基于SEM的胃癌术前辨证标准的生物学指标探讨  

Exploration of Biological Index for Gastric Cancer Before Operation Syndrome Differentiation Based on SEM

作　　者：王克穷 马娟[2] 严惠芳[2] 叶峥嵘[2] 毛照海 马永录 高建魁 于明阳 牛晓梅 张锦 李晨 黄启云 

机构地区：[1]陕西中医药大学附属医院肿瘤三科,陕西咸阳712000 [2]陕西中医药大学,陕西咸阳712046 [3]武威市中医医院,甘肃武威733000 [4]甘肃省酒泉地区医院,甘肃酒泉735000 [5]金昌市人民医院,甘肃金昌737100

出　　处：《中华中医药学刊》2017年第11期2741-2744,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81102561);陕西省自然科学基金项目(2014JM2-8158)

摘　　要：目的:利用SEM结构方程模型探讨胃癌术前的中医证候分型与相关生物学指标之间的联系。方法:以胃癌患者术前的中医四诊信息和实验室检测指标(如血常规、肝肾功、肿瘤标志物、CT、MRI等)为自变量,通过探索性因子分析构建中医辨证初始模型,后以中医证型为潜变量,以四诊信息及检测指标为外显变量,验证生物学指标与辨证标准之间的对应关系的SEM结构方程模型。结果:(1)胃癌术前个体综合辨证模型中各证型的鉴别性指标及预测性指标主要为:(1)肝郁脾虚证:NEU、头晕、心率、精神紧张、焦虑、心下痞满、脉弱、尿胆原8个指标;(2)脾虚证:嘈杂不适、食欲不振、形体消瘦、GB、胃脘喜温5个指标;(3)肝胃不和证:舌质淡、嗳气反酸、胃脘痛有定处、TP4个指标。(2)胃癌术前群体综合辨证中各证型的鉴别性指标及预测性指标主要为:(1)气血两虚证:焦虑、食欲不振、形体消瘦、胃脘隐痛、心下痞满、腹部压痛、舌质淡、面色萎黄、嘈杂不适、头晕、苔薄白、四肢无力、胃脘痛有定处、胃脘喜按、语声低弱、脉弱、卡氏评分、BUN18个指标;(2)肝胃不和证:气短、嗳气反酸、心烦、呃逆、LDH、CREA、DBIL、AST、TBA9个指标;(3)肝郁脾虚证:腹腔引流液为黄绿色胆汁样液体、多梦、心悸、精神紧张、胸脘胀闷、胃脘喜温、IBIL7个指标;(4)肝胃虚寒证:喜热饮、痛窜胸胁、胸胁苦满、胃脘喜温、胃脘疼痛、胃脘喜按、语声低弱、RBC8个指标。结论:构建并验证了胃癌术前的个体和群体的辨证模型,并通过模型拟合的优劣验证了含有相关生物指标的辨证标准,为其它疾病及潜证辨证标准研究提供科学的依据。Objective：By using SEM structural equation model to explore the relationship between biological indicators and regularity of syndrome classification for gastric cancer before operation. Methods： Four examinations in TCM and in- dicators of laboratory tests（ such as blood routine tests, liver and kidney function, tumor markers, CT, MRI, etc. ） of gastric cancer patients before operation as independent variables. Use exploratory factor analysis to build the initial model of TCM. Take TCM syndromes as latent variables to verify the structural equation model＇ s corresponding relationship be- tween biology index and dialectical standard. Results： （ 1 ） Diagnostic and predictive indicators for different syndrome types of individual comprehensive syndrome differentiation model of gastric cancer patients before operation：①Liver depression and spleen deficiency syndrome ： NEU, dizziness, heart rate, stress, anxiety, weak pulse, epigastric fullness, UBG（ 8 indicators）. ②Spleen deficiency syndrome： noisy discomfort, loss of appetite, GB, emaciation, gastral cavity cold （5 indicators）. ③Liver - stomach disharmony syndrome ： TP, epigastric pain, pale tongue, belching and acid regurgitation（4 indicators）. （2）Diagnostic and predictive indicators for different syndrome types of gastric cancer patients before operation ：①Syndrome of deficiency of both qi and blood ： anxiety, loss of appetite, emaciation, epigastric pain, epigastric fullness, abdominal tenderness, pale tongue, BUN, limb weakness, voice low, weak pulse, noisy discomfort, dizziness, kps, epigastric pain fixed, pale complexion, white thin moss, epigastric pain and preferring to be pressed （18 indicators ）. ②Liver - stomach disharmony： shortness of breath, belching, acid regurgitation, upset, hiccup, LDH, CREA, DBIL, AST,TBA（9 indicators）.③Liver stagnation and spleen deficiency ：dreaminess, palpitation, nervousness, chest epigastric fullness, epigastric cold,IBIL（9 indicators）. ④Spleen deficienc

关 键 词：结构方程模型 胃癌术前 辨证标准 

分 类 号：R735.2[医药卫生—肿瘤]