基于结构方程模型的腹泻型肠易激综合征中医量化辨证模型研究  

Quantitative Analysis of Syndrome Differentiation in Chinese Medicine for Diarrhea-predominant Irritable Bowel Syndrome with Structural Equation Modeling

作　　者：黄仲羽 刘宪华 刘凤斌[3] HUANG Zhong-yu;LIU Xian-hua;LIU Feng-bin(First School of Clinic Medicine of Guangzhou University of Traditional Chinese Medicine,Guangzhou,510000;Department of Spleen and Stomach Diseases,Shenzhen Baoan Traditional Chinese Medicine Hospital Group,Guangdong,518101;Department of Spleen and Stomach Diseases,First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou,510000)

机构地区：[1]广州中医药大学第一临床医学院,广州510000 [2]深圳市宝安中医院集团脾胃病科,广东518101 [3]广州中医药大学第一附属医院脾胃病科,广州510000

出　　处：《中国中西医结合杂志》2019年第8期1004-1008,共5页Chinese Journal of Integrated Traditional and Western Medicine

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

摘　　要：目的以腹泻型肠易激综合征为研究对象,通过运用结构方程模型进行中医证候量化分析的方法学探索,尝试建立中医证候量化研究的方法学范例。方法经过小组评议、文献回顾及专家评议的方法完成了理论模型的建立、调整、优化及验证。结合386例回顾性临床调查病例数据,运用结构方程模型进行腹泻型肠易激综合征中医典型证候辨证模型的构建和优化。结果建立了涵盖肝郁脾虚、脾肾阳虚、湿热阻滞及脾气虚弱四个主要证候的量化辨证模型。模型总体拟合指标度良好[拟合优度指数(GFI)=0.901,比较拟合指数(CFI)=0.907,近似误差均方根(RMSEA)=0.032]。直接效应指数显示各证候的典型症状表现均有较高的荷载,可实现证候间的有效鉴别。结论基于结构方程模型的中医证候模型构建与评价,为中医证候理论的定量化解析与应用推广提供良好的解决方案。Objective To establish quantitative syndrome differentiation model with structural equation modeling(SEM)for diarrhea-predominant irritable bowel syndrome(IBS-D)so as to offer a methodology guidance for standardization research of Chinese medicine.Methods Theoretical model was set up,modified and optimized via group evaluation,literature review and experts evaluation.SEM was performed with data collected from 386 IBS-D patients to evaluate and modify analytical feature of the syndrome differentiation model.Results Theoretical model was consisted of four typical syndromes including Gan stagnation and Pi deficiency,Pi-qi weakness,Pi-Shen Yang deficiency and block of damp-heat.Structural equation model of IBS-D showed that the fit indicators of the model proposed by this study were acceptable with indices GFI=0.901 CFI=0.907 and RMSEA=0.032,which presented good consistent with data structure.With significant correlation between symptoms and related syndrome,the model was evaluated to be with feasibility and consistency for theoretical interpretation and clinical practice.ConclusionSEM served as an effective quantification approach for complex syndrome models of Chinese medicine that could be helpful for application and promotion of Chinese medicine theory.

关 键 词：结构方程模型 腹泻型肠易激综合征 量化辨证 

分 类 号：R25[医药卫生—中医内科学]