数学模型应用于膝关节骨性关节炎中医临床疗效评价的研究

Application of Mathematics Model to Evaluate the TCM Effects of Knee Osteoarthritis

目的建立膝关节骨性关节炎(KOA)中医临床疗效模糊数学评价模型,并检验其科学性。方法根据KOA辨证要素积分表和中医证型识别数学模型,确立KOA疗效评价模糊数学模型。符合纳入标准且通过诊断一致性判定的KOA患者,按就诊先后顺序分别分配到风寒湿痹组、风湿热痹组、瘀血闭阻组、肝肾亏虚组。以《中医临床路径实用指南》中膝痹病的治疗方案进行治疗,分别于治疗开始前和治疗结束后评定病情严重程度指数、JOA膝关节骨性关节炎治疗效果判定标准、WOMAC指数。结果共计86例患者完成研究。经pearson相关分析,风寒湿痹组的病情严重程度指数与JOA得分的相关系数为-0.389(P>0.05),其余各组的相关系数在-0.700～0.842,总相关系数为-0.511。病情严重程度指数与WOMAC指数得分的相关系数在0.413～0.853,总相关系数为0.505。风寒湿痹组和风湿热痹组的效应尺度分别为-0.986、-1.186,总效应尺度为-0.768。结论数学模型能够较准确地反应KOA的病情变化,部分因子需做进一步调整。

Objectives： To preliminarily establish the fuzzy mathematical model to evaluate TCM efficacy of KOA. Methods： Based on KOA differentiation factors integral table and fuzzy mathematical recognition model for syndrome type differentiation of KOA,the mathematics model was built to evaluate TCM effects of KOA. KOA patients who met the inclusion criteria and consistent diagnoses principle were arranged to wind-cold-dampness arthralgia group, wind-fever-dampness arthralgia group, syndrome of blood stasis group,deficiency of liver and kidney group according to visit order. All patients were treated by the treatment program for knee arthralgia in ＂A Practical Guide to The Clinical Pathway of Chinese Medicine＂. Before and after treatment,the JOA knee osteoarthritis curative effect criteria,WOMAC index and KOA TCM syndrome severity index were used to observe the condition changes. Results： 86 patients completed the trial. Through Pearson linear correlation analysis,the correlation coefficient of KOA TCM syndrome severity index and JOA score in wind-cold-dampness arthralgia group was -0.389（P〉 0.05）. The other groups were from -0.700 to -0.842. The totle score was-0.511. The correlation coefficient of KOA TCM syndrome severity index and WOMAC index score were from 0.413 to 0.853,totle score 0.505. The effect sizes of KOA TCM syndrome severity index were wind-cold-dampness arthralgia group with -0,986,wind-fever-dampness arthralgia group with -1.186. The totle effect size was -0.768. Conclusion： The fuzzy mathematical model can sensitively evaluate TCM efficacy of KOA. Some items need to be further modified.