经前期综合征肝气逆证辨证规范的大样本多中心研究

Large Sample Multicenter Study on Syndrome Differentiation Standard of Premenstrual Syndrome with Liver-qi Invasion Pattern

目的:通过经前期综合征(Premenstrual Syndrome,PMS)肝气逆证辨证的规范研究,从而解决传统四诊合参难以采集患者主观感受为主诉的病症中所包含的全面辩证信息的问题。方法:采用整群抽样法进行调查,根据病例特征的多维指标,建立合适的结构方程模型,并对该模型进行修订。结果:"信息采集医生用表"结构方程结果:情绪维度、躯体症状维度、机体状态维度载荷系数分别为0.715、0.574、0.904,"信息采集患者用表"情绪维度、躯体症状维度、机体状态维度载荷系数分别为0.705、0.945、0.848,各维度之间具有较强相关性,结合中医理论,确定PMS肝气逆证辨证规范为:以烦躁易怒为主症,以头痛、乳房胀痛、小腹及胃脘胀痛为次症,亦可伴随疲乏、失眠多梦、肢体浮肿、工作理家能力降低、思想不集中等症状。结论:采用医患双方采集辨证信息的方法,建立了较为全面的信息采集体系。首次建立了PMS肝气逆证辨证规范,以流行病学调查为基础,为深入开展PMS证候及其亚型的相关研究提供重要参考。

This study was aimed to solve the problem of overall syndrome differentiation information collection on patient’s main complain of traditional Chinese medicine （TCM） four diagnostic methods, in order to make syndrome differentiation standard of premenstrual syndrome （PMS） with liver-qi invasion pattern. The method of cluster sampling was applied in the investigation. The appropriate structural equation modeling （SEM） was established according to multi-dimension indexes of case features and TCM theories. The results of the “information acquisition form for doctor” structural equation showed that emotion dimension, body-symptom dimension, organism condition dimension load coefficients were 0.715, 0.574 and 0.904, respectively. The results of the “information acquisition form for patient” structural equation showed that emotion dimension, body-symptom dimension, organism condition dimension load coefficients were 0.705, 0.945 and 0.848, respectively. There were strong relativities among all dimensions. Combined with TCM theories, the main symptom of identified PMS with liver-qi invasion pattern was “irritable and angry”. And the secondary symptoms contained headache, breast tenderness, distention and pain of lower abdomen and stomach. The combining symptoms were insomnia, dreaminess, swelling of extremities, fatigue, inefficiency for work and housework, hard to focus the attention. It was concluded that the combination of information acquisition method from both the doctor and patient established a relative comprehensive information acquisition system. It established the syndrome differentiation standard of PMS with liver-qi invasion pattern for the first time based on epidemiologic investigation. It provided important reference for the study of PMS subtype.