基于偏最小二乘法的中医临床肝炎肝硬化主、次证候分类特征研究

Studies on Characteristics of TCM Syndromes of Patients with Post-hepatitic Cirrhosis based on Method of Partial Least-Squares

目的:运用偏最小二乘法探讨临床肝炎后肝硬化中医主证候及其兼夹证候的分类特征。方法:规范采集明确诊断的肝炎后肝硬化患者临床症状、体征、舌象、脉象及相关实验室检查等临床表征及生物学信息;采用偏最小二乘法(Partial Leastsquares,PLS)对278例临床资料完整的样本进行证候分类建模(设证候类型为因变量矩阵、相关临床信息为自变量矩阵,采用Leave-One-Out法完成建模),并以之对临床样本进行中医证候分类和预测。结果:278例肝炎后肝硬化临床样本中,有证可辨者共计261例(93.9%)。主证候以瘀热蕴结证(108例)和湿热内蕴证(79例)最多,占71.6%;兼有两个或两个以上的复合证候者215例,占82.38%。其中,主证候为肝郁脾虚证的45例中,兼夹1个次证的29例,包括湿热内蕴证18例,瘀热蕴结证11例。兼夹2个次证的15例,均为瘀热蕴结和湿热内蕴证;主证候为湿热内蕴证的79例中,兼夹1个次证的53例,以兼肝郁脾虚证者为最多(47例,88.7%),其次为瘀热蕴结证。兼夹2个次证的有9例,均为瘀热蕴结和肝郁脾虚证;在主证候为湿热内蕴与肝郁脾虚证的124例病例中,表现为两者复合证候的有76例(62.3%);29例肝肾阴虚主证候中,均兼夹1个次证,均为瘀热蕴结证;同样,108例主证候为瘀热蕴结者中,兼夹1个次证的78例,68例为兼肝肾阴虚证(87.2%)。结论:肝炎肝硬化中医证候复杂,以复合证候为主,且证候相兼出现有一定的规律性。在肝郁脾虚、肝肾阴虚、湿热内蕴及瘀热蕴结4个主证候中,湿热内蕴和肝郁脾虚以及肝肾阴虚和瘀热蕴结组合是最常见的兼夹证候组合,反映了肝炎后肝硬化临床证候多虚实夹杂的特点,也表明中医证候分类具有一定的临床科学基础。

Objective：To study the clinical characteristic of the main syndromes and concurrent syndromes of the patients with post -hep-atitic cirrhosis using the method of partial least-squares.Methods： Criteria for case-included, case-excluded and biological information （symptoms, signs, tongue, pulse and biological parameters ） harvesting and inputting was established .Stepwise regression was used to analyze the clinical information , including clinical symptoms , biological parameters and TCM syndromes , which were obtained from 278 patients with posthepatitic cirrhosis by means of clinical epidemiological research .Mathematical models were obtained by Leave-One-Out in partial least squares program .Results：For the 278 patients with posthepatitic cirrhosis , damp-heat brewing internally （79 cases） and stasis heat in the interior （108 cases） were the most common syndromes .Among the 261 cases whose patterns could be identified , 215 cases （82.38%） were vacuity with repletion complication .Among the 45 patients with liver-kidney yin vacuity syndrome , 29 patients had one concurrent syndrome including 18 cases of damp-heat brewing internally and 11 cases of stasis heat in the interior , and the left cases had two concurrent syndromes including damp-heat brewing internally and stasis heat in the interior .Among the 79 patients with damp-heat brewing internally , 53 patients had one concurrent syndromes including 47 cases of liver depression and spleen vacuity , and 6 cases of stasis heat in the interior , and the left 9 cases had two concurrent syndromes namely liver depression and spleen vacuity and stasis heat in the interior .Among the 124 cases with damp-heat brewing internally or liver depression and spleen vacuity , 76 cases had both of these two syndromes;all 29cases with liver-kidney yin vacuity had the concurrent syndrome of stasis heat in the interior ;and a-mong the 108 cases with stasis heat in the interior , 78 patients had one concurrent syndrome .It was hard to obtain the conclusion of spleen-kidney yang vacuity syndrome due to the limited quantity of case .Conclusion：Among the 4 main syndromes of posthepatitic cir-rhosis , the most common combinations of concurrent syndromes are liver depression and spleen vacuity /damp-heat brewing internally and stasis heat in the interior/liver-kidney yin vacuity .The distribution of syndromes represents that “vacuity with repletion complication” is the clinic character of posthepatitic cirrhosis .