基于结构方程模型的功能性消化不良中医病机演化模型研究  

Evolution Path Analysis of Chinese Medicine Pathogenesis for Functional Dyspepsia Using Structural Equation Modeling

作　　者：黄仲羽 刘凤斌[2] 曹月红 HUANG Zhong-yu;LIU Feng-bin;CAO Yue-hong(First School of Clinic Medicine ,Guangzhou University of Traditional Chinese Medicin;The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicin;The People＇s Hospital of Longhua District,Shenzhen Guangdon)

机构地区：[1]广州中医药大学第一临床医学院脾胃病科,广州510405 [2]广州中医药大学第一附属医院脾胃病科,广州510405 [3]广东省深圳市龙华区人民医院,广东518109

出　　处：《中国中西医结合杂志》2018年第7期786-789,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81774264,No.81373786,No.81303148)

摘　　要：目的以功能性消化不良为例,运用结构方程模型进行中医病机演化模型的构建和分析,探索中医病机演化路径研究与应用的新模式。方法在文献回顾和临床调查的基础上,应用前瞻性临床调查,共采集临床病例507例。经过专家小组评议,提取核心病机元素,完成病机演化路径构建,结合临床表征构建初步的中医病机演化理论模型。运用临床数据对病机演化结构方程模型进行拟合评价及修正优化,并从模型拟合度及解释度两方面进行模型评价。结果共提取出脾胃气虚、肝郁、气滞、痰湿和热5个核心病机要素,形成4条基本病机路径。经结构方程模型拟合评价和优化,最终的病机演化模型拟合度良好(CFI=0.92,NFI=0.93,RMSEA=0.042,RMR=0.049,ECVI=2.41),模型结构具有良好的实用性和理论解释性。结论运用结构方程模型进行中医病机演化路径的模型化构建和定量化分析具有良好的可行性。Objective To establish evolution path of Chinese medicine pathogenesis for functional dyspepsia using structural equation modeling so as to explore possible methodology for quantitative and intuitive presentation of Chinese Medicine pathogenesis. Methods According to literature reviews and clinical investigations of functional dyspepsia,the core pathogenesis elements were extracted. Through experts reviews,the evolution path of pathogenesis was constructed in a preliminary model of TCM pathogenesis evolution. Clinical data in a prospective study were used to evaluate and modify the theoretical model with structure equation modeling in AMOS 21. Results Totally 507 cases were enrolled in the prospective clinical investigation. According to the characteristics of clinical data and experts＇ opinions,5 core pathogenesis factors： Pi-Wei qi deficiency,Gan-qi depression,qi stagnation,phlegm dampness,and heat were extracted to form 4 basic pathogeneses pathways. After modification in structural equation modeling,goodness of fit for the model was evaluated to be adequate with indices CFI = 0. 92,NFI = 0. 93,RMSEA = 0. 042,RMR = 0. 049,and ECVI = 2. 41. With significant correlation between pathogenesis factors and related symptoms or signs,the model was evaluated to having feasibility and consistency for theoretical interpretation and clinical practice. Conclusion Structural equation modeling provides a feasible technical scheme for modeling and quantitative analysis of pathogenesis path in Chinese medicine.

关 键 词：功能性消化不良 结构方程模型 病机 辨证 

分 类 号：R259[医药卫生—中西医结合]