430例围绝经期失眠症患者肾虚肝郁证的判别分析

Discriminative analysis on kidney-deficiency and liver-stagnation syndrome of menopausal insomnia patients

目的:采用判别分析法探讨围绝经期失眠症患者肾虚肝郁证的诊断规律。方法:收集430例围绝经期失眠症患者,制定肾虚肝郁证的中医证候调查问卷,包括常见的36种症状和体征,将患者中医辨证分为肾虚肝郁证284例和非肾虚肝郁证146例,并将临床症状分为"有"和"无"2级,分别计为"1"和"0"分。根据患者中医证型对变量进行逐步判别分析,将有显著贡献的变量建立判别函数式,并使用逐一回代法和刀切法对函数式的一致率进行检验。结果:筛选出对区分肾虚肝郁证有显著贡献的10个变量:潮热、情绪抑郁、善太息、五心烦热、急躁易怒、盗汗、苔少(或苔薄或薄黄)、腰膝酸软、舌红和目睛干涩。建立围绝经期失眠症肾虚肝郁证的中医证型判别函数为:肾虚肝郁证=-6.310+1.367×舌红+2.763×苔少(或苔薄或薄黄)+3.897×情绪抑郁+3.102×急躁易怒+3.706×潮热+1.682×盗汗+2.715×五心烦热+3.897×善太息+1.066×目睛干涩+1.588×腰膝酸软;非肾虚肝郁证=-1.858+0.414×舌红+1.653×苔少(或苔薄或薄黄)+0.315×情绪抑郁+1.840×急躁易怒+0.594×潮热-0.068×盗汗+0.286×五心烦热+0.484×善太息+0.065×目睛干涩+0.463×腰膝酸软。逐一回代法判别总一致率为91.2%,刀切法计算一致率为90.7%。结论:围绝经期失眠症肾虚肝郁证判别函数与临床诊断吻合良好,可提高围绝经期失眠症中医诊断的客观性和准确性。

Objective： To explore the diagnosis rules of kidney-deficiency and liver-stagnation syndrome of menopausal insomnia patients with discriminatory analysis. Methods： The data of 430 menopausal insomnia patients was collected, A questionnaire on kidney-deficiency and liver-stagnation syndrome of insomnia was worked out, which included 36 common symptoms of menopausal insomnia. The patients were differentiated into two syndromes： kidney-deficiency and liver -stagnation （284 cases） and non-kidney deficiency and liver stagnation （146 cases）. The clinical symptoms were marked as ＇yes＇ and ＇no＇, and scored as ＇1＇ and ＇0＇. According to the TCM symptom of patients, the variabilities were step-by-step discriminatively analyzed, those significant contributors were attributed into the discriminant function formulae, and the uniformity of which were tested with returning-replacement and knife-cut methods. Results： The 10 variabilities of significant contribution in differentiating the two syndromes were screened out as following： hectic fever, depression, sighs, hot sensation in chest, palms and soles, bad temper, night sweat, less coating of tongue, soreness and weakness of lower back and knee, red tongue, and eye acerbity. The discriminant function formulae were established as： kidney deficiency and liver stagnation=-6.310＋1.367×red tongue＋2.763×less coating of tongue＋3.897×depression＋3.102×bad temper＋3.706×hectic fever＋1.682×night sweat＋2.715×hot sensation in chest, palms and soles＋3.897×sighs＋1.066×eye acerbity＋1.588×soreness and weakness of lower back and knee; non-kidney deficiency and liver stagnation=-1858＋0.414×red tongue1.653×less coating of tongue＋0.315×depression＋1.840×bad temper＋0.594×hectic fever- 0.068×night sweat＋0.286×hot sensation in chest, palms and soles＋0.484×sighs＋0.065×eye acerbity＋0.463×soreness and weakness of lower back and knee. The total uniformity examined by the returning-replacement step-by-step was 91.2%, and that calculated by knife-cut was 90.7%. Conclusion： The discriminant function formulae of kidney deficiency and liver stagnation syndrome of menopausal insomnia patients matched well with the clinical diagnosis. It improves the accuracy and objectivity of TCM diagnosis.