冠心病心绞痛中医证候的规范及心气亏虚证的计量研究  

The Standard of TCM Syndromes of Angina Pectoris of Coronary Heart Disease and Measurement Research of Heart Qi Deficiency

作　　者：李艳娟[1,2] 王凤荣[3] 陈星 王蕾[2] 王丹[2] 

机构地区：[1]辽宁中医药大学,沈阳110032 [2]沈阳市第二中医医院,沈阳110101 [3]辽宁中医药大学附属第一医院,沈阳110032 [4]营口出入境检验检疫局,营口115000

出　　处：《世界中医药》2016年第2期355-359,共5页World Chinese Medicine

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目(编号:LNCC-C01-2015)

摘　　要：目的：探讨冠心病心绞痛中医证候的规范及心气亏虚证量化诊断方法。方法：本研究搜集了冠心病心绞痛相关20年的论文,3 090例患者的中医证候信息,运用频率、排序、logistic逐步回归法最大似然法模型等统计方法,初步确定冠心病心绞痛最常见证型：心气亏虚证、心血瘀阻证、痰阻心脉证、心气阴两虚证、心阳亏虚证、寒滞心脉证、心阴亏虚证,而心阴亏虚证在冠心病心绞痛的临床证型中较少见。进一步采用单因素分析和logistic逐步回归法选定相关因素;应用条件概率换算方法[1-2]对相关因素进行赋分;应用最大似然判别法确定量化诊断阈值;并对建立的冠心病心绞痛心气亏虚证量化诊断标准进行回顾性检验,分别计算其敏感度、特异度、准确度、阳性预测值、阴性预测值。结果：冠心病心绞痛心气亏虚证的中医证候量化诊断相关因素为胸闷、心胸隐痛、气短、神疲乏力、自汗、倦怠懒言、舌淡、苔薄白、脉细,赋分为2~13分;心气亏虚证的诊断阈值为28分;经进行回顾性检验,敏感度、特异度、准确度、阳性预测值、阴性预测值分别为71.25%、87.14%、83.37%、63.32%、90.68%。结论：以症状出现频次为基础,建立冠心病心绞痛中医证候量化标准的方法是可行的。Objective： To explore the standard of syndromes of coronary heart disease（ CHD） angina pectoris and conduct a quantitative diagnosis on qi deficiency of heart. Methods： This study collected twenty years of papers discussing coronary heart disease associated with angina,and the information of 3090 cases of TCM syndrome. Using frequency,sorting,logistic stepwise regression method to determine the most common syndrome of angina pectoris of coronary heart disease： heart qi deficiency,blood stasis,phlegm stagnate syndrome,qi and yin deficiency,yang deficiency,cold stagnation and yin deficiency. Yin deficiency is actually rare to be seen. Single factor analysis and logistic stepwise regression method was further used to select the relevant factors. Conditional probability conversion method was used to mark the related factors. Applying maximum likelihood discriminant method to determine the threshold of quantitative diagnosis. Besides,to do retrospectively test of standard quantitative diagnosis of deficiency syndrome of heart qi deficiency,the establishment of the coronary heart disease and angina pectoris. Their sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were calculated respectively. Results： The quantitative diagnosis related factors Chinese Medicine syndrome of heart qi deficiency was： chest tightness,heart and chest pain,shortness of breath,lassitude,spontaneous perspiration,burnout lazy words,pale tongue,thin white fur,and fine pause. The score was 2-13. The diagnostic threshold of qi deficiency syndrome of qi was 28. According to the retrospective test,sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were 71. 25%,87. 14%,83. 37%,63. 32%,90. 68% respectively.Conclusion： Based on the frequency of symptoms,it is feasible to establish a quantitative criteria of TCM syndrome in patients with coronary heart disease.

关 键 词：冠心病心绞痛 中医证候 心气亏虚证 计量学 

分 类 号：R256.22[医药卫生—中医内科学]