基于决策树法缺血性脑卒中与短暂性脑缺血发作患者血瘀证识别模式比较研究  

Comparison study of recognization patterns of ischemic stroke and TIA patients with blood stasis syndrome based on decision tree

作　　者：刘玥[1] 张允岭[2] 金香兰[2] 陈建新[1] 卢朋[3] 刘西[3] 王嘉麟[2] 周春宇[2] 郭蓉娟[2] 陈志刚[2] 张志辰[2] 杨秀泉 张志军 吴皓[6] 张永顺 

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078 [3]中国科学院自动化研究所,北京100190 [4]北京市丰台区王佐镇社区卫生服务中心,北京100074 [5]北京市丰台区蒲黄榆社区卫生服务中心,北京100075 [6]北京市丰台区方庄社区卫生服务中心,北京100078 [7]北京市丰台区花乡社区卫生服务中心,北京100070

出　　处：《中华中医药杂志》2015年第5期1723-1727,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：2011年医改重大专项;北京中医药大学科研创新团队项目(No.2011-CXTD-23);国家中医药管理局2010年度中医药行业科研专项(No.201007002);2011年北京市科技计划项目(No.Z111107056811040)~~

摘　　要：目的:初步建立缺血性脑卒中与短暂性脑缺血发作(TIA)患者血瘀证识别模式,并比较两者异同。方法:将临床收集的1 113例缺血性脑卒中、812例TIA患者中医四诊信息进行归一化处理后,采用卡方自动交互检测(CHAID)决策树方法从筛选出的中医四诊信息中分别提取血瘀证识别规律,形成识别模式,据此比较两者识别模式的异同。结果:舌暗、舌下络脉迂曲、舌有齿痕经筛选进入缺血性脑卒中血瘀证决策树模型,对该模型测试结果显示:敏感度为76.6%,特异度为81.6%,准确率为79.1%。舌暗、头重如裹、肢倦身重、苔薄,经筛选进入TIA血瘀证决策树模型,对该模型测试结果显示:敏感度为66.3%,特异度为81.2%,准确率为74.1%。收益及指数图显示两者模型均具备良好性能。结论:决策树模型可基于中医四诊信息数据清晰、直观地进行缺血性脑卒中与TIA患者血瘀证的识别;舌诊在以上两种疾病血瘀证识别模式中均具重要意义;舌暗为所共见的首要症状,皆可直接用于血瘀证判定,TIA患者病机多为正气渐衰,脾虚湿聚,待发展至缺血性脑卒中阶段正气已衰,脾虚则成为其主要临床表现。Objective： To construct a comparison of recognization pattern of ischemic stroke and TIA patients with blood stasis and compare their difference. Methods： TCM four diagnostic information of 1 113 ischemic stroke patients and 812 TIA patients were collected and normalized. Chi-squared automatic interaction detector （CHAID） decision tree was applied to self- extract recognization rules from TCM four diagnostic information selected by t-test outcome, and the comparison of recognization pattern of blood stasis syndrome was established. Results： Dark tongue, flexible sublingual venae, tongue with tooth prints were selected to enter the ischemic stroke pattern. The sensitivity and specificity of the decision tree pattern could reach to 76.6% and 81.6%, and the accuracy was 79.1%. The dark tongue, head heavy as if swathed, fatigued limbs and heavy body, thin fur were selected to the TIA pattern. The sensitivity and specificity of the decision tree pattern could reach to 66.3% and 81.2%, and the accuracy was 74.1%. The gain and index charts showed that both of the patterns had good performances. Conclusion： Decision tree pattern could identify the blood stasis syndrome of ischemic stroke and patients clearly and intuitively based on TCM four diagnostic information. Tongue diagnostic is vital important in the recognization of blood stasis in patients with ischemic stroke and TIA. Dark tongue is the first and foremost symptom in the recognization pattern of ischemic stroke and TIA, which could also distinguish whether a patient is blood stasis syndrome or not. Spleen-deficiency played an important role in ischemic stroke and TIA with blood stasis syndrome. In the former phase, the vital qi is fading gradually with dampness obstructing spleen. In the second phase, the vital qi is deficiency, with spleen-deficiency as the obvious manifestation.

关 键 词：CHAID决策树 缺血性脑卒中 短暂性脑缺血发作 血瘀证 识别模式 比较研究 

分 类 号：R277.7[医药卫生—中医学]