以听力学指标为基础的多元判别函数与耳鸣辨证关系

Relationship between the Multiple Discriminant Function Based on Audiology Indexes and Tinnitus Syndrome

目的:前瞻性验证前期工作中建立的以听力学指标为基础的多元判别函数对耳鸣辨证的临床价值。方法:选择以主观性耳鸣为主要症状且符合风热侵袭、肝火上扰、痰火郁结、脾胃虚弱、肾精亏损5个证候之一的辨证标准的患者作为研究对象,进行系统的听力学测试取得相关指标,根据过去所建立的以听力学指标为基础的多元判别函数进行客观证型判别,以中医传统辨证作为标准对照,计算客观辨证的敏感度、特异度、准确度。结果:符合标准的耳鸣患者共95例,其中风热侵袭型24例,肝火上扰型14例,痰火郁结型14例,脾胃虚弱型22例,肾精亏损型21例;风热侵袭与肝火上扰型判别函数的敏感度较高(分别为66.7%和64.3%),而特异度亦不低;肾精亏损型判别函数的特异度最高(达94.6%),但敏感度最低(23.8%);痰火郁结和脾胃虚弱型判别函数的敏感度与特异度介于以上3个判别函数之间;5个判别函数的平均准确度为81.7%,平均误判率为18.3%。结论:本组判别函数对风热侵袭与肝火上扰型的判别较为理想,但存在30%左右的漏诊率及15%左右的误诊率;若判为肾精亏损或脾胃虚弱,则可信度也较高;若判为痰火郁结,需慎重考虑可能有一定的误判;若经判别5个证型都不符合,可视为漏诊的肾精亏损而考虑补肾治疗。

Objective： Prospective certification preparatory work to establish the parameters for the hearing based on the multiple discrirainant function of tinnitus dialectical clinical value. Mett;ods ： Subjective tinnitus to the main symptoms consistent with Wind thermal invasion, disturbing upward of liver - fire, pyrophlegm blues, weakness of the spleen and stomach, Kidney essence loss five Syndromes, which one of the Diagnostic Criteria for patients as the object of study. systematic audiological tests related indicators, According to the past to establish the parameters for the hearing based on the multiple discriminant function of objective evidence - based discrimination. Differentiation of traditional Chinese medicine as a standard, calculated objective proof sensitivity, specificity, and accuracy. Restdts： To meet the standards of tinnitus patients with a total of 95 cases, of which Wind thermal invasion in 24 cases, disturbing upward of liver - fire in 14 cases, pyrophlegm blues in 14 cases, weakness of the spleen and stomach in 22 cases, Kidney essence loss in 21 cases ; Wind thermal invasion with disturbing upward of liver - fire on the interference - discriminant function of a higher sensitivity （ 66.7% and 64.3% ）, and the specificity was not low; Kidney essence loss on the interference - diseriminant function of the highest specificity （ up 94.6% ） , However, the minimum sensitivity （ 23.8% ） ; pyrophlegm blues and weakness of the spleen and stomach on the interference - discriminant function of the sensitivity and specificity between the above three diseriminant function ; five discriminant function of the average accuracy was 81.7%, the average rate for the misjudgment of 18.3%. Conclusion： The discriminant function of Wind thermal invasion with disturbing upward of liver - fire on the type of discrindnant interference is more ideal, But there are around 30% of the rate of missed diagnosis and 15% misdiagnosis rate; If sentenced it to Kidney essence loss or weakness of the spleen and stomach,Reliability is also higher; If sentenced it to pyrophlegm blues that need to consider carefully. Because it may have some misjudgment. If the five - discriminant can not met, we could consider it as a missed diagnosis of Kidney essence loss and consider to invigorate the kidney.