3088例动脉粥样硬化性脑梗死患者中医证候特征回顾性研究  

A Retrospective Study on the Characteristics of Traditional Chinese Medical Syndromes in 3088 Cases of Atherosclerotic Cerebral Infarction

作　　者：曹依兰 万海同[1] 韩进[1] 徐彬[1] 周惠芬[1] 虞立[1] 周鹏[1] 杨洁红 何昱[1] CAO Yilan;WAN Haitong;HAN Jin;XU Bin;ZHOU Huifen;YU Li;ZHOU Peng;YANG Jiehong;HE Yu(Zhejiang Chinese Medical University,Hangzhou,310053)

机构地区：[1]浙江中医药大学中医心脑血管研究院,浙江杭州310053

出　　处：《中医杂志》2023年第21期2216-2223,共8页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划(2019YFC1708600)。

摘　　要：目的探讨动脉粥样硬化性脑梗死(ATCI)不同阶段中医证候特征及病机演变规律。方法通过检索医院信息系统,回顾性收集2015年1月1日—2019年12月31日来自6个地区8家医院的ATCI患者临床资料,经分期及临床症状统计后,使用因子分析中主成分分析法提取公因子,在因子分析的基础上进行聚类分析,结合证素辨证、聚类分析及专家讨论结果探讨动ATCI不同分期的证候情况。结果纳入3088例ATCI患者,其中急性期2290例,非急性期798例。除去中风主要症状(肢体麻木、无力及活动不利,言语不利,头晕),对84项四诊信息变量中出现频率≥5%的指标进行统计,急性期为36项,非急性期35项,经因子分析各提取出14项公因子,选取载荷系数>0.3的公因子进行证素判定,再将14个公因子组作为变量进行聚类,最终急性期、非急性期各聚为5类,结合临床实际和专家意见,急性期证候为气阴两虚、风痰瘀阻证(36.07%),气虚血瘀证(20.74%),风火上扰证(15.15%),阴虚风动证(9.43%),脾虚肝亢证(3.80%);非急性期证候为气阴两虚、瘀血阻络证(45.49%),气阴两虚证(20.05%),气滞血瘀证(16.42%),脾肾亏虚证(8.52%),肝阳上亢证(4.89%)。结论ATCI急性期证素以血瘀、火、内风、阳亢、气虚、阴虚等为主,非急性期以阴虚、气虚、血瘀、气滞等为主。ATCI的主要病机特征为气阴两虚,痰浊、血瘀阻络,根本病机为气阴两虚。Objective To investigate the characteristics of traditional Chinese medicine syndrome and the evolution of pathogenesis in different stages of atherosclerotic thrombotic cerebral infarction(ATCI).Methods Clinical data of 3088 ATCI patients from 8 hospitals in 6 provinces and cities were collected from the hospital information system during January 1,2015 to December 31,2019.After staging and counting clinical symptoms,common factors were extracted using the principal component analysis method in factor analysis.Cluster analysis was then carried out on the basis of the factor analysis.The results of the combination of the evidence element identification,cluster analysis and expert discussion were used to discuss the evidence of the different disease stages of atherosclerotic cerebral infarction.Results Of the 3088 ATCI patients included,2290 cases were in the acute phase and 798 in the non-acute phase.Excluding the main symptoms of ischaemic stroke,such as numbness and weakness of limbs,unfavourable movement,unfavourable speech and dizziness,we identified 84 indicators with a frequency≥5%of the four diagnostic information variables.Of these,36 indicators were observed in the acute phase and 35 in the non-acute phase.Factor analysis extracted 14 common factors from each phase.We selected factors with a loading coefficient >0.3 for evidence determination.These 14 groups of common factors were used as variables for clustering.After clustering,the acute,non-acute phase were each divided into 5 categories.Based on a combination of clinical practice and expert opinion,the symptoms identified in the acute period were syndrome of deficiency of both qi and yin,syndrome of blockade of wind-phlegm-static blood(36.07%),syndrome of qi deficiency and blood stasis(20.74%),syndrome of upward disturbance of wind-fire(15.15%),syndrome of stirring wind due to yin deficiency(9.43%),and syndrome of spleen deficiency and liver hyperactivity(3.80%).In the non-acute phase,the symptoms were qi and yin deficiency with syndrome of qi stag

关 键 词：动脉粥样硬化性脑梗死 证候特征 证素 因子分析 聚类分析 

分 类 号：R277.7[医药卫生—中医学]