基于因子分析和聚类分析的非急性发作期哮喘中医证候研究  

Traditional Chinese medical syndromes of non-acute exacerbation of asthma based on factor analysis and cluster analysis

作　　者：韩静 赵锐恒[2,3] 李云 韩泽璐[2,3] 林江涛 HAN Jing;ZHAO Ruiheng;LI Yun;HAN Zelu;LIN Jiangtao(Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine,Beijing 101300,China;Beijing University of Chinese Medicine,Beijing 100029,China;China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中医医院顺义医院,北京101300 [2]北京中医药大学,北京100029 [3]中日友好医院,北京100029

出　　处：《现代中西医结合杂志》2023年第23期3248-3255,共8页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的 分析非急性发作期哮喘患者中医证候学特点及与实验室检查指标的相关性,探讨中医宏观指标与微观指标之间的联系。方法 通过横断面研究方法,收集2020年10月—2022年1月在中日友好医院诊断为非急性发作期哮喘的315例患者社会人口学资料、中医四诊信息及实验室检查数据[肺通气功能指标、呼出气一氧化氮(FeNO)、诱导痰细胞学检查指标、外周血嗜酸性粒细胞计数及百分比、血清总IgE水平];对中医四诊信息进行因子分析,提取哮喘病性、病位等,运用样品聚类分析方法(Q聚类)、K均值法进行数据聚类分析,确定哮喘证型,分析患者的证候特点及不同中医证型间实验室指标的差异性。结果 非急性发作期哮喘患者常见的10种症状体征为咳嗽、喘息、痰多、喉中哮鸣有声、气短、喷嚏、鼻塞、流涕、神疲乏力、痰白;因子分析显示哮喘病位在肺,涉及脾、肾、心、肝,病理因素涉及痰饮、气滞、风邪、气虚、阳虚、阴虚;聚类分析得到肺脾气虚证、痰湿蕴肺证、血虚风燥证、脾肾阳虚证、肝郁肾虚证、气阴两虚证6种证型,肺脾气虚证占比最高,其次是痰湿蕴肺证;气阴两虚证患者肺功能相对较差;痰湿蕴肺证患者痰中性粒细胞计数明显低于血虚风燥证、肺脾气虚证、脾肾阳虚证患者(P均<0.05),痰嗜酸粒细胞计数、FeNO、血嗜酸性粒细胞计数及百分比均明显高于脾肾阳虚证患者(P均<0.05),且痰嗜酸粒细胞计数及血嗜酸性粒细胞计数均明显高于肺脾气虚证患者(P均<0.05)。结论 非急性发作期哮喘患者以咳、喘、痰、虚以及过敏症状为主要临床表现,病位以肺为主,涉及脾、肾、心、肝四脏,病性本虚标实,虚实夹杂;气阴两虚证、肝郁肾虚证、痰湿蕴肺证、血虚风燥证、肺脾气虚证、脾肾阳虚证为非急性发作期哮喘常见证型,中医证型与实验室指标有相关性,气阴两虚证�Objective It is to analyze the characteristics of traditional Chinese medicine(TCM)syndromes of patients with non-acute exacerbation of asthma and their correlation with laboratory test indicators,and to explore the relationship between macro-indicators and micro-indicators in TCM.Methods The socio-demographic data,information of the four diagnostic methods,and laboratory examination data[indicators of pulmonary ventilation function,exhaled nitric oxide(FeNO),indicators of induced sputum cytology,counts and percentage of eosinophils in peripheral blood,and serum level of total IgE]of 315 patients who were diagnosed as non-acute exacerbation of asthma at the China-Japan Friendship Hospital from October 2020 to January 2022 were collected through the cross sectional study methodology.The information of the the four diagnostic methods were analyzed by factor analysis to extract the nature and location of asthma,the data clustering analysis was performed on using the sample cluster analysis method(Q clustering)and K-mean method to confirm the syndrome type of asthma,the characteristics of the patients’syndromes and the differences in laboratory indicators among different TCM syndromes were analyzed.Results The 10 common signs and symptoms in patients with non-acute exacerbations of asthma were cough,wheezing,much phlegm,rales in the throat,shortness of breath,sneezing,nasal congestion,runny nose,fatigue,and white sputum.Factor analysis showed that asthma was located in the lungs,involving the spleen,kidneys,heart,and liver,and that the pathological factors involved phlegm,stagnant qi,wind,deficiency of qi,yang,and yin.Cluster analysis revealed 6 syndrome types:syndrome of lung spleen qi deficiency,syndrome of phlegm dampness accumulating in the lung,syndrome of blood deficiency and wind dryness,syndrome of spleen kidney yang deficiency,syndrome of liver depression and kidney deficiency,and syndrome of qi yin deficiency.The proportion of syndrome of lung spleen qi deficiency was the highest,followed by syndrome of p

关 键 词：支气管哮喘 聚类分析 中医证候 肺通气功能 呼出气一氧化氮 IGE 

分 类 号：R256.12[医药卫生—中医内科学]