基于聚类分析的肩痛症中医证候研究

Research on traditional Chinese medicine syndromes of shoulder pain based on clustering analysis

目的:探讨肩痛症的中医证候分型及其分布特征。方法:制定肩痛症中医证候临床调查表,对符合入选标准的肩痛症患者的中医证候进行调查,采集患者的中医望、闻、问、切四诊信息。将采集的中医四诊信息进行0、1编码数据转换,采用主成分分析方法对处理好的数据进行降维处理,采用K-Means算法对降维后的样本数据进行聚类分析,采用轮廓系数评估聚类效果。肩痛症中医证候要素分布及各中医证型的证候要素分布采用频数分析。不同性别、年龄段之间肩痛症中医证型分布的组间比较均采用χ^(2)检验,检验水准α=0.05。结果:①数据聚类结果。初始聚类后,279例肩痛症患者的基本数据被分成3类,即风寒湿型、瘀滞型、气血亏虚型,但风寒湿型仍可进行拆分,且聚集性没有另外两类的效果好。经第2次聚类后,风寒湿型被拆分出一种新类型即湿热型。第2次聚类的轮廓系数(0.876)较第1次聚类的轮廓系数(0.774)提高了约10%,聚类效果明显提升。②肩痛症中医证候要素分布。279例肩痛症患者中,肩痛、肩部压痛、肩关节活动障碍出现频率均为100%。③肩痛症各中医证型的证候要素分布。279例肩痛症患者的中医证候要素经聚类分析后,被分为4类证候,分别为气血亏虚型、湿热型、风寒湿型和瘀血型。剔除低于15%的证候要素后,气血亏虚型肩痛症的证候要素中肩关节活动障碍、肩部压痛、气短懒言、四肢乏力、脉细涩出现频率均为100%;湿热型肩痛症的证候要素中肩关节活动障碍、肩部压痛、脉濡数(滑数)出现频率均为100%;风寒湿型肩痛症的证候要素中肩关节活动障碍、肩部压痛、四肢沉重、脉弦滑出现频率均为100%;瘀滞型肩痛症的证候要素中肩关节活动障碍、肩部压痛、脉弦紧(弦涩)出现频率均为100%。④不同性别中医证型分布。279例肩痛症患者中,男性患者各中医证型占比由高至低依次为瘀滞型、气血亏虚型、湿热型、风寒湿型,女性患者各中医证型占比由高至低依次为气血亏虚型、瘀滞型、湿热型、风寒湿型;男女间中医证型分布的差异无统计学意义(χ^(2)=5.672,P=0.129)。⑤不同年龄段中医证型分布。279例肩痛症患者中,年龄<45岁的患者各中医证型占比由高至低依次为湿热型、风寒湿型、瘀滞型,年龄45~54岁的患者各中医证型占比由高至低依次为瘀滞型、湿热型、风寒湿型、气血亏虚型,年龄55~64岁的患者各中医证型占比由高至低依次为气血亏虚型、瘀滞型、湿热型、风寒湿型,年龄65~74岁的患者各中医证型占比由高至低依次为气血亏虚型、瘀滞型、湿热型、风寒湿型,年龄>74岁的患者各中医证型占比由高至低依次为气血亏虚型、瘀滞型、湿热型;不同年龄段之间中医证型分布的差异有统计学意义(χ^(2)=129.962,P=0.000)。结论:肩痛症的中医证型除气血亏虚型、瘀滞型、风寒湿型外,还存在湿热型;这些中医证型在不同性别患者间的分布并没有差异,但在不同年龄段患者间的分布有差异,45岁以下患者最常见湿热证,45~54岁患者最常见瘀滞证,54岁以上患者最常见气血亏虚证。

Objective:To explore the classification of traditional Chinese medicine(TCM)syndromes of shoulder pain and their distribution characteristics.Methods:A clinical questionnaire was developed for investigating the TCM syndromes of patients who met the inclusion criteria for shoulder pain,and the information was collected via four examinations including inspection,listening and smelling,inquiry and pulse feeling and palpation and then converted into 0 or 1 coded data.The principal component analysis was conducted to reduce the dimension of the processed data,which were then subjected to K-Means clustering analysis,followed by silhouette coefficient-based evaluation for the clustering effect.The distribution of TCM syndrome elements of shoulder pain and element distribution of each TCM syndrome were subjected to frequency analysis.Theχ^(2) test was employed to compare the TCM syndrome element distribution of shoulder pain among different genders and age groups,with the inspection level set atα=0.05.Results:①Data clustering results.As revealed by initial clustering,the basic data of 279 patients with shoulder pain were clustered into three categories,namely wind-cold-dampness type,blood-stasis type and qi-blood deficiency type.The first type could be further sub-clustered,but the clustering effect was not as good as those of the other two.In the second-order clustering,the wind-cold-dampness type was sub-clustered into a dampness-heat type,with the silhouette coefficient(0.876)increasing by 10 percent in comparison with 0.774 of the first-order clustering,indicating an improved clustering effect.②Distribution of TCM syndrome elements of shoulder pain.In 279 patients with shoulder pain,the occurrence frequencies of shoulder pain,shoulder tenderness and shoulder joint movement disorder were all 100%.③Element distribution of each TCM syndrome of shoulder pain.The clustering analysis of TCM syndrome elements in 279 patients with shoulder pain yielded four clusters,namely,the qi-blood deficiency type,dampness-heat type,wind-cold-dampness type and blood-stasis type.Following the elimination of syndrome elements less than 15%,the occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,shortness of breath,laziness to speak,limb weakness and thready-unsmooth pulse in patients with shoulder pain due to qi-blood deficiency syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness and soggy rapid(slippery and rapid)pulse in patients with shoulder pain due to dampness-heat syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,limb heaviness and wiry and slippery pulse in patients with shoulder pain differentiated into wind-cold-dampness syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,and wiry and tight(wiry and unsmooth)pulse in the ones with shoulder pain resulting from blood-stasis syndrome were all 100%.④Distribution of TCM syndromes between males and females.The TCM syndromes of male and female patients with shoulder pain were separately ranked in a descending order by proportion as follows:blood-stasis type,followed by qi-blood deficiency type,dampness-heat type and wind-cold-dampness type for male patients;while qi-blood deficiency type,followed by blood-stasis type,dampness-heat type and wind-cold-dampness type for females.There was no statistical significance in the distribution of TCM syndromes between male patients and female patients(χ^(2)=5.672,P=0.129).⑤Distribution of TCM syndromes in different age groups.The TCM syndromes of shoulder pain patients in different age groups were separately ranked in a descending order by proportion as follows:dampness-heat type,followed by wind-cold-dampness type and blood-stasis type for those aged less than 45 years old;blood-stasis type,followed by dampness-heat type,wind-cold-dampness type and qi-blood deficiency type for those aged from 45 to 54 years old;qi-blood deficiency type,followed by blood-stasis type,dampness-heat type and wind-cold-dampness type for those aged from 55 to 74 years old;while qi-blood deficiency type,followed by blood-stasis type and dampness-heat type for those aged over 74 years old.Statistically significant differences were observed in the distribution of TCM syndromes among different age groups(χ^(2)=129.962,P=0.000).Conclusion:In addition to qi-blood deficiency type,blood-stasis type and wind-cold-dampness type,there is also dampness-heat type for shoulder pain.The distribution of these TCM syndromes does not vary significantly between males and females,but existing statistical significance among different age groups,with the dampness-heat syndrome most frequently found in patients aged less than 45 years old,the blood-stasis syndrome in those aged from 45 to 54 years old,and the qi-blood deficiency syndrome in those aged over 54 years old.