基于关联规则算法的慢性乙型肝炎证型诊断量表多中心研究

Study on multicenter pattern diagnosis scale for chronic hepatitis B: on the basis of association rules

目的探讨慢性乙型肝炎(CHB)证型诊断量表模型的建立及应用。方法收集721例慢性乙型肝炎患者的中医四诊信息,构建慢性乙型肝炎病案数据库,采用关联规则算法确定中医证候元素对证型判定的贡献度(权重),形成诊断量表;进而采用对照数据集对量表进行合理性评估。结果①慢性乙型肝炎的常见证型以肝胆湿热证(50.90%)最多,其次为肝郁脾虚证(26.07%)和肝肾阴虚证(15.12%),其他证型较少(7.91%)。②枯舌、腻苔及长脉3个证候元素对肝胆湿热证的诊断具有重要意义(贡献度大于0.9)。肌肤甲错和短脉2个证候元素对肝肾阴虚证的诊断具有重要意义(贡献度为1)。蜘蛛痣、白苔、滑脉和濡脉4个证候元素对肝郁脾虚证的诊断具有重要意义(贡献度大于0.9)。③抽样组与对照组比较,量表诊断符合率差异无统计学意义(P>0.05),实习医师诊断符合率差异无统计学意义(P>0.05)。量表诊断与实习医师诊断比较,抽样组、对照组及平均值符合率差异均有统计学意义(P<0.05)。结论慢性乙型肝炎中医证型诊断量表的准确率较高,说明其模型设计合理,效果满意;该量表的使用可能会提高实习医师的CHB中医证型诊断水平。

Objective To explore the establishment and application of pattern diagnosis scale for chronic hepatitis B （CHB）. Methods Four diagnostic informations of 721 CHB cases were collected. The data base was constructed to form the diagnosis scale on the basis of association rules. We evaluated the rationality of the scale. Results （~ Damp-heat of liver and gallbladder （50.90%） , stagnation of liver qi and spleen deficiency （26.07%） , yin deficiency of liver and kidney （ 15.12% ） were the major syndromes of CHB, and others is 7.91%. （~） Damp-heat of liver and gallbladder pattern was characterized by withered tongue, greasy fur and long pulse. Yin deficiency of liver and kidney pattern was characterized by squamous and dry skin, short pulse. Stagnation of liver qi and spleen deficiency pattern was characterized by spider nevus, white tongue, slippery or sluggish pulse. （~） No significant difference was found in experts＇ diagnosis and interns＇ diagnosis between sample group and control group （ P 〉 0.05 ）. There was significant difference in accordance rate of average value between experts and interns （ P 〈 0.05 ）. Conclusion This diagnosis scale is accurate and the modeling design is reasonable. The skills of interns need to be improved for CHB diagnosis.