特发性疲劳证候要素应证组合及疲劳数字化评定量表研究

发布时间：2018-06-21 18:38

本文选题：特发性疲劳 + 证候要素　；参考：《中国中医科学院》2016年硕士论文

【摘要】：特发性疲劳以神疲、乏力为主要症状,不伴有器质性疾病,严重影响患者的生活及工作质量、社交活动。目前对于特发性疲劳,西医并无特效治疗,中医对其治疗有一定优势。为进一步提高对特发性疲劳的防治水平,我们对证候要素及应证组合、疲劳评价方法、中医治疗的疗效影响因素进行了研究。目的：研究特发性疲劳的临床(证候要素及其应证组合)特点,制定疲劳数字化评定量表并通过在临床研究中试用评价量表的临床应用价值。方法：1.特发性疲劳证候要素应证组合研究：收集2010年至2013年我院疲劳门诊患者就诊资料,共268例,提取其中的证候要素,采用聚类方法分析证候要素的应证组合。2.疲劳数字化评定量表研究：参考疼痛量表制定包括体力、记忆力及精神三个维度的疲劳数字化评定量表,采用流调方式对142例样本进行调查,同时用FS-14量表作为金标准进行量表评估,研究疲劳数字化评定量表的敏感度、特异度、准确度及信度情况。3.疲劳数字化评定量表临床应用评价：在课题组疲劳症的随机双盲安慰剂对照临床试验中采用本量表进行疗效评价。试验共纳入特发性疲劳患者90例,按照2：1随机分为试验组与对照组,辨证试验组60例,对照组30例,试验组给予中药口服,对照组给予安慰剂口服(成分为试验组1/20的药物),在使用FS-14量表、中医症状积分进行疗效评价的同时采用疲劳数字化评定量表进行疗效评价,分析以上不同评价方法的疗效影响因素,FS-14量表与疲劳数字化评定量表在评价疗效方面的相关性。结果：1.特发性疲劳证候要素应证组合研究结果：268例特发性疲劳男性170例,女性98例,平均年龄33.75±8.46岁。共提取8个证候要素,出现频数由高至低分别为：气滞246例(91.79%)、气虚236例(88.06%)、火热180例(67.16%)、阴虚85例(31.72%)、血虚40例(14.93%)、阳虚35例(13.06%)、痰33例(8.58%)、血瘀20例(7.46%)；分别按三分类、四分类、五分类的聚类分析,分3类时,聚类结果为气滞化火兼气虚162例、痰热郁滞兼气虚22例、气机郁滞兼气虚84例；分4类时,聚类结果为气滞化火兼气虚痰阻34例、气滞化火兼气虚119例、气滞化火气阴两虚83例,气滞兼气(阳)虚32例；分5类时,结果为气滞化火气虚血瘀17例、气滞化火兼气虚108例、气滞化火气阴两虚83例、气滞兼气(阳)虚30例、气滞痰郁化火30例。通过对各证候要素在每个证型中的检出率来看,气滞化火兼气虚的组合在三种分类方法中均为最高,其次是气机郁滞兼气虚,气滞化火气阴两虚。2.疲劳数字化评定量表评价结果对142例样本调查,其中男性43例,女性99例,平均年龄32.27±7.69岁。初步筛查排除引起疲劳的器质性疾病,其中FS-14量表评价符合疲劳诊断122例,健康人20例。根据约登指数初步确定疲劳数字化评定量表的评分在7分以上可诊断为疲劳。以FS-14量表作为金标准,疲劳数字化评定量表的敏感度86%,特异度65%,准确度83%。52例重测样本中,疲劳32例,非疲劳20例,结果：疲劳数字化评定量表的总分相关系数为0.83,体力值相关系数为0.729,记忆力值相关系数为0.76,精神值相关系数为0.801,FS-14量表的总分相关系数为0.666,体力值相关系数为0.801,脑力值相关系数为0.357。3.疲劳中医治疗疗效影响因素与疲劳数字化评定量表用于疗效评价试用结果对90例中医辨证治疗特发性疲劳的随机双盲安慰剂对照研究发现,试验组中医症状总积分有效率为93.3%,对照组中医症状总积分有效率为70.0%,试验组FS-14量表评分下降5.27±3.00分,中医症状积分下降16.23±7.12分,疲劳数字化评定量表积分下降6.96±3.79分,对照组FS-14量表评分下降3.80±3.23分,中医症状积分下降10.83±9.78分,疲劳数字化评定量表积分下降4.72±3.47分,试验组优于对照组(各个指标P值0.05)。疗效影响因素：中医症状疗后积分下降值、疲劳数字化评定量表疗后积分下降值,FS-14量表疗后积分下降值,均和组别(治疗方法)、自身基线相关。疲劳数字化评定量表与FS-14量表疗效评定结果相关性分析发现,疲劳数字化评定量表与FS-14量表总分相关性较好r=0.624,体力相关性较好r=0.644,脑力相关性较低r=0.296。结论：1.特发性疲劳的证候要素,出现频数较高的有以下八种,由高至低排序为：气滞、气虚、火热、阴虚、血虚、阳虚、痰、血瘀。通过对各证候要素在每个证型中的检出率来看,以气滞化火兼气虚的组合出现次数最高,其次是气机郁滞兼气虚、气滞化火气阴两虚。2.疲劳数字化评定量表的诊断能力较好,确定7分以上为其诊断值。疲劳数字化评定量表重测信度高于FS-14量表,说明前后一致性较好,通过与以FS-14量表为金标准的诊断结果分析,疲劳数字化评定量表具备较高敏感度和准确度,疲劳数字化评定量表与FS-14量表在总分及体力分方面的相关性较好。初步研究结果可以用于临床疲劳的初筛与疗效评定。3.中药治疗特发性疲劳,中药试验组疗效明显优于对照组,服药后患者SDS、 SAS、FS-14量表、疲劳数字化评定量表评分均有显著下降,且与中医症状改善存在相关性。中医症状积分、疲劳数字化评定量表积分、FS-14量表积分疗效受治疗分组及自身基线的影响。
[Abstract]:Idiopathic fatigue is the main symptom of fatigue and fatigue as the main symptom, without organic disease, which seriously affects the life and work quality of the patients and social activities. At present, there is no special treatment for the patients with idiopathic fatigue, western medicine has certain advantages. In order to further improve the prevention and treatment of idiopathic fatigue, we have the syndrome factors and evidence. Combination, the method of fatigue evaluation and the influencing factors of the curative effect of traditional Chinese medicine. Objective: To study the characteristics of the clinical (syndrome elements and combination) of the idiopathic fatigue, to formulate the fatigue digital rating scale and to try the clinical value of the evaluation scale through the clinical study. Method: 1. syndromes of idiopathic fatigue syndrome should be confirmed. Combined study: a total of 268 patients were collected from 2010 to 2013 in our hospital's fatigue outpatient clinic. A total of 268 cases were collected, and the syndrome factors were extracted. The data of the syndrome factors were analyzed by clustering method. The fatigue digital assessment of three dimensions, including physical strength, memory and spirit, was made by the reference pain scale. Table, 142 samples were investigated by flow modulation, and the FS-14 scale was used as the gold standard. The sensitivity, specificity, accuracy and reliability of the fatigue digital rating scale were evaluated by the.3. fatigue digital assessment scale: a randomized, double-blind, placebo-controlled clinical trial of group fatigue. A total of 90 patients with idiopathic fatigue were included in the test. According to 2:1, the test group was randomly divided into the experimental group and the control group. The test group was divided into the experimental group and the control group, the test group was 60 cases, the control group was 30 cases, the experimental group was given the Chinese medicine orally, the control group was given the placebo orally (the component was the test group 1/20), and the symptom score of the Chinese medicine was used in the FS-14 scale. At the same time, the effectiveness evaluation was evaluated by the fatigue digital rating scale, and the effect factors of the different evaluation methods were analyzed. The correlation between the FS-14 scale and the fatigue digital rating scale in the evaluation of the curative effect. Results: 1. the results of the combined study on the syndrome factors of idiopathic fatigue syndrome: 268 cases of idiopathic fatigue men, 170 cases, A total of 98 women, with an average age of 33.75 + 8.46 years, extracted 8 syndrome factors, including 246 cases of Qi Stagnation (91.79%), 236 cases of qi deficiency (88.06%), 180 cases (67.16%), 85 cases of yin deficiency (31.72%), 40 cases of blood deficiency (14.93%), phlegm cases, blood stasis and blood stasis. The cluster analysis was divided into 3 categories: 162 cases of qi stagnation and Qi deficiency, 22 cases of phlegm stagnation and Qi deficiency, 84 cases of qi stagnation and Qi deficiency, 34 cases of qi stagnation and Qi deficiency, 34 cases of qi stagnation and Qi deficiency, 119 cases of qi stagnation and Qi deficiency, 83 cases of qi stagnation and two deficiency, 32 cases of qi stagnation and two deficiency and 32 cases of qi stagnation and Qi deficiency (yang deficiency), and qi stagnation in 5 categories when the result was qi stagnation. 17 cases of qi deficiency and blood stasis, 108 cases of qi stagnation and Qi deficiency, 83 cases of qi stagnation and two deficiency of Qi Yin, 30 cases of qi stagnation and Qi deficiency (Yang) deficiency and 30 cases of qi stagnation and phlegm depression and 30 cases, the combination of qi stagnation fire and Qi deficiency in each syndrome type is the highest among the three kinds of classification methods, followed by qi stagnation and Qi deficiency and qi stagnation. The results of the.2. fatigue digital rating scale were investigated in 142 cases, including 43 males and 99 females, with an average age of 32.27 + 7.69 years. Preliminary screening eliminated organic diseases causing fatigue, of which the FS-14 scale was consistent with 122 Fatigue Diagnosis and 20 healthy persons. The quantitative table was diagnosed as fatigue at more than 7 points. The FS-14 scale was used as the gold standard, the sensitivity of the fatigue digital assessment scale was 86%, the specificity was 65%, the accuracy was 65% in the 83%.52 sample, 32 cases of fatigue and 20 non fatigue. The results were: the total correlation coefficient of the fatigue digital rating scale was 0.83, the correlation coefficient of physical strength was 0.729, memory was 0.729. Memory The correlation coefficient of the force value is 0.76, the correlation coefficient of the mental value is 0.801, the total score correlation coefficient of the FS-14 scale is 0.666, the correlation coefficient of the physical value is 0.801, the correlation coefficient of the mental value is the influence factor of 0.357.3. fatigue in the treatment of Chinese medicine and the fatigue digital rating scale for the treatment of the curative effect of 90 cases of idiopathic fatigue in the treatment of 90 cases of TCM syndrome differentiation. The randomized double blind placebo-controlled study found that the total effective rate of TCM symptom score was 93.3% in the experimental group, the total effective rate of TCM symptoms in the control group was 70%, the FS-14 scale in the experimental group decreased by 5.27 + 3, the symptom score of Chinese medicine was 16.23 + 7.12, the integral of the fatigue digital assessment scale decreased by 6.96 + 3.79, and the control group was evaluated by the FS-14 scale. The score dropped by 3.80 + 3.23 points, the score of TCM symptom decreased by 10.83 + 9.78 points, and the integral of fatigue digital rating scale decreased by 4.72 + 3.47 points. The experimental group was superior to the control group (each index P value 0.05). The influence factors of the curative effect: the integral descending value after the symptom treatment of Chinese medicine, the drop value of the fatigue digital assessment scale after the treatment, and the decrease of the integral after the treatment of the FS-14 scale, The correlation analysis between the fatigue digital assessment scale and the FS-14 scale results showed that the correlation between the fatigue digital rating scale and the total score of the FS-14 scale was better r=0.624, the physical correlation was better r=0.644, and the mental correlation was lower r=0.296. conclusion: 1. syndrome factors of idiopathic fatigue, The high to low frequency of the following eight kinds, from high to low order: Qi stagnation, Qi deficiency, heat, yin deficiency, blood deficiency, Yang deficiency, phlegm, blood stasis. Through the detection rate of each syndrome factor in each type of syndrome, the combination of qi stagnation and Qi deficiency is the highest, followed by qi stagnation and Qi deficiency, qi stagnation and two deficiency of.2. fatigue numbers. The diagnostic ability of the scale was better than that of the FS-14. The retest reliability of the fatigue digital rating scale was higher than that of the FS-14 scale, and the consistency was better. The fatigue digital assessment scale had higher sensitivity and accuracy and the fatigue digital rating scale was higher than the results of the FS-14 scale as the gold standard. The correlation of the total score and the physical strength of the FS-14 scale was better. The preliminary results could be used for the initial screening and evaluation of clinical fatigue..3. was used to treat idiopathic fatigue. The effect of the Chinese medicine test group was obviously superior to the control group. The scores of SDS, SAS, FS-14 and the fatigue number character rating scale were significantly decreased. There was correlation between improvement of medical symptoms. TCM symptom score, fatigue digital rating scale, and FS-14 scale integral curative effect were influenced by treatment group and baseline.
【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】：2016
【分类号】：R259

【相似文献】