甲状腺癌术后中医证候聚类分析

Cluster analysis on TCM patterns in patients with thyroid cancer after surgery

目的通过对甲状腺癌术后患者四诊信息进行聚类分析,探讨该病的证候分布特点及中医辨证方法。方法采用横断面流行病学调查研究方法,收集304例甲状腺癌术后患者四诊信息,并进行量化分级,建立数据库,根据每例患者的量化得分情况,运用"样品聚类分析方法(Q聚类)"进行聚类,得出每一类别的四诊信息比重。根据四诊信息比重、前期德尔菲法专家调查形成的甲状腺癌证候初步标准,并结合临床实际进行证候判断。结果将304例甲状腺癌术后患者聚成9类,分别用A1~A9表示,其中A1类频数为77例、A2类7例、A3类1例、A4类7例、A5类105例、A6类7例、A7类87例、A8类11例、A9类2例,结合临床实际和专家经验将A1、A7;A5、A6;A3、A4合并,分别判断为气阴两虚证(164例,占53.9%);肝郁气滞证(112例,占36.8%);脾肾阳虚证(8例,占2.6%);A2判断为瘀热伤阴证(7例,占2.3%);A8、A9四诊信息比重分散判断为其他类证候(13例,占4.4%)。结论甲状腺癌术后中医证候分布具有规律性,聚类分析结合专家经验进行中医证候的判断具有可行性。

Objective To investigate the distribution features of TCM patterns and differentiation method of thyroid cancer through cluster analysis on data of TCM four examinations after surgery. Methods The data of TCM four examinations were collected from 304 patients by applying cross-section epidemiological survey,and then given quantitative classification and a database was established. The quantitative scores of each patient were given cluster analysis by using sample clustering analysis method（ Q clustering） for getting the proportion of each category of four examination information. The preliminary criterion for patterns of thyroid cancer was made according to the proportion of four examinations information and expert survey of Delphi method at earlier stage,which was combined with clinical practice to determine the patterns. Results All 304 patients were clustered into 9 categories indicated by from A1 to A9. The frequency of A1 was 77 cases; A2,7; A3,1; A4,7; A5,105; A6,7; A7,87; A8,11 and A9,2.Based on clinical practice and experts＇ experiences,A1 and A7,A5 and A6,and A3 and A4 were merged and evaluated respectively as pattern of dual deficiency of qi and yin（ 164 cases,53. 9%）,pattern of liver depression and qi stagnation（ 112 cases,36. 8%） and spleen-kidney yang deficiency pattern（ 8 cases,2. 6%）. A2 was evaluated as pattern of yin damaged by stasis heat（ 7 cases,2. 3%）.The proportions of four examination information of A8 and A9 were disperse and evaluated as other patterns（ 13 cases,4. 4%）. Conclusion The distribution of TCM patterns in the patients with thyroid cancer after surgery has its regularity. It is feasible to evaluate TCM patterns with cluster analysis combining with experts＇ experiences.