成人初治血液系统疾病外周全血细胞减少症中医辨证分型聚类分析

发布时间：2018-07-07 21:20

本文选题：全血细胞减少 + 聚类分析　；参考：《云南中医学院》2017年硕士论文

【摘要】：【研究目的】:本课题主要是研究外周全血细胞减少且西医诊断属血液系统疾病(排外其他系统)的成人患者。主要利用聚类分析(Cluster analysis)中的分层凝集、指标聚类研究方法,该方法是根据证候指标(症状、体征等)之间的相似程度,将性质相差比较大的归在不同类,通过分析某类患者的症候特征,运用中医整体观念、辨证分析等思维方式,脏腑辩证、八纲辩证等辩证方法对患者进行四诊资料的收集,进行数据分析、整合、统计等证明症状与证候之间的关系,进而判定此类患者代表何种证候,统计中医证型的发生几率,研究其内在联系及规律,为临床辨证和诊疗提供参考,为中医药研究的规范化、现代化、数理化做出努力。【研究方法】:将符合西医诊断标准及本研究纳入标准的102例全血细胞减少症患者纳入研究,分别记录年龄、性别等一般情况,血常规值、西医诊断及MDS具体分型、AA程度分型,并邀请五位省级三级甲等中医院高年资临床中医师和二位中职以上血液专科医师、二位导师(省第一人民医院、市中医院)共同组成论文指导小组,通过望闻问切等方法收集临床资料,然后对每个纳入病例共同进行中医四诊资料的判定,收集整理,填写调查表,并根据症状频数分布运用变量之间相似度测定对照得出每一临床症状聚类对应的中医证型类别;最终将具有统计学意义的研究对象的临床症状等各项指标数据严格输入,在计算机数据库建立模型,再用SPSS等统计软件对数据做如下处理:整合、统计,分析,从而得出结论。【研究结果】:本课题共观察到102例全血细胞减少症患者,其中血液系统疾病共观察巨幼细胞性贫血(Megaloblastic anemia)、再生障碍性贫血(Aplastic anemia)、骨髓增生异常综合征(Myelodysplastic syndrome)三种,在本项观察中病例数目排序为MDS、AA、MA,其中(1)MA共16例,男9例,女7例,中位年龄60.1岁,50岁以上老年人13例,占81.2%;(2)AA共23例,男13例,女10例,中位年龄40.7岁,45岁以下16例,占69.5%;(3)MDS共63例,男31例,女32例,中位年龄52.4岁,50岁以上有37例,占58.7%;由以上可见,上述三种疾病的发病年龄以中老年居多,男女比例相差不大,无明显集中趋势;中医辩证类型分型中,以观察到的病例数目降序排列,其中巨幼细胞性贫血为心脾气血两虚型、脾胃气虚型、痰湿阻滞型、肾阳虚弱型、肾阴虚弱型、瘀血内阻型、痰热内扰型;再生障碍性贫血为肾阳虚弱型、血热妄行型、肝肾阴虚型、瘀血内阻型、热毒炽盛型、阴虚火旺型;骨髓增生异常综合征为心脾气血两虚型、脾肾阳虚型、瘀血内停型、脾虚湿阻型、肝肾阴虚型、热毒炽盛型。【结论】:聚类分析等现代数据统计分析方法越来越多的得到大家的关注,其应用在传统医学及临床观察上,将能够极大地提高辨证论治的客观性、规范性和准确性,亦将会极大地增强中医药客观化、标准化进程,从而为临床治疗提供依据,提高临床治疗的可重复性。
[Abstract]:Objective: to study adult patients with peripheral blood cytopenia diagnosed by western medicine as a blood system disease (exclusion of other systems). The method of stratified agglutination and index clustering in cluster analysis is mainly used. According to the similarity of syndromes (symptoms, signs, etc.), the different properties are classified into different classes. By analyzing the symptoms and characteristics of a certain type of patients, using the methods of thinking such as the whole concept of traditional Chinese medicine, dialectical analysis of syndromes, dialectical methods of viscera dialectics, eight principles dialectical and other dialectical methods, the data of four diagnoses of the patients are collected, and the data are analyzed and integrated. Statistics prove the relationship between symptoms and syndromes, and then determine what kind of syndromes such patients represent, statistics the occurrence probability of TCM syndromes, study their internal relations and laws, and provide reference for clinical syndrome differentiation and diagnosis and treatment. To make efforts to standardize, modernize, and quantify the study of traditional Chinese medicine. [methods]: 102 patients with whole blood cytopenia who met the diagnostic criteria of Western medicine and included in this study were included in the study, and their ages were recorded. Gender and other general information, blood routine value, Western medicine diagnosis and MDS-specific classification of AA degree, and invited five senior clinical Chinese medicine doctors and two Chinese vocational blood specialists at the provincial Grade 3A Chinese medicine hospital, The two mentors (the first Provincial people's Hospital, the Municipal Hospital of Chinese Medicine) jointly formed a paper steering group to collect clinical data through the methods of looking at and hearing questions and cutting, and then to judge and collect the data of the four diagnoses of TCM for each included case. Fill out the questionnaire, and according to the frequency distribution of symptoms, use the similarity between variables to determine and control each clinical symptom cluster corresponding to TCM syndromes; Finally, the clinical symptoms and other index data of the statistically significant research object are strictly input, the model is established in the computer database, and the data is processed as follows with SPSS and other statistical software: integration, statistics, analysis, Conclusion: in this study, 102 patients with whole blood cytopenia were observed. Three types of megakaryocytic anemia), aplastic anemia, (Aplastic anemia), myelodysplastic syndrome, were observed in this study. In this study, the number of cases was ranked as MDSU AAMA, of which (1) there were 16 cases of MA, 9 males, 7 females, 13 cases (81.2%) with median age of 60.1 years and over 50 years old, (2) 23 cases of AA, 13 males and 10 females, 16 cases with median age of 40.7 years and under 45 years, (3) there were 63 cases of MDS, 31 males, 32 females, 37 cases (58.7%) with median age of 52.4 years or over. In the classification of dialectical types of TCM, the number of cases observed was arranged in descending order, in which megaloblastic anemia was characterized by deficiency of heart and spleen qi and blood, deficiency of spleen and stomach qi, phlegm and dampness block, deficiency of kidney yang, weakness of kidney yin, and internal obstruction of blood stasis. Phlegm heat internal disturbance type; aplastic anemia type with deficiency of kidney yang, blood heat type, liver and kidney yin deficiency type, blood stasis type, heat toxin type, yin deficiency fire type; myelodysplastic syndrome type are heart and spleen qi and blood deficiency type, spleen and kidney yang deficiency type, Blood stasis, spleen deficiency and dampness obstruction, liver and kidney yin deficiency, heat and toxin are flourishing. [conclusion]: cluster analysis and other modern data statistical analysis methods have been paid more and more attention to, its application in traditional medicine and clinical observation, It will greatly improve the objectivity, standardization and accuracy of dialectical treatment, and will greatly enhance the objective and standardized process of traditional Chinese medicine, thus providing the basis for clinical treatment and improving the repeatability of clinical treatment.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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