基于隐结构的弥漫性间质性肺疾病症-证-药初探

Research on Symptom,Syndrome and Medication Rules of Diffuse Interstitial Lung Disease(DPID) Based on Latent Structure Models

目的探讨弥漫性间质性肺疾病的中医症状和证候分类特征,以及用药规律初探,为后期该疾病的临床诊断和诊治提供依据。方法基于已经建立的肺系疾病文献数据库,包含现代名老中医肺病数据库和期刊中医肺病数据库,构造症状量化表,构建现代名老中医诊治弥漫性间质性肺疾病文献数据库,然后利用隐结构分析数据,得到隐结构模型和隐变量;根据中医知识,诠释隐变量含义及与症状之间、症状与常用药物之间的关系,同时使用关联规则对症状进行分析,挖掘症状之间的潜在关系。结果本病涉及的主要症状有咳嗽、咳痰、胸闷、疲乏、自汗等,该病以心肺气阴亏虚、肺气亏虚、寒凝心肺为主要证候特点。与心肺气阴亏虚关系最密切的症状为盗汗、心烦、口唇青紫,常用药物为瓜蒌、桑白皮、款冬花、黄芩;与肺气亏虚关系最密切的症状为疲乏、胸闷、消瘦、动则喘甚、短气、自汗,常用川贝母、杏仁、桔梗、薏苡仁等润肺生津药物;与寒凝心肺关系最密切的症状为气喘、形寒肢冷、紫绀、憋气、呼吸困难、干咳等,常用丹参、川芎、赤芍等活血祛瘀药物。结论隐结构分析以统计的方式得到概率同现模型,模型结果能明确隐变量与显变量之间的概率关系,为疾病从症状到证候的分类及用药提供依据,从而为弥漫性间质性肺疾病的临床中医证候诊断、用药规律的建立提供参考依据。

Objective To research the TCM symptoms of diffuse interstitial lung disease(DPID),obtain the objective evidence for the diagnostic criteria of the TCM syndrome and study the medication rules.Methods Based on the database of lung disease literature,we searched the Experiences of Modern Famous Veteran Chinese Medicine Doctor for Lung Disease and Journal Database of Chinese Medicine for Lung Disease.And then we built a quantitative chart of symptoms and the literature database of Modern Famous Veteran Chinese Medicine Doctor for Diffuse Interstitial Lung Disease.After that,we used the latent structure analysis and obtained the model,the relationship between hidden variables and the symptoms based on the knowledge of TCM.Meanwhile,association rules were used to analyze the symptoms,and the potential relationship between symptoms was explored.Results The main symptoms of this disease included cough,expectoration,chest tightness,fatigue and spontaneous perspiration,etc.The syndromes of DPID in traditional Chinese medicine were characterized by deficiency of Qi and Yin in heart and lung,deficiency of lung Qi and cold coagulation of heart and lung.The symptoms most closely related to the deficiency of Qi and Yin in heart and lung were night sweats,perturbed and blue lips.The commonly-used drugs were Gualou(Trichosanthis Fructus),Sangbaipi(Mori Cortex),Kuandonghua(Farfarae Flos)and Huangqin(Scutellariae Radix).The symptoms most closely related to lung Qi deficiency were fatigue,chest tightness,emaciation,dyspnea,shortness of breath and spontaneous sweating.The commonly-used drugs were Chuanbeimu(Fritillariae Cirrhosae Bulbus),Xingren(Armeniacae Semen Amarum),Jiegeng(Platycodonis Radix)and Yiyiren(Coicis Semen).Symptoms most closely related to cold coagulation were asthma,cold-shaped limbs,cyanosis,breathlessness,dyspnea and dry cough,etc.Drugs for promoting blood circulation and removing blood stasis such as Danshen(Salviae Miltiorrhizae Radix et Rhizoma),Chuanxiong(Chuanxiong Rhizoma)and Chishao(Paeoniae Radix Rubra)were commonly used.Conclusion The latent structure analysis method for the classification of disease symptoms of DPID can obtain hidden variables and the quantitative relationship between the variables,which can provide evidence for the classification of diseases from symptoms to syndromes and provide clinical syndromes a reliable basis for the establishment of the standard.