基于多元统计分析的类风湿关节炎证候诊断评价标准研究  

Research on Syndrome Diagnostic Evaluation Criteria in Rheumatoid Arthritis Based on Multivariate Statistical Analysis

作　　者：白云静[1] 姜德训[1] 申洪波[2] 安娜[1] 赵丽萍[1] 

机构地区：[1]中国人民解放军北京军区总医院,北京市东城区南门仓5号100700 [2]北京大学第三医院

出　　处：《中医杂志》2014年第24期2124-2128,共5页Journal of Traditional Chinese Medicine

基　　金：首都医学科技发展基金资助(SF-2009-Ⅲ-51)

摘　　要：目的建立类风湿关节炎(RA)的证候诊断标准,并验证该标准的诊断性能。方法制订RA临床证候调查表,采用横断面调查研究的方法对700例RA患者进行调查,对调查信息先后进行聚类分析、Logistic逐步回归分析、逐步判别分析、主成分分析、因子分析等多元统计分析,并用判别分析法验证RA证候诊断标准的诊断性能。结果 700例RA患者179个诊断指标经过初筛后降为124个;聚类分析得出基本证型为湿热痹阻证、肝肾阴虚证、瘀血痹阻证、寒湿痹阻证、气血两虚证、痰瘀阻络证、脾肾阳虚证7个;Logistic逐步回归分析将7种证型的诊断指标由124个降为41个;逐步判别分析得出46个诊断指标作为补充。将上述指标合并,并参考聚类分析得出的诊断证候群,确立RA 7种基本证型的诊断敏感指标共52个。对52个指标进行主成分分析,保留的指标为47个。对47个指标再次进行因子分析,根据症状对证型贡献度的大小,列出了RA 7种基本证型的证候诊断标准;判别分析证实该诊断标准的诊断准确率为83.39%。结论 RA中医证候诊断分为湿热痹阻证、寒湿痹阻证、肝肾阴虚证、气血两虚证、瘀血痹阻证、痰瘀阻络证、脾肾阳虚证7个基本证型,具有较高的诊断准确率。Objective To establish a syndrome diagnostic criterion for rheumatoid arthritis（ RA） and validate the diagnostic performance of the criteria. Methods We drew up a RA clinical syndrome questionnaire and applied cross-sectional study method. 700 RA patients were surveyed. Then survey information underwent multivariate statistical analysis,including cluster analysis,logistic stepwise regression analysis,stepwise discriminant analysis,principal component analysis,and factor analysis. The diagnostic performance of RA syndrome diagnostic criteria was validated with discriminant analysis. Results Diagnostic indicators of 700 RA patients were reduced from 179 to 124 after first screening; cluster analysis showed that the basic syndromes were damp-heat stagnation,liver-kidney yin deficiency,stagnation of blood stasis,cold-damp stagnation,blood and qi deficiency,phlegm and blood stasis blocking collaterals,and spleen-kidney yang deficiency. By Logistic stepwise regression analysis,the diagnostic indicators of these 7 syndromes were reduced from 124 to 41. Forty six diagnostic indicators were added after stepwise discriminant analysis. Summing up the indicators above,we confirmed that there were 52 sensitive diagnostic indicators for 7 basic syndromes of RA. And after principal component analysis was applied on these 52 indicators,47 remained. Factor analysis then was done on the 47 indicators. According to contributions of the symptoms to the syndrome,syndrome diagnostic criteria of 7 RA basic syndrome types were developed. It is proved with discriminant analysis that the diagnostic accuracy of the criteria was 83. 39%. Conclusion There are 7 basic TCM syndromes in RA,and TCM syndrome diagnostic criteria of RA have a relatively high diagnostic value.

关 键 词：多元统计分析 证候诊断 类风湿关节炎 

分 类 号：R259[医药卫生—中西医结合]