基于因子分析和聚类分析的斑秃患者中医证候分布研究

Distribution of Traditional Chinese Medicine Syndromes in 600 Patients with Alopecia Areata Based on Factor Analysis and Cluster Analysis

目的探讨斑秃中医证候分布规律,为其临床治疗提供参考。方法收集中日友好医院皮肤科毛发专病门诊就诊的斑秃患者,制定调查问卷,内容包括患者的一般情况、脱发病史(起病时间、诱因和加重因素、病情变化)、刻下症(症状、体征)、既往史、个人史、家族史和毛发镜检查结果。运用因子分析和聚类分析的方法,判定证候要素,总结证型分类。结果共纳入600例斑秃患者,其中男性218例(36.33%),女性382例(63.67%)。128例(21.33%)患者有脱发家族史,326例(54.33%)患者既往有相关基础疾病。斑秃的诱因和病情加重因素居第一位的均为紧张、焦虑,分别为335例(55.83%)和285例(47.50%)。患者出现频率最高的前10个症状为头皮出油、焦虑、心烦、易怒、多梦、疲劳感、瘙痒、紧张、乏力、有头屑。因子分析结果显示,因子旋转在9次迭代后收敛,最终得出12个公因子、34个变量,累积贡献率58.59%。斑秃的病位证素主要分布在肝、脾、肾,病性证素以湿热、气滞、阴虚、气虚、血虚为主。对12个公因子聚类分析结果显示,中医证型主要为湿热内蕴证、肝肾亏虚证、气血亏虚证、肝郁脾虚证。不同年龄段、不同性别患者中医证型分布差异有统计学意义(P<0.001)。结论斑秃病位主要在肝、脾、肾三脏,其中又以肝为要,中医证型多为湿热内蕴证、肝肾亏虚证、气血亏虚证、肝郁脾虚证。

Objective To explore the distribution of traditional Chinese medicine(TCM)syndromes of alopecia areata(AA),and to provide reference for TCM clinical syndrome differentiation and classification of AA.Methods AA patients who visited the specialized hairiness clinic of Beijing China-Japan Friendship Hospital were included.A questionnaire was developed including general information of the patients,history of hair loss(onset time,triggers and exacerbating factors,disease progression),current symptoms(symptoms and signs),medical history,personal history,family history,and hair microscopy examination results.The factor analysis and cluster analysis were used to determine the syndrome elements and to summarize the syndrome types.Results A total of 600 patients with AA were included,including 218 males(36.33%)and 382 females(63.67%).Totally,128 patients(21.33%)had a family history of hair loss,and 326 patients(54.33%)had a previous related underlying disease.The leading trigger⁃ing and exacerbating factors of AA were tension and anxiety,accounting for 335 cases(55.83%)and 285 cases(47.50%),respectively.The top 10 symptoms involved among patients were scalp oil,anxiety,irritability,dreami⁃ness,fatigue,itching,tension,weakness and dandruff.The factor analysis showed that the factor rotation converged after 9 iterations,and finally obtained 12 common factors and 34 variables,with a cumulative contribution rate of 58.59%.In terms of disease location of AA,the main syndrome elements were liver,spleen and kidney,and the disease nature syndrome elements were mainly dampness-heat,qi stagnation,yin deficiency,qi deficiency,and blood deficiency.The clustering analysis of the 12 common factors showed that TCM syndromes could be summarized into four categories:internal retention of damp-heat,liver-kidney deficiency,qi and blood deficiency,and liver con⁃straint and spleen deficiency.There were significant differences in the distribution of TCM syndromes in patients of different ages and genders(P<0.001).Conclusion The main disease location of AA is in the liver,spleen,and kidney,with the liver being the key.The disease mechanism of AA is a deficiency-excess complex,initially manifested as excess and later becoming deficiency.The TCM syndromes mainly include four types which are internal retention of damp-heat,liver-kidney deficiency,qi and blood deficiency,and liver constraint and spleen deficiency.