下肢慢性皮肤溃疡辨证分型标准的临床研究

Clinical study of syndrome differentiation standards for chronic skin ulcer of lower limbs

目的:建立下肢慢性皮肤溃疡临床辨证分型标准,为指导临床,进一步提高临床疗效以及建立综合的临床疗效评价体系奠定基础。方法:通过338例下肢慢性皮肤溃疡患者证候的临床病例观察,提取证候要素,在此基础上进行聚类分析及主成分分析,结合国内相关专家问卷调查修正,得出下肢慢性皮肤溃疡的临床辨证分型标准。结果:338例下肢慢性皮肤溃疡患者证候要素经聚类分析聚为4类,通过专家修正,第1、3类(气血两虚证、气虚血瘀证)合并为气虚血瘀证,第2类为脾虚湿盛证,第4类为湿热瘀阻证,并由主成分分析和专家平均排位情况确定每一类证型的主症和次症。这3种证型反映了下肢慢性皮肤溃疡患者的临床基本证候。结论:下肢慢性皮肤溃疡的临床基本证候可辨证为气虚血瘀证、脾虚湿盛证和湿热瘀阻证。局部辨证在下肢慢性皮肤溃疡的临床辨证中尤为重要。

Objective： To establish evidence and standards for syndrome differentiation of patients with chronic skin ulcer of lower limbs, which can be used to supervise and further improve the clinical treatment. The evidence and standards would also lay a foundation for the integrative evaluation system of clinical effects. Methods： This is a prospective study of clinical case collection and analysis. The syndrome factors of chronic skin ulcer of lower limbs were collected from clinical cases, and then the essential factors of syndromes were chosen to make cluster analysis and principal component analysis. After syndrome classification, specialist consultation was performed. Forecasting syndrome models were established on the basis of the statistical analysis and the specialist consultation. Results. The syndrome factors in 338 cases of chronic skin ulcer of lower limbs were clustered into four syndrome categories including deficiency of both qi and blood, spleen deficiency with dampness encumbrance, qi deficiency with blood stasis and blood stagnation with dampness-heat. The deficiency of both qi and blood, and qi deficiency with blood stasis were merged into qi deficiency with blood stasis by expert revision. The primary and secondary symptoms were identified by principal component analysis and average ranking determined by experts. The qi deficiency with blood stasis, spleen deficiency with dampness encumbrance, and blood stagnation with dampness-heat could reflect the clinical syndrome characteristics in patients with chronic skin ulcer of lower limbs. Conclusion： Chronic skin ulcer of lower limbs can be differentiated in three syndrome types, and differentiation of local symptoms of the ulcer is very important in syndrome differentiation of chronic skin ulcer of lower limbs.