海洛因依赖稽延性戒断症状760例中医证候分类及其计量诊断的初步探讨

Primary Discussion on the Classification of the TCM Patterns and Measurable Diagnosis of 760 Cases of Protracted Abstinent Syndrome by Heroin Addiction

目的探讨海洛因依赖稽延性戒断症状的中医证候分类和计量诊断标准。方法通过文献研究和临床研究初步建立中医证候学概念和诊断标准 ,设计中医稽延性戒断症状量表 ,并用量表对海洛因依赖者分别在其戒断后第 15、30、6 0、90和 12 0天进行 5次临床调查 ,运用临床流行病调查学和计量诊断学等方法 ,确立稽延性戒断症状的中医证候分类 ,参照数理诊断最大似然法建立相应的诊断指数表。结果 (1)稽延性戒断症状的常见中医证候类型是毒瘀蕴结气血亏虚型 ,毒瘀蕴结气阴不足型 ,毒瘀蕴结阴虚火旺型和毒瘀蕴结阴阳两虚型。 (2 )对诊断指数表进行回顾性检验和前瞻性检验 ,结果显示诊断指数表具有较高的灵敏度和特异度 ,较低的误诊率和漏诊率。结论应用临床流行病调查学和计量诊断学方法对海洛因依赖稽延性戒断症状中医证候进行计量诊断是可行的 ,采用数理诊断最大似然法建立的指数诊断表有一定的临床实用性。

Objective To discuss the TCM pattern classification and measurable diagnosis criterion of the protracted symptoms of heroin addiction abstinence (PSHAA). Methods Through literature review and clinical study, the concept of TCM patterns and diagnostic standard were established, and a TCM pattern scale for quantitatively analysis of PSHAA was formulated. The scale were used on the clinical investigation on the abuser for 5 times on day 15, 30, 60, 90 and 120 after abstinence. Then the TCM patterns of PSHAA was classified using methods of DME and quantitative diagnosis, to create a corresponding scale of diagnostic indexes referring maximum likelihood method. Results (1) The TCM patterns of PSHAA commonly seen were Toxin stasis accumulation (TSA) with Qi blood insufficiency, TSA with Qi yin deficiency, TSA with Yin deficiency and Fire excess and TSA with Yin Yang deficiency. (2) The retrospective and prospective verification of the scale of diagnostic indexes showed it has high sensitivity and speciality, with low rates of misdiagnosis and of missed diagnosis. Conclusion T5BZ]