非创伤性股骨头坏死的中医证候特点研究

Research on the characteristics of TCM clinical syndrome of non-traumatic osteonecrosis of femoral head

目的:探讨非创伤性股骨头坏死的中医证候特点,为其临床辨证论治提供理论依据。方法:以前期证候量表为基础,参考近年有关股骨头坏死中医证候特点的研究文献,对其中的中医证候信息进行统计,筛去频率<5%的证候信息,经专家组讨论,最终选取48个中医证候信息制定成《非创伤性股骨头坏死的中医证候信息量表》。应用聚类分析及主成分分析对273例患者的证候信息进行分析,归纳出非创伤性股骨头坏死的证候分型以及各分型中的主、次症,并探讨证候分型与国际骨循环研究会(ARCO)分期的相关性。结果:非创伤性股骨头坏死的中医证候特点可归纳为脾气亏虚、痰瘀阻络型;气虚血瘀、经脉痹阻型;气血不足、肝肾亏虚型3类。聚类所得3种证候分型与骨坏死早、中、晚期的病例符合率分别为97.84%、96.50%、92.85%。结论:三期辨证分型思路客观地反映了股骨头坏死的中医证候特点,为其临床辨证论治提供理论依据;应用聚类分析及主成分分析有助于股骨头坏死中医证型的规范化研究。

Objective： To investigate the characteristics of TCM clinical syndrome of non-traumatic osteonecrosis of femoral head（NONFH）, and to provide a theory basis for the treatment based on syndrome dif erentiation. Methods： To analyze the frequency of syndromes information according to the research literatures about characteristics of NONFH and previous syndrome scale. The frequency of syndromes information less than 5% should be screened out. After discussion of experts group, 48 syndromes information was selected and the syndrome information scale was finished. Clustering analysis and principal component analysis were used to analyze the syndromes information of 273 patients. The syndrome classii cation and the primary and secondary symptoms in each syndrome classii cation of NONFH were concluded, and the correlation between syndrome classification and ARCO stages was discussed. Results： The TCM symptoms characteristics of NONFH could be summarized as the following three types： types of spleen qi deficiency and retention of phlegm and blood stasis in the meridian, types of blood stagnancy due to deficiency of qi and obstruction of channels and types of insui ciency of the vital energy and blood and the impairment of the liver and kidney. Coincidence rate of cases in early, middle and late stages of three types of syndrome classification and osteonecrosis was 97.84%, 96.50%, 92.85% respectively according to the results of clustering analysis. Conclusion： Syndrome dif erentiation of three stages rel ecte the TCM syndrome characteristics of NONFH objectively and provide theoretical basis for the syndrome dif erentiation and treatment in clinic. The application of clustering analysis and principal component analysis is conducive to the standardization research of TCM syndromes with NONFH.