股骨头坏死中医证型分布规律的文献研究和系统评价

Systematic evaluation and literature research on distributive regularity of Traditional-Chinese-Medicine syndrome type for femoral head necrosis

目的对股骨头坏死中医证型分布规律进行文献研究和系统评价。方法计算机检索1979～2012年间有关股骨头坏死中医证型的研究文献,采用频数分布、X2检验统计方法对中医复合证型、中医单证证型进行整理,将目前临床应用频率最高的复合证型拆分后进行聚类分析,得出目前最适宜临床应用的证型体系。结果共有46篇文献符合纳入标准,文献中出现42种证型,病例总数1705例,共15种复合证型,其中肝肾亏虚、气滞血瘀、气血双虚三种证型出现频数较高,将复合证型拆分后得到14种单证证型,经聚类分析聚成三类,第一类为血瘀、肾虚、气滞,在股骨头坏死发病中的起到重要作用。结论文献中股骨头坏死中医证型尚无一致标准,根据文献研究结果,结合统计学方法和临床工作,可认为气滞、血瘀、肾虚是股骨头坏死的基本证候。

Objective To systematically research the literatures on distribution regularity of syndrome type of traditional Chinese medicine （TCM） for femoral head necrosis. Methods Computerized retrieval of literatures between 1979 and 2012 about distribution regularity of TCM syndrome type for femoral head necrosis was carried out. The compound and single syndrome types of TCM was sorted out by using statistical analysis of 2 test and frequency distribution. After splitting the composite syndrome which was the highest frequency for clinical application, cluster analysis methods were used. The aim was to achieve the most appropriate syndrome type system for clinical application. Results 46 literatures conformed to the inclusion criteria, including 42 syndrome types and 1705 cases. Among 15 composite syndrome types, the most common syndrome types were liver and kidney deficiency type, Qi stagnation and blood stasis type and Qi and blood deficiency type. After splitting the composite syndrome, 14 single syndrome types were achieved. By using cluster analysis, the syndrome types were clustered into three categories, among which the first category was blood stasis, kidney deficiency and qi stagnation which was an important category in the femoral head necrosis incidence. Conclusions Syndrome type of traditional Chinese medicine for femoral head necrosis has no consistent standard in the published literatures. According to the results of literature research, Combining with statistical methods and clinical work, it is believed that blood stasis, kidney deficiency, qi stagnation may be the basic syndromes for femoral head necrosis.