基于复杂网络和隐结构模型的溃疡性结肠炎中医证候要素及辨证规律研究

Research on the Elements of Traditional Chinese Medicine Syndrome and Syndrome Differentiation Rule of Ulcerative Colitis based on Complex Network and Latent Structure Model

目的系统挖掘溃疡性结肠炎(UC)中医证候要素分布及其辨证规律,为量化临床辨证规则和规范中医证候诊断提供科学依据。方法基于前期建立的UC中医四诊信息条目池形成临床观察表,前瞻性收集患者信息,搭建UC临床特征数据库。采用R软件进行统计分析,借助IBM SPSS Modeler软件Apriori算法进行复杂网络关联分析,运用Lantern平台LTM-EAST算法构建隐结构分析模型,采用贝叶斯信息准则(BIC)进行模型评价,并绘制关联规则网状图和隐树结构图,人机结合进行模型诠释,挖掘中医证候要素分布及其辨证规律。结果最终纳入405例UC患者,涉及162个中医四诊信息(症状)条目,累计频率排名前十的条目分别为:舌有齿痕、乏力、脓血便、舌质淡红、肠鸣、脉细弦、腹部隐痛、腹泻、苔薄白、畏寒怕冷。复杂网络关联规则分析获得32条强关联规则,发现9个核心症状体征(群),分别为腹泻、脓血便、腹部隐痛、乏力、肠鸣、苔薄白、舌质淡红、舌有齿痕、脉细弦,体现了UC疾病发作的基本特征及常见证候表现。隐结构分析得出19个隐变量,BIC模型评分为-11449.87;6个综合聚类结构模型,推断出UC病位主要涉及大肠、脾、胃、肝、肾、肺等脏腑,病理因素包括湿热、热毒、气滞、气虚、阳虚、血瘀等,包括大肠湿热、脾胃气虚、脾虚湿困、血瘀肠络、肝郁脾虚、脾肾阳虚6种常见证候。结论UC常见证候有大肠湿热证、脾胃气虚证、脾虚湿困证、血瘀肠络证、肝郁脾虚证、脾肾阳虚证,隐结构模型反映了病位、病性及症状与证候的相关性,为UC中医证候规范化研究提供依据。

Objective To systematically explore the distribution and evolution of traditional Chinese medicine(TCM)syndrome elements of ulcerative colitis(UC),and to provide scientific basis for quantifying clinical syndrome differentiation rules and standardizing TCM syndrome diagnosis.Methods A case report form for clinical observation was developed based on the item pool of the four examinations of UC established in the previous stage,and patient information was collected prospectively to build a UC clinical feature database.R software was used for statistical analysis,and IBM SPSS Mo-deler software Apriori algorithm was adopted for complex network association analysis.Lantern platform LTM-EAST(BI)algorithm was used to construct latent structure analysis model.The Bayesian Information Criterion(BIC)was used for model evaluation,and the association rule network diagram and hidden tree structure diagram were drawn.Man-machine integration was used for model interpretation,and the distribution of TCM syndrome elements and the rules of syndrome differentiation were excavated.Results Finally,405 UC patients were included,involving 162 TCM information(symptoms)items of the four examinations The top 10 symptoms in terms of cumulative frequency were teeth-marked tongue,fatigue,pus and blood in the stool,pale red tongue,borborygmus,thready wiry pulse,abdominal dull pain,diarrhea,thin white coating,fear of cold.Thirty-two strong association rules were obtained through the complex network association rule analysis,finding 9 core symptoms and signs(groups)including diarrhea,pus and blood in the stool,abdominal dull pain,fatigue,borborygmus,thin white coating,pale red tongue,teeth-marked tongue,and thready wiry pulse,which indicated the basic characteristics and common manifestations of UC.The hidden structure analysis obtained 19 hidden variables,and the BIC model score was-11449.87;six comprehensive clustering structure models showed that the mainly involved disease locations were large intestine,spleen,stomach,liver,kidney,and lung,and the pathological factors included damp heat,heat toxin,qi stagnation,qi deficiency,yang deficiency,blood stasis and others.Large intestine damp-heat,spleenstomach qi deficiency,spleen deficiency leading to damp encumbrance,blood stasis in the intestinal collaterals,liver constraint and spleen deficiency,and spleen-kidney yang deficiency were the six common syndromes.Conclusion The commonly seen syndromes of UC include large intestine damp-heat,spleen-stomach qi deficiency,spleen deficiency leading to damp encumbrance,blood stasis in the intestinal collaterals,liver constraint and spleen deficiency,and spleen-kidney yang deficiency.The hidden structure model reflects the disease location,disease nature,and the relationship between syndromes and symptoms,laying a certain foundation for the standardization of TCM syndrome research in UC.