原发性骨质疏松症维吾尔医异常体液病证诊断标准研究

发布时间：2018-09-12 14:52

【摘要】：目的:建立原发性骨质疏松症维吾尔医异常体液病证诊断标准。方法:首先以非疾病诊断相关临床信息(精神状况、睡眠质量、肌肤、皮肤表面温度、眼部变化、眼角膜颜色,面色、欲饮与口味、舌象、脉象、小便、大便)为依据进行量化诊断入选项专家咨询研究。利用多分类Logistic回归分析法和主成分改进的多分类Logistic回归分析法,分析不同异常体液证候与证候要素之间的非线性相关关系,确立每个不同证候要素对该证候的贡献率;根据OR值分数明确原发性骨质疏松症不同证型的主症、次症,制定原发性骨质疏松症维吾尔医异常体液“分型诊断标准”。其次,通过文献及专家咨询研究,收集、归纳骨质疏松症临床诊断特征性症状(核心症状),并应用积分法及构成比计算法研究骨质疏松症核心症状在各异常体液分型中的分布规律,结合原发性骨质疏松症维吾尔医异常体液分型诊断标准的研究结果,建立原发性骨质疏松症维吾尔医异常体液“病证诊断标准”;最后,取符合纳入标准的166例原发性骨质疏松症患者及30名健康对照组作为研究对象,检测骨代谢相关指标,探索原发性骨质疏松症异常体液分型相关的骨代谢敏感指标。结果:1)原发性骨质疏松症最核心并最常见的异常体液类型是异常黑胆质型,其次为异常粘液质型;异常黑胆质型中其他体液烧焦后的异常黑胆质型最多见;异常粘液质型中涩味粘液质型较多见;2)异常黑胆质型主症:面色晦暗、皮肤粗糙起鳞屑、多梦、噩梦、抑郁心态;次症:口味苦涩、舌质暗红、舌苔灰或黑色、大便干结、脉细、沉。异常血液质型主症:面色发红、皮肤较热、小便色橙黄、肢体沉重、脉象粗、有力;次症:驼背、睡眠尚少、口干、舌质暗红、舌苔少。异常粘液质型主症:腰背肢体冷痛、肢体畏寒喜暖、面色暗淡、口黏、少气懒言;次症:面色fD白、舌体胖大边缘齿痕、睡眠较多、肢体麻木、脉象粗、沉、弱。异常胆液质型主症:骨有灼痛、刺痛、疼有定处、皮肤较热、口干咽燥、口味甘苦、失眠、小便次数偏多、脉细、紧。次症:面色微黄、舌苔黄、盗汗;3)原发性骨质疏松症最核心并最常见的症状是骨疼、身长缩短、驼背、骨折、发落齿摇;它们在各异常体液分型中分布规律有差异,骨疼在4种异常体液分型中都出现骨疼症状,并在出现率上无明显差异;其他症状中,身长缩短、驼背、脆性骨折在异常黑胆质型中所占的比例较其他证型均高;发落齿摇在异常黏液质型中所占的比例较其他证型高;积分值≥7.5视为主要症状列入为主证,≤7.5视为次要症状列入为次证;4)4种异常体液型核心症状轻重有区别,异常黑胆质型较其他分型症状较重,它们的轻重程度排序为:异常黑胆质型异常黏液质型异常血液质型异常胆液质型;5)骨密度及骨密度T值数越低,患者的异常体液分型越倾向于异常黑胆质型;反过来25羟基维生素D水平越接近正常值水平,患者的异常体液分型越倾向于异常胆液质型,研究结果可作为原发性骨质疏松症辨证的微观指标之一。结论:此标准的建立,为原发性骨质疏松症辩异常体液论治提供了可靠的依据,为异常体液分型提供了数据支持,为进一步深入研究提供了标准化尺度,提高辨证的可操作性、科学性。
[Abstract]:Objective: To establish the diagnostic criteria of abnormal humoral syndrome in Uygur medicine for primary osteoporosis.Methods: The clinical information of non-disease diagnosis (mental status, sleep quality, skin, skin surface temperature, eye changes, corneal color, complexion, appetite and taste, tongue, pulse, urine, stool) was used as the basis for quantitative diagnosis. Expert Consultation Research. By using multi-classification logistic regression analysis and principal component improved multi-classification logistic regression analysis, the non-linear correlation between different abnormal body fluid syndrome and syndrome elements was analyzed, and the contribution rate of each different syndrome element to the syndrome was determined. Secondly, through the literature and expert consultation research, collect and summarize the clinical diagnostic characteristic symptoms (core symptoms) of osteoporosis, and study the core symptoms of osteoporosis by integral method and composition ratio calculation method. According to the results of Uygur medical diagnostic criteria for abnormal body fluids in primary osteoporosis, the diagnostic criteria for abnormal body fluids in primary osteoporosis were established. Finally, 166 patients with primary osteoporosis and 30 healthy controls were selected as the study subjects. Subjects: Bone metabolic markers were detected to explore the sensitive markers of bone metabolism related to abnormal humoral typing in primary osteoporosis. Results: 1) Abnormal black bile type was the most important and common abnormal humoral type in primary osteoporosis, followed by abnormal mucinous type, and abnormal black bile type after burning of other body fluids in abnormal black bile type. Type B is the most common type; type B is the most common type of abnormal mucinous type of astringent mucinous type; 2) abnormal dark gallbladder type of main symptoms: dark complexion, rough skin scaling, dreams, nightmares, depressive mood; secondary symptoms: bitter taste, dark red tongue, tongue fur gray or black, dry stool, fine veins, sinking. Abnormal blood type of main symptoms: redness, hot skin, urine orange yellow, limbs. The main symptoms of abnormal mucinous type: cold and painful back and limbs, cold and warm extremities, dull complexion, sticky mouth, less gas and idle talk; secondary symptoms: white complexion, tongue fat edge teeth, more sleep, numbness of limbs, pulse thick, heavy, weak. Burning pain, tingling pain, pain has a fixed place, the skin is hot, dry mouth and pharynx, taste sweet and bitter, insomnia, urination frequency, fine pulse, tight. Secondary symptoms: yellowish complexion, tongue coating yellow, night sweat; 3) Primary osteoporosis the most core and most common symptoms are bone pain, shortening body length, hump back, fracture, loss of teeth shake; They are in the distribution of abnormal body fluid types in the law is poor. In other symptoms, shortening of body length, hump back and brittle fracture accounted for a higher proportion in abnormal black gall type than in other syndromes; the proportion of falling teeth in abnormal mucus type was higher than that in other syndromes; the score (> 7.5) was regarded as the main symptom. If the symptoms were included as the main symptom, <7.5 as the secondary symptom was included as the secondary syndrome; (4) The core symptoms of the four abnormal humoral types were different in severity, and the abnormal melanobiliary type was more serious than other types of symptoms. The order of severity of these symptoms was as follows: abnormal melanobiliary type, abnormal mucinous type, abnormal blood type, abnormal biliary type; 5) the higher bone mineral density and bone mineral density T value. The abnormal body fluid typing of the patients tended to be abnormal melanobiliary type, while the abnormal body fluid typing of the patients tended to be abnormal biliary type when the level of 25-hydroxyvitamin D approached the normal level. The results could be used as one of the microscopic indicators for the differentiation of primary osteoporosis. It provides a reliable basis for the treatment of abnormal body fluids and data support for the classification of abnormal body fluids. It also provides a standardized scale for further study and improves the operability and scientificity of syndrome differentiation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R29

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