亚健康中医症状群的流行病学研究

Epidemiological study of clinical symptoms of sub-health

目的分析北京地区亚健康人群常见的症状特征。方法利用北京地区亚健康状态流行病学调查数据，应用探索性因素分析，研究各症状的特征、性质及其之间的潜在关系，寻找代表亚健康状态的常见症状群，并用结构方程模型（SEM）验证各症状群之间及因子与其各组成因素之间的关系。结果取特征值大于1．0的因子共计13个，其累计贡献率达55．67％，结合专业知识，合并为10个因子。以疲劳为中心潜变量建立结构方程模型，卡方检验值与自由度的比值（X^2／df）为3，65，拟合优度指标、调整拟合优度指标、相对拟合指数、塔克尔勒威斯指数均在0．9以上。潜变量之间的直接效用说明疲劳与视疲劳、睡眠、疼痛关系最为密切，权重系数在0．7～1，0，疲劳与二便情况、口咽部症状、出汗症状之间关系较大，权重系数约在0．5。疲劳与潜变量之间的间接效用说明疲劳间接对情绪失调起作用，其相关因子之间的多阶间接作用总和为0．702和0．112。结论亚健康状态的症状表现复杂多样，常以某一症状为主，伴有多种症状同时出现；最常见的代表症状群依次为情绪失调、疲劳、睡眠异常、二便失调、心态不平和、视疲劳和疼痛等。各症状群之间、症状群内症状与症状之间均存在强弱不等的因果关系，说明亚健康状态症状表现有其群集性和复杂性等特征。

Objective To epidemiologically analyze the common clinical symptoms of sub-health in Beijing area. Methods By analysis of sub-health, epidemiological data and the method of factors analysis, we studied the features and properties of various symptoms and their relationships that represent various kinds of sub-health. We used the structural equation modeling to validate the relationship between the symptom groups and between the symptom groups and their components. Results The amount of the factors whose weight values were larger than 1.0 was 13, and the cumulative value of all the factors was 55.67%. With the domain knowledge, however, the total factors were merged into 10. We took fatigue as the main hidden variable to build a structural equation model. The function was X^2/df = 3.65, and GFI, AGFI, CFI,Tucber- Lewis indexes were all above 0.9. The direct effects between the hidden variables showed that fatigue is closely related to fatigue of eyes, sleep, and pain with the weighted coefficient ranging from 0.7 to 1.0. Fatigue is somehow related to the symptoms of stool, pee, fauces, mouth, and sweat with the weighted coefficients about 0.5. The indirect effects between fatigue and hidden variables showed that fatigue has an effect on moods indirectly with standardized indirect effects and standardized total effects was 0. 702 and 0. 112, respectively. Conclusions The symptoms of sub-health are complex with a dominating symptom and many other secondary symptoms. The common symptom groups are maladjustment of mood, fatigue, abnormity of sleep, maladjustment of stool and pee, double-minded, fatigue of eyes, and pain. The results of structural equation model shows that the causality between symptoms that are in a symptom group is different, so is the causality between the symptom groups, which shows that the symptoms of the sub-health are of diversity.