脾虚证微观指标同步检测及其与症状相关性研究

发布时间：2018-06-15 14:13

本文选题：脾虚证 + 唾液淀粉酶活性比值　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:在以往脾虚证计量化诊断和微观辨证研究的基础上,将脾虚患者通过"脾虚证诊断计分表"得到的诊断分值、"脾虚证四诊资料登记表"积分值与"唾液淀粉酶活性比值(salivaryalpha-amylase,sAA)"及"尿木糖排泄率"两个脾虚证经典微观指标进行相关分析,将脾虚证主要的症状与经典微观指标进行多元线性回归分析,得出特定的症候组合,以探讨脾虚证主客观指标之间的关系,以促进宏观辨证与微观辨证的结合。方法:一、文献研究:通过查阅、分析整理资料,对"唾液淀粉酶活性比值"及"尿木糖排泄率"与脾虚证之间的既往研究资料进行整理。二、临床试验研究:(一)本研究病例来自于广州中医药大学第一附属医院脾胃病科门诊及住院部就诊的患有慢性浅表性胃炎(chronic superficial gastritis,CSG)且中医辨证为脾虚证的患者。(二)制定"脾虚四诊资料的登记表",仔细记录纳入研究患者的症状以及体征,并根据"脾虚证诊断计分表"对其进行量化评分。(三)对纳入研究的脾虚患者进行唾液、尿液样本的采集,并及时按照实验步骤及方法进行"唾液淀粉酶活性比值"及"尿木糖排泄率"的检测工作。(四)用IBM SPSS Statistics Version 19.0统计软件对收集的临床、实验室数据进行分析处理。对年龄比较采用单因素方差分析,性别比较采用卡方检验。对脾虚证主要症状进行聚类分析,将一组数据按照本身的内在规律较合理的分为几类,使数据分析结果更具客观性;将脾虚证诊断计分值及四诊资料积分结合两个经典微观指标进行相关分析,求出相关系数,以表现变量之间数量变化的相关程度;对脾虚证主要症状结合两个经典微观指标进行多元逐步回归分析,由多个自变量的最优组合共同来预测或估计因变量,求出回归系数及回归方程,并进行相关系数的显著性检验。结果:一、聚类分析结果:"脾虚四诊资料的登记表"的症状组合中:形寒肢冷、食欲减退、大便稀烂、胃痛、肢体倦怠、脘胀这八个症状可聚为一类,性质比较接近,而嗳气、泛酸、口干口苦、痛连两胁这四个症状未能与上述典型脾虚表现聚成一类,考虑不同的虚实证候,其内在规律的不同而不能聚成一类。二、相关分析结果:sAA活性比值与尿木糖排泄率呈正相关,有统计学差异;脾虚诊断计分与四诊资料积分呈显著正相关,有统计学差异;两个微观指标与脾虚证诊断计分值有一定的线性关系,但无统计学差异;两个微观指标与四诊资料积分均呈负相关,有统计学差异。体现两个经典的微观指标在脾虚证的诊断及对病情的评估上有一定的临床意义。三、多元逐步回归结果:脾虚患者sAA活性比值与脾虚主要症状中的脘胀、肢体倦怠、食欲减退关系较为密切,呈负相关,提示随sAA活性比值下降,脾虚患者更容易出现脘胀、肢体倦怠、食欲减退的症状;脾虚患者尿木糖排泄率与脾虚主要症状中的嗳气、食欲减退、腹痛绵绵关系较为密切,呈负相关,提示随木糖排泄率下降,提示脾虚患者更容易出现嗳气、食欲减退、腹痛绵绵的症状。结论:一、聚类分析结果显示:脾虚患者中肢体倦怠、大便稀烂、恶心、形寒肢冷、食欲减退、胃痛、脘胀这八个症状可聚为一类,均为脾虚失运,脾阳不足的体现,而嗳气、泛酸、口干口苦、痛连两胁这四个症状未能与前面症状聚成一类,且均为肝胃不和之体现,提示脾虚患者中,不同的虚实证候表现不能聚成一类。二、相关分析结果显示:(一)sAA活性比值与尿木糖排泄率呈正相关,说明大部分脾虚患者,sAA活性比值与尿木糖排泄率均有不同程度的下降,符合既往研究结果,提示脾虚患者的两个微观指标存在一定的内在联系;(二)脾虚诊断计分值与四诊资料积分呈显著正相关,说明该表对脾虚证的诊断有较高的准确性、敏感性、特异性之余,其分值对临床患者病情的评估有一定的借鉴意义,同时提示该表选定的脾虚症状指标较为典型;(三)sAA活性比值、尿木糖排泄率两个微观指标与脾虚证诊断计分值有一定的线性关系,但无统计学差异;(四)sAA活性比值、尿木糖排泄率两个微观指标与四诊资料积分均呈负相关,有统计学差异,提示随着两个微观指标的下降,患者症状积分增高,脾虚的程度逐步加重,可初步窥探出两个微观指标在脾虚患者中的诊断意义及等级相关关系,也反映了脾虚患者脾胃虚损的一面。三、多元逐步回归结果显示:(一)脾虚患者sAA活性比值与脾虚主要症状中的脘胀、肢体倦怠、食欲减退关系较为密切,呈负相关,提示脘胀、肢体倦怠同时出现时,更能反映sAA活性比值的变化,即sAA比值越小,脾虚患者越容易表现出脘胀、肢体倦怠、食欲减退的症状。(二)脾虚患者尿木糖排泄率与脾虚主要症状中的嗳气、食欲减退、腹痛绵绵关系较为密切,均呈负相关,提示尿木糖排泄率越低,脾虚患者越容易出现嗳气、食欲减退、腹痛绵绵的症状。考虑无论是副交感神经的偏亢致使脾虚患者应急能力低下,还是因患者小肠吸收能力低下,在广泛的脾虚范畴中,均可致脾运化失职的诸多表现。
[Abstract]:Objective: on the basis of quantitative diagnosis and microscopic syndrome differentiation of spleen deficiency syndrome, the diagnosis score of spleen asthenia patients through the "score table of spleen deficiency syndrome diagnosis", "salivaryalpha-amylase, sAA" and "urine sugar excretion rate" are the two classic microscopic indexes of spleen deficiency syndrome The main symptoms of spleen deficiency syndrome and the classic microscopic index were analyzed by multiple linear regression analysis to obtain the specific syndrome combination to explore the relationship between the subjective and objective indexes of the spleen deficiency syndrome, and to promote the combination of the macroscopic syndrome differentiation and the microscopic syndrome differentiation. Sex ratio "and" and "urine sugar excretion rate" between the previous study of the spleen deficiency syndrome. Two, clinical trial study: (1) the case from the First Affiliated Hospital of the Guangzhou University of Chinese Medicine, the spleen and stomach department outpatient and inpatient department of the patients with chronic superficial gastritis (chronic superficial gastritis, CSG) and the TCM syndrome differentiation of the spleen Patients with deficiency syndrome. (two) establish a "Registration Form for the four diagnosis of spleen deficiency syndrome", carefully record the symptoms and signs of the patients studied, and carry out quantitative score according to the "spleen deficiency syndrome diagnosis score scale". (three) take saliva and urine samples for the spleen asthenia patients in the study, and carry out "saliva starch" in time according to the experimental procedures and methods. Enzyme activity ratio "and" urine sugar excretion rate "detection work. (four) use IBM SPSS Statistics Version 19 statistical software to analyze the collected clinical data and laboratory data. The age comparison of single factor analysis of variance, sex comparison with chi square test. The main symptoms of spleen deficiency syndrome were cluster analysis, a group of data according to the data The inherent laws of the system are divided into several kinds, which make the result of data analysis more objectivity, and combine the score of the spleen deficiency syndrome diagnosis and the four diagnosis data integral combined with two classical microscopic indexes to analyze the correlation coefficient to show the correlation degree between the variable number of variables, and to combine the main symptoms of the spleen deficiency syndrome with two classical microscopes. Multiple stepwise regression analysis was carried out. The regression coefficient and regression equation were obtained from the optimal combination of multiple independent variables. The regression coefficient and regression equation were obtained and the correlation coefficient was tested. The eight symptoms of pain, body tiredness and distention can be grouped into one class, and the properties are close, and the four symptoms of belching, pantothenic acid, dry mouth, pain and two flank can not come together with the typical spleen deficiency, considering the different syndromes of deficiency and reality, and their internal rules can not be grouped into a class. Two, the correlation analysis results: sAA activity ratio and urine wood There was a positive correlation between the sugar excretion rate and the statistical difference. There was a significant positive correlation between the diagnosis score of spleen deficiency and the data integral of four diagnosis. There was a linear relationship between the two micro indexes and the score value of the spleen deficiency syndrome diagnosis, but there was no statistical difference. The two micro indexes were negatively correlated with the four diagnosis material integral, and there were two statistical differences. The classical microcosmic index has certain clinical significance in the diagnosis of spleen deficiency syndrome and the evaluation of the disease. Three, multiple stepwise regression results: the ratio of sAA activity to spleen asthenia is more closely related to the main symptoms of spleen deficiency, the relationship between the body burnout and anorexia is more closely related, the ratio of the sAA activity decreases, and the spleen asthenia is more likely to appear in the stomach. The symptoms of swelling, burnout and loss of appetite; the urine sugar excretion rate of the spleen asthenia and the main symptoms of spleen asthenia in the main symptoms of belching, anorexia and abdominal pain are more closely related, showing a negative correlation with the decrease of the excretion rate of xylose, suggesting that the patients with spleen deficiency are more likely to appear belching, anorexia and abdominal pain. In the patients with spleen deficiency, the eight symptoms of body burnout, stool, nausea, cold limb cold, anorexia, stomachache and distention can be gathered into one class, which are the embodiment of spleen deficiency and spleen yang deficiency, and the four symptoms of belching, pantothenic acid, dry mouth and two flank symptoms fail to come together with the front symptoms, and all are the manifestation of liver stomach disharmony, suggesting spleen asthenia. In the patients, the symptoms of different deficiency and solid syndromes could not be gathered into a class. Two, the results of correlation analysis showed that (1) the ratio of sAA activity was positively correlated with the excretion rate of urine xylose, indicating that the ratio of sAA activity and urinary xylose excretion rate decreased in most of the spleen asthenia patients, which accords with previous research results, suggesting that the two microscopic indexes of spleen asthenia are stored. (two) there is a significant positive correlation between the score of the spleen deficiency diagnosis and the integration of the four diagnosis data, which indicates that the table has a high accuracy, sensitivity and specificity for the diagnosis of spleen deficiency syndrome, and the score has certain reference significance for the evaluation of the clinical patient's condition. (three) the index of spleen deficiency symptoms selected in the table is more typical. There was a linear relationship between the sAA activity ratio and the two microcosmic indexes of urine xylose excretion rate and the score of the spleen deficiency syndrome diagnosis, but there was no statistical difference. (four) the ratio of sAA activity, the two microscopic indexes of urine xylose excretion rate were negatively correlated with the four diagnosis data integral, and there were statistical differences, suggesting that with the decrease of the two microscopic indexes, the symptom integral of the patients was marked. The degree of spleen deficiency increased gradually, and the diagnostic significance and grade correlation of the two microscopic indexes in spleen asthenia were detected, and the deficiency of spleen and stomach in spleen asthenia patients was also reflected. Three, multiple stepwise regression results showed: (1) sAA activity ratio of spleen asthenia with spleen asthenia in the main symptoms of abdominal distention, body burnout, anorexia. The relationship is more close and negative correlation, suggesting that the abdominal distention, when the body burnout simultaneously appears, can reflect the change of the sAA activity ratio, that is, the smaller the ratio of sAA, the more easily the spleen asthenia patients show the symptoms of abdominal distention, burnout, and anorexia. (two) the urine sugar excretion rate of spleen deficiency patients and the main symptoms of spleen asthenia, anorexia and abdominal pain continuous pass. The lower the urinary xylose excretion rate, the lower the urine sugar excretion rate, the more easy the patients with spleen deficiency to appear belching, anorexia and abdominal pain. Considering whether the hyperactivity of the parasympathetic nerve causes the low emergency ability of the spleen asthenia, or the low intestinal absorption capacity of the patients, it can cause the loss of spleen in the spleen deficiency. Many performance of the job.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R241

【参考文献】