基于SEM的胃癌术前辨证标准的生物学指标探讨

发布时间：2019-06-22 11:01

【摘要】：目的:利用SEM结构方程模型探讨胃癌术前的中医证候分型与相关生物学指标之间的联系。方法:以胃癌患者术前的中医四诊信息和实验室检测指标(如血常规、肝肾功、肿瘤标志物、CT、MRI等)为自变量,通过探索性因子分析构建中医辨证初始模型,后以中医证型为潜变量,以四诊信息及检测指标为外显变量,验证生物学指标与辨证标准之间的对应关系的SEM结构方程模型。结果:(1)胃癌术前个体综合辨证模型中各证型的鉴别性指标及预测性指标主要为:(1)肝郁脾虚证:NEU、头晕、心率、精神紧张、焦虑、心下痞满、脉弱、尿胆原8个指标;(2)脾虚证:嘈杂不适、食欲不振、形体消瘦、GB、胃脘喜温5个指标;(3)肝胃不和证:舌质淡、嗳气反酸、胃脘痛有定处、TP4个指标。(2)胃癌术前群体综合辨证中各证型的鉴别性指标及预测性指标主要为:(1)气血两虚证:焦虑、食欲不振、形体消瘦、胃脘隐痛、心下痞满、腹部压痛、舌质淡、面色萎黄、嘈杂不适、头晕、苔薄白、四肢无力、胃脘痛有定处、胃脘喜按、语声低弱、脉弱、卡氏评分、BUN18个指标;(2)肝胃不和证:气短、嗳气反酸、心烦、呃逆、LDH、CREA、DBIL、AST、TBA9个指标;(3)肝郁脾虚证:腹腔引流液为黄绿色胆汁样液体、多梦、心悸、精神紧张、胸脘胀闷、胃脘喜温、IBIL7个指标;(4)肝胃虚寒证:喜热饮、痛窜胸胁、胸胁苦满、胃脘喜温、胃脘疼痛、胃脘喜按、语声低弱、RBC8个指标。结论:构建并验证了胃癌术前的个体和群体的辨证模型,并通过模型拟合的优劣验证了含有相关生物指标的辨证标准,为其它疾病及潜证辨证标准研究提供科学的依据。
[Abstract]:Objective: to investigate the relationship between TCM syndrome classification and related biological indexes of gastric cancer by using SEM structural equation model. Methods: taking the four diagnosis information of traditional Chinese medicine (TCM) and laboratory detection indexes (such as blood routine, liver and kidney function, tumor markers, CT,MRI, etc.) as independent variables, the initial model of TCM syndrome differentiation was constructed by exploratory factor analysis, and then the SEM structural equation model of the corresponding relationship between biological indexes and syndrome differentiation criteria was verified by using TCM syndrome type as latent variable and four diagnosis information and detection index as explicit variables. Results: (1) the discriminant indexes and predictive indexes of each syndrome type in the comprehensive syndrome differentiation model of gastric cancer before operation were as follows: (1) liver depression and spleen deficiency syndrome: NEU, dizziness, heart rate, mental tension, anxiety, subcardiac fullness, pulse weakness, urine gallbladder source, (2) spleen deficiency syndrome: noisy discomfort, anorexia, body wasting, GB, stomach febrile 5 indexes; (3) liver and stomach discord syndrome: tongue is light, belching acid regurgitation, stomachache has fixed place, TP4 index. (2) Identification index and predictive index of each syndrome type in preoperative group syndrome differentiation of gastric cancer are as follows: (1) deficiency of qi and blood: anxiety, loss of appetite, emaciation of body, epigastric pain, full of heart, abdominal tenderness, pale tongue, yellow complexion, noise discomfort, dizziness, thin and white moss, weakness of extremities, (1) deficiency of qi and blood: anxiety, loss of appetite, emaciation of body, epigastric pain, abdominal tenderness, pale tongue, yellowness of face, noise discomfort, dizziness, thin and white moss, weakness of limbs, Stomachache has fixed place, stomach epigastric press, low voice, weak pulse, Karschner score, BUN18 index; (2) liver and stomach disharmony syndrome: shortness of breath, belching acid regurgitation, upset, hiccup, LDH,CREA,DBIL,AST,TBA9 index; (3) liver depression and spleen deficiency syndrome: abdominal drainage fluid is yellow-green bile-like liquid, dreamy, palpitation, mental tension, chest distension and tightness, stomach epigastric distension and warming, IBIL7 index; (4) liver and stomach deficiency cold syndrome: Xireyin, pain channeling chest threat, chest threat full, stomach epigastric warm, epigastric pain, stomachache press, low voice weak, RBC8 index. Conclusion: the syndrome differentiation model of individual and population before operation of gastric cancer was constructed and verified, and the syndrome differentiation standard containing relevant biological indexes was verified by the fitting of the model, which provided scientific basis for the study of syndrome differentiation standard of other diseases and latent syndrome.
【作者单位】：陕西中医药大学附属医院肿瘤三科;陕西中医药大学;武威市中医医院;甘肃省酒泉地区医院;金昌市人民医院;
【基金】：国家自然科学基金项目(81102561) 陕西省自然科学基金项目(2014JM2-8158)
【分类号】：R273

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