甲状腺结节辨证分型标准的临床研究  

Clinical Research of Syndrome Differentiation Standards for Thyroid Nodule

作　　者：仇莲胤[1] 阙华发[2] 

机构地区：[1]上海中医药大学图书信息中心,上海201203 [2]上海中医药大学附属龙华医院中医外科,上海200032

出　　处：《上海中医药大学学报》2013年第4期26-30,共5页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市卫生系统优秀学科带头人培养计划资助项目(XBR2011062);上海市海派中医传承研究项目(ZYSNXD-CC-APCC-JD002)

摘　　要：目的:建立甲状腺结节中医辨证分型标准,为指导临床、进一步提高疗效以及建立综合的临床疗效评价体系奠定基础。方法:文献调研结合以甲状腺结节患者症状询问为主的问卷调查,提取证候要素,采用聚类分析及主成分分析方法,形成甲状腺结节的辨证分型模型,然后通过该领域专家咨询,建立甲状腺结节的临床辨证分型标准。结果:309例甲状腺结节患者的证候要素经聚类分析聚为5类,通过专家咨询修正,第2、4类(脾肾阳虚证、脾虚湿盛证)合并为脾肾阳虚证,第1类为肝郁痰凝证,第3类为痰瘀互结证,第5类由"气阴两虚证"改为"阴虚内热证"。由主成分分析和专家平均排位情况确定每一类证型的主症和次症。这4种证型反映了甲状腺结节的临床基本证候。结论:甲状腺结节的临床基本证候为肝郁痰凝证、脾肾阳虚证、痰瘀互结证和阴虚内热证。Objective： To establish the evidence and standards for syndrome differentiation of patients with thyroid nodule, which can be used to improve clinical treatment and lay a foundation for the integrative evaluation system of clinical effects.Methods ： The syndrome factors were collected by literature survey combined with symptom-inquiring questionnaire survey. The syndrome differentiation models were established through cluster analysis and principal component analysis, and then the syndrome differentiation standards of thyroid nodule were established through specialist consultation. Results ： The syndrome factors in 309 cases of thyroid nodule were clustered into five syndrome categories including yang deficiency of spleen and kidney, spleen deficiency with dampness encumbrance, liver depression with phlegm retention, phlegm accumulating with blood stagnation, and deficiency of both qi and yin. The yang deficiency of spleen and kidney and spleen deficiency with dampness encumbrance were merged into yang deficiency of spleen and kidney, and the deficiency of both qi and yin was instead of yin deficiency with interior heat by expert revision. The primary and secondary symptoms were identified by principal component analysis and average ranking determined by experts. These four syndromes could reflect the clinical syndrome characteristics in patients with thyroid nodule. Conclusion ： The thyroid nodule can be differentiated into 4 syndromes ： liver depression with phlegm retention,yang deficiency of spleen and kidney,phlegm accumulating with blood stagnation,and yin deficiency with interior heat.

关 键 词：甲状腺结节 辨证分型 标准 临床研究 

分 类 号：R259[医药卫生—中西医结合]