慢性脑缺血中医证候分布规律研究

Study on the Distribution of TCM Syndromes in Chronic Cerebral Ischemia

目的探讨慢性脑缺血患者中医证候分布规律及特征为慢性脑缺血的中医辨证论治提供依据。方法收集慢性脑缺血患者中医证候学资料制定中医证候学观察量表,采用频数分析、描述性分析方法对患者的一般资料、各证型分布规律进行统计分析,采用因子分析和聚类分析方法对中医证候进行挖掘。结果本研究共收集病例478例,年龄分布主要集中在51~70岁之间,对其四诊信息进行频数分析得出头晕、视物模糊、颈部强直、双目干涩、肩背部沉重、失眠、胸闷、憋气(气短)、心慌心悸、颈部疼痛、头痛、记忆力减退等症状最为常见,舌象以舌质红、舌质暗、白苔为主,脉象多为弦脉、滑脉、细脉等;通过因子分析得出病性要素主要有肾虚、气虚、痰浊、血瘀、阴虚、火热、阳虚、气滞等,病位要素主要与肾、心、肝、脾有关;利用因子分析得到的19个公因子得分作为变量对其进行K-means聚类分析,发现聚成4类时分布最为合理,其中气虚血瘀型占34.31%,肾虚血瘀型占29.71%,阴虚火旺型占27.62%,痰浊瘀阻型占8.37%。结论慢性脑缺血是以瘀血、气虚、痰浊、肾虚为主的一类虚实夹杂的疾病,主要病位在肝、肾、脾,常见证型为气虚血瘀、肾虚血瘀、阴虚火旺、痰浊瘀阻,临床治疗应从整体观念出发辨证论治。

Objective To explore the distribution pattern and characteristics of TCM syndromes in patients with chronic cerebral ischemia,and to provide a basis for TCM syndrome differentiation and treatment of chronic cerebral ischemia.Methods The information of patients with chronic cerebral ischemia were collected,the TCM syndromes observation scale was developed,the general information and the distribution pattern of each syndrome of 478 patients were analyzed by frequency analysis and descriptive analysis,the TCM syndromes were mined by factor analysis and cluster analysis.Results A total of 478 cases were collected in this study.The age distribution was mainly from 51 to 70 years old.Frequency analysis of four diagnosis information results showed that symptoms such as dizziness,blurred vision,neck stiffness,dry eyes,heavy shoulders and back,insomnia,chest tightness,breath-holding(shortness of breath),panic and palpitation,neck pain,headache,and memory loss were most common,and the tongue was mainly red,dark and white coated,and the pulse was mainly string,slippery and thready.The main pathological elements were kidney deficiency,Qi deficiency,phlegm,blood stasis,Yin deficiency,fire-heat,Yang deficiency,Qi stagnation.The pathological locations were mainly kidney,heart,liver and spleen.Using the 19 common factor scores obtained from factor analysis as variables for K-means cluster analysis,it was found that the distribution was most reasonable when clustered into 4 categories,with Qi deficiency and blood stasis accounting for 34.31%,kidney deficiency and blood stasis accounted for 29.71%,Yin deficiency and fire accounted for 27.62%,phlegm and stagnation accounted for 8.37%.Conclusion Chronic cerebral ischemia was a disease characterized by stasis of blood,Qi deficiency,phlegm and kidney deficiency.The main disease sites were liver,kidney and spleen.The common syndrome types were Qi deficiency and blood stasis,kidney deficiency and blood stasis,Yin deficiency and fire,phlegm turbidity and blood stasis.Clinical treatment should start from the overall concept and treat according to syndrome differentiation.