high to low is: Lian Pu Yin, Banxia Xiexin soup, Huanglian Wendan soup, three kernel soup, huppu Xia Ling soup, Qinghua drink. The use of the medicine from high to low is yellow Coptis, Pinellia ternata, Radix Glycyrrhizae, Fuling, Scutellaria baicalensis, dandelion, dandelion, coix seed, patchouli, cardamom, Atractylodes, Fructus aurantii. From high to low, from high to low, the order of medicine is bamboo Ru, corrugated, rhubarb, and Cuba. The incidence of spleen and stomach damp heat syndrome in Guangdong, Beijing, Jiangsu, Fujian and Shandong is higher than the other regions in Guangdong, Beijing, Jiangsu, Fujian and Shandong. The majority of patients in the clinical study are spleen and stomach damp heat syndrome in 2 weeks. The diet preference of chronic gastritis and spleen and stomach damp heat syndrome is mainly based on the diet preference. Spicy food is the most common food, followed by greasy food, pickled food, drinking, the symptoms are obviously aggravated, the afternoon symptoms are more obvious. In the main symptoms of chronic gastritis, spleen and stomach damp heat syndrome, the middle frequency of chronic gastritis is from high to low in the following order: stomach distention, stomach, stomach, stomach, heart, heart, heart and loose stool A total of 50% and a statistically significant item were selected as a diagnostic scale for the spleen and stomach damp heat syndrome of chronic gastritis. It was determined that 1 abdominal distention, 2 limbs heavy, 3 stomachs, 4 thirst, 5 halitosis, 6 loose stools, 7 belching, 8 sleep poor, 8 poor sleep, 8 The symptom was the related factors of spleen and stomach damp heat syndrome of chronic gastritis. Comprehensive literature and clinical study were made to make quantitative diagnosis of spleen and stomach damp heat syndrome of chronic gastritis, including the specific symptoms of chronic gastritis, classification of the severity of chronic gastritis clinical symptoms, and the severity of spleen and stomach damp heat syndrome. The main syndromes were the 1 stomach in turn. Abdominal distention or stomachache pain or heartburn pain or epigastric pain (specific symptoms), 2 limbs heavy, 3 stomachs, 4 thirst little drink, 5 halitosis, 6 loose stools, 7 nausea, 8 tongue edge sharp red with prickly, fat tongue body, or tongue sharp red with tongues old; the root part of the tongue fur thick; or the tongue root moss yellow thick; or tongue in the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the back tongue of the tongue. In the middle of the tongue, the root is yellow and greasy, or the thick and greasy tongue in the back of the tongue is thick and greasy 10 pulse, or pulse, or pulse. It has 18910, that is, a chronic gastritis with a special symptom of the tongue, the pulse can diagnose the spleen and stomach damp heat syndrome of chronic gastritis. The severity grade of chronic gastritis clinical symptom (reference table 2-1). Degree classification: 1 mild tongue edge sharp red with a little prick, the root of the tongue is yellow and greasy; 2 moderate tongue edge sharp red with prick, the root part of the tongue is thick and greasy, or the tongue is thin yellow and yellow fur; or the tongue edge sharp red tongue is fat, the tongue is thick and thick with the thick.3 for the tongue edge sharp red crimson, the tongue is old, the tongue in the back moss yellow thick greasy, or lingual sharp red and red crimson with obvious tongue side. Pricking, tongue old, full tongue coating dry thick and greasy; or tongue tip red, tongue fat, tongue in the back of the thick moss; or tongue tip dark red, tongue fat, tongue in the back of the moss thick and greasy.
【学位授予单位】：湖北中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R259

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