基于症状—中药—诊断模型2型糖尿病及并发症中医证治特征分析  

Analysis of TCM syndrome differentiation and treatment of type 2 diabetes mellitus and its complication based on the symptom-Chinese herbal medicine-diagnosis model

作　　者：陈世波[1] 刘保延[2] 周雪忠[3] 倪青[1] 张小平[2] CHEN Shi-bo;LIU Bao-yan;ZHOU Xue-zhong;NI Qing;ZHANG Xiao-ping(Guanganmen Hospital, China Academy of Chinese Medical Sciences ,Beijing 100053;China Academy of Chinese Medical Sciences,Beijing 100700;College of Computer,Beijing Jiaotong University,Beijing 100044)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]中国中医科学院,北京100700 [3]北京交通大学计算机学院,北京100044

出　　处：《世界中西医结合杂志》2018年第10期1336-1339,共4页World Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金重大研究计划项目(90709006);人社部归国留学人员基金项目

摘　　要：目的基于首诊住院病例探讨2型糖尿病及其并发症中医证治特征。方法运用"症状—中药—诊断"模型对来自7家医院3238例住院2型糖尿病患者首次诊疗数据进行分析和挖掘,所有数据均为实时、现场采集。结果总样本数3238例,男1539例,女1699例。年龄最大者89岁,最小者24岁。年龄分布:<40岁199人; 40岁~59岁之间(含40岁和59岁) 1291人,≥60岁1748人。根据主题间距离系数(KL)确定最优分类结果,并对其中的3个主题进行分析。第1类主题的症状概率值、主题概率值分别为0. 627 04、0. 065 45。以肢体活动不利、言语不利、步履不稳、语言蹇涩、口舌歪斜、表情淡漠、手震颤、呛咳为主要特征;中药使用以活血化瘀、醒脑化痰、安神定志为主。符合脑血管病的特征性表现。对应疾病为脑梗死,属于中医中风病范畴。提示以脑梗死及相应症状群为特征的患者有相当占比,且代表一类患者首诊特征,是临床决策时优先关注的重点和难点。第2类主题的症状概率值、主题概率值分别为0. 666 3、0. 084 97。以脉数、发热、咽痛、恶寒、咽后壁充血、咽干、脉浮、扁桃体肿大、神疲、唇色淡白等为主要特征,是上呼吸道感染的固有表现,属于中医感冒或发热范畴。相对应的中药功效主要以疏风清热、解毒利咽为主,符合急则治其标的中医治疗法则。第3类主题的症状概率值、主题概率值分别为0. 742 21、0. 086 18。症状以纳差、脉滑、恶心、尿急、尿痛为特征表现,伴呕吐、苔厚、腰痛、腹部胀满、小便灼热、胃脘胀满、胃脘疼痛、返酸等其他症状。提示该类患者以糖尿病合并泌尿系感染为主要矛盾,中医属于淋证范畴。相应中药以清热化湿、利水通淋为主,同时兼以化浊止呕、理气养阴。结论 3个主题代表了三类不同的住院患者群体,即是2型糖尿病合并脑梗死、2型糖尿病合并上呼吸道感染,�Objective To explore TCM syndrome differentiation and treatment of type2diabetes mellitus(T2DM)and its complication based on the first-visiting hospitalized cases.Methods Using the symptom-Chinese herbal medicine-diagnosis model,the data of3238cases at the first treatment from7hospitals were analyzed and mined.Results All of the data were collected at real time and at the spot.Age distribution:<40years old for199cases,≥40years old and<59years old for1291cases,>40years old for1748cases.The optimal classification result was determined according to distance coefficient among the themes.3themes of them were collected for analyzed.The symptom probability and the theme probability of the first category were0.62704and0.06545.The main symptoms included motor im-pairment,slurred speech,unstable walking,deviation of mouth and tongue,dull expression,hand trembling and coking.Chinese herbal medicines were for activating blood circulation and removing stasis,regaining consciousness and resolving phlegm as well as tranquilizing the mind,which is responded to the characteristics of cerebrovascular disorders.Cerebral infarction is in the category of stroke in TCM.It was shown that the group with the characteristics of cerebral infarction and the corresponding symptoms account for a quite high proportion.It indicated the characteristics of the patients in this category on the first visit which are the key point and the difficult point for the attention in the priority in clinical decision.The symptom probability and the theme probability of the second category were0.6663and0.08497respectively.The main symptoms were rapid pulse,fever,sore throat,chills,pharynx congestion,dry throat,swollen tonsil,lassitude,pale lips.They are the common manifestation of the upper respiratory infection,belonging to the category of common cold or fever in TCM.The applicable herbal medicines should focus on eliminating wind,clearing heat,removing toxin and benefiting the throat in compliance with the TCM principle for treating the secondary at acute

关 键 词：2型糖尿病 症状-中药-诊断模型 真实世界数据 辨证论治 个体化治疗 

分 类 号：R587.2[医药卫生—内分泌]