抑郁症中医证候诊断标准中证-症对应关系研究

Study on syndrome-symptom relationship in TCM syndrome diagnostic criteria for depression

目的:确定抑郁症各证候与症状/体征之间的对应关系。方法:通过流行病学调查收集了首都医科大学附属安定医院、首都医科大学附属北京中医医院、北京市崇文区精神病防治院的门诊和住院抑郁症患者的临床资料共398例,抑郁症的诊断采用DSM-Ⅳ标准;用隐变量分析方法,对抑郁症相应症状对应关系初始模型进行修订,确定最终模型。结果:确定了抑郁症患者肝郁证、脾气虚证、心血虚证、痰证、火证等5个常见证候的临床症状对应关系,并分析了用隐变量分析方法得出的结果与传统理论认识上存在差异的原因,强调建立中医辨证标准应体现中医诊断四诊合参、病证结合的原则。同时,指出隐变量数学模型的优点是:①有效地分析症状(显变量)与证候(隐变量)之间的关系;②有效地分析证候与证候之间(即隐变量之间)组合关系。

Objective： To determine the syndrome-symptom relationship in TCM syndrome for depression. Methods： Clinical data of 398 cases with depression from An’ding Hospital Affiliated to Capital University, Beijing Hospital of TCM Affiliated to Capital University and Psychosis Prevention Hospital in Chongwen District were collected by epidemiologic survey. DSM-IV diagnostic criteria was used for depression. The syndrome-symptom relationship model was modi ed, and then the nal syndrome-symptom relationship model was developed through latent variable analysis. Results： The syndrome- symptom relationship of stagnation of liver qi, spleen qi de ciency, heart blood de ciency and re syndromes were con rmed and the di erence between results of latent variable analysis and cognitions of traditional theories were elucidated. Principle of ＂synthesis of the four diagnostic methods＂ and ＂integrative disease and syndrome＂ can’t be ignored while setting up TCM syndrome diagnostic criteria. Meanwhile, the advantages of mathematical model of latent variable were pointed out as following： ①analyzing the relationship between symptom （obvious variable） and syndrome （latent variable） e ectually. ②analyzing the combined relationship among syndromes（latent variables） e ectually.