基于因子分析与聚类分析的颈源性失眠的证候要素提取及证型研究

Syndrome Factors Extration and Syndrome Type Research of Cervical Insomnia Based on Factor Analysis and Cluster Analysis

目的探讨颈源性失眠患者的中医证候分布规律及特点。方法采集250例颈源性失眠患者的四诊信息,运用因子分析与聚类分析相结合的方法对调查结果进行分析,结合证素辨证体系寻找本病的中医证素要点及证型分布规律。结果本研究共收集72项症状及体征,选取对临床证候有意义的67个四诊信息进行统计分析,KMO检验统计量为0.878,Bartlett球形检验近似卡方值为18973.563(P=0.000 <0.001)。应用主成分分析方法得到9个公因子,其中病位证素涉及心、肝、脾、肾、颈肩部(局部),病性证素涉及阴虚、痰湿、气滞、气虚、血虚、血瘀、湿热;聚类分析得出7大类中医证型及其分布比例,依次为:肝郁脾虚(24.0%,60/250)、肝肾阴虚(20.0%,50/250)、气滞血瘀(16.0%,40/250)、痰湿阻滞(12.8%,32/250)、湿热侵袭(11.2%,28/250)、肝脾两虚(10.4%,26/250)、心脾两虚(5.6%,14/250)。结论颈源性失眠的基本中医证型有7类,病位的体现可以整体为主或局部为主;但在调查患者过程发现失眠与颈肩部不适密切相关,可见颈肩部的经络不通为颈源性失眠的致病关键;因此,临床上治疗本病应注意结合整体及局部辨证。

Objective To investigate the distribution and characteristics of TCM syndromes in patients with cervical insomnia.Methods Four diagnostic methods information of 250 patients with cervical insomnia was collected,and the investigation results were analyzed by combining factor analysis and cluster analysis,and the TCM syndrome elements and syndrome type distribution rules of this disease were found by combining syndrome element differentiation system.Results In this study,a total of 72 symptoms and signs were collected,and 67 four diagnostic methods information meaningful for clinical syndromes were selected for statistical analysis.The KMO test statistic was 0.878,and the Bartlett spherical test approximate chi-square value was 18973.563(P = 0.000 < 0.001).The principal component analysis method was used to obtain 9 common factors,among which the syndromes involved heart,liver,spleen,kidney,neck and shoulder,and the syndromes involved Yin deficiency,phlegm dampness,Qi stagnation,Qi deficiency,blood deficiency,blood stasis,dampness and heat.Cluster analysis revealed 7 categories of TCM syndromes and their distribution proportions,which were successively liver-stagnation and spleen deficiency(24.0%,60/250),liver-kidney Yin deficiency(20.0%,50/250),Qi stagnation and blood stasis(16.0%,40/250),phlegm-dampness blocking(12.8%,60/250),dampness and heat invasion(11.2%,28/250),liver-spleen deficiency(10.4%,26/250),and heart-spleen deficiency(5.6%,14/250).Conclusion There are 7 types of basic TCM syndromes of cervical insomnia,and the manifestation of the disease position can be holistic or local.However,during the investigation of the patients,it was found that insomnia was closely related to the discomfort of neck and shoulder,which showed that the obstruction of meridians and collaterals of neck and shoulder was the key to the pathogenesis of cervical insomnia.Therefore,the clinical treatment of this disease should pay attention to the combination of overall and local syndrome differentiation.