基于聚类分析的视神经炎患者糖皮质激素治疗前后中医证候学研究

Study on Traditional Chinese Medicine Syndromes of Patients with Optic Neuritis before and after Glucocorticoid Therapy Based on Cluster Analysis

目的本研究运用聚类分析法探究视神经炎在使用糖皮质激素治疗前后的中医证候特点。方法纳入视神经炎患者合计170例,填写视神经炎糖皮质激素治疗前后证候观察表记录患者治疗前及治疗后28d的四诊信息,采用K-均值聚类分析探索视神经炎患者激素治疗前后的证候特点。结果视神经炎患者糖皮质激素治疗前后症状、体征、舌脉均发生了不同程度变化,导致患者证型的改变。视神经炎患者糖皮质激素治疗前证型包括肝肾阴虚证、气血两虚证、脾肾阳虚兼有肝郁证、肝经实热兼有热盛伤阴证。视神经炎患者糖皮质激素治疗后证型包括阴虚火旺证(61.2%)、气血两虚兼有阴虚证(22.9%)、肾阴虚兼有肝郁证(15.9%)。结论研究表明糖皮质激素的大剂量长期使用对视神经炎患者的中医证型变化影响显著,尤其是阴虚火旺证是激素治疗后视神经炎患者的最常见的证型之一,临床需加以重视。

OBJECTIVE The paper mainly explores the anteroposterior TCM syndrome characteristic of patients with optic neuritis which received glucocorticoid therapy using cluster analysis. METHODS 170 cases of the optic neuritis patients were brought into the research. In accordance with the TCM syndrome characteristic observation questionnaires of optic neuritis,the four methods of diagnosis information before glucocorticoid therapy in patients with optic neuritis and 28±3 days after therapy are registered. The syndrome characteristics of optic neuritis patients before and after glucocorticoid therapy are explored by using K-Means clustering analysis. RESULTS In our research,the symptoms,signs and tongue veins of patients with optic neuritis before and after glucocorticoid treatment have changed in varying degrees,which leads to the change of syndrome types of patients. Syndromes of optic neuritis patients before glucocorticoid therapy are liver-kidney Yin deficiency,Qi-blood asthenia,spleen-kidney Yang deficiency& liver Qi stagnation,Liver is hot & Yin injured by heat. Syndromes of optic neuritis patients after glucocorticoid therapy are fire excess from Yin deficiency(61.2%),Qi-blood deficiency & deficiency of Yin(22.9%),kidney Yin deficiency & liver Qi stagnation(15.9%). CONCLUSIONS The studies have shown that a high dosage and long-term use of glucocorticoid has significant impact on the change of TCM syndrome types of patients with optic neuritis. And hyperactivity of fire caused by deficiency of Yin is one of the most common syndromes of optic neuritis patients after glucocorticoid therapy,so great attention should be paid to it in clinical practice.