冠心病稳定期痰湿证主要临床表征诊断权重研究

Weight Analysis on Diagnosing the Main Clinical Manifestations of the Phlegm Dampness Syndrome in Patients with Stable Coronary Heart Disease

目的:应用层次分析法研究冠心病稳定期痰湿证主要临床表征诊断权重。方法:邀请全国各地具有丰富临床经验的中医心脑血管病专家,现场填写课题组设计的调查问卷,问卷内容是判定冠心病稳定期痰湿证的临床表征(临床症状、舌象、脉象)在临床诊断中的重要程度,采用层次分析法分析冠心病稳定期痰湿证临床表征的权重。结果:(1)冠心病稳定期痰湿证权重(wi值)为:舌象0.529>临床症状0.295>脉象0.176。(2)冠心病稳定期痰湿证舌象权重顺序为:苔腻0.497>苔白滑0.269>舌胖边有齿痕0.233;(3)冠心病稳定期痰湿证临床症状权重顺序为:胸闷胸痛0.222>肢体困重0.120>口粘0.112>体胖0.108>脘腹痞满0.091>面色晦浊0.082>大便粘滞0.076>嗜睡0.075>纳呆0.072>呕恶0.055);(4)冠心病稳定期痰湿证脉象权重顺序为:脉滑0.517>脉濡0.303>脉缓0.179。结论:冠心病稳定期痰湿证所有要素排序权重的结果中,苔腻、苔白滑、舌胖边有齿痕、脉滑、胸闷胸痛、脉濡、肢体困重、口粘占冠心病稳定期痰湿证临床表征总权重的80%,在冠心病稳定期痰湿证诊断中具有重要参考依据。

This study aimed to perform the weight analysis on the main clinical manifestations of the phlegm dampness syndrome in traditional Chinese medicine（TCM） of stable coronary heart disease（CHD）. Experienced TCM experts in cardiovascular disease across China were invited to participate in the questionnaire survey over CHD, in which the importance of the clinical manifestations（e.g. clinical symptoms, tongue image and pulse condition） of phlegm dampness syndromes would be determined in diagnozing stable CHD. The weights of the clinical manifestations were analyzed using analytic hierarchy process（AHP）. As a result, the AHP weight（wi value） of phlegm dampness syndrome of stable CHD were allocated to tongue image（0.529）, clinical symptoms（0.295） and pulse condition（0.176）. The weights of tongue image in the phlegm dampness syndrome of stable CHD were distributed among greasy fur（0.497）, white slippery fur（0.269） and fat tongue with teeth marks（0.233）. The weights of clinical symptoms of the phlegm dampness syndrome in stable CHD patients were allocated to chest tightness or chest pain（0.222）, heavy cumbersome limbs（0.120）, sticky mouth（0.112）, obesity（0.108）, fullness（0.091）, dark and muddy facial expression（0.082）, sticky stool（0.076）, lethargy（0.075）, anorexia（0.072）, and vomiting（0.055）. The weights of pulse condition of the phlegm dampness syndrome of stable CHD were distributed among slippery pulse（0.517）, soft pulse（0.303） and slow pulse（0.179）. It was concluded that clinical manifestations, including greasy fur, white slippery fur, fat tongue with teeth marks, slippery pulse, chest tightness or chest pain, soft pulse, heavy cumbersome limbs and sticky mouth, accounted for 80% in all weights of clinical manifestations of the phlegm dampness syndrome of stable CHD, which provided significant evidence behind its diagnosis.