基于潜在类别分析和隐结构分析探究代谢综合征中医证候类型分布特点  

Characteristics of traditional Chinese medicine pattern distribution of metabolic syndrome based on latent class analysis and latent structure analysis

作　　者：马丽娜·阿新拜 杨一点 张欢 赵玉清 张立平[1,4] Malina AXINBAI;YANG Yidian;ZHANG Huan;ZHAO Yuqing;ZHANG Liping(Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078,China;College of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830011,China;Department of Traditional Chinese Medicine,Shenzhen Bao′an People′s Hospital,Shenzhen 518100,China;Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学东方医院,北京100078 [2]新疆医科大学中医学院 [3]深圳市宝安区人民医院中医科 [4]北京中医药大学研究生院

出　　处：《北京中医药大学学报》2024年第4期532-544,共13页Journal of Beijing University of Traditional Chinese Medicine

基　　金：北京市自然科学基金面上项目(No.7212181);北京中医药大学重点攻关项目(No.2020-JYB-ZDGG-138)。

摘　　要：目的通过对代谢综合征(metabolic syndrome,MS)中医证候类型分布进行分析,更准确、精细地得出MS患者的证候属性、证候特征。方法回顾性分析北京中医药大学东方医院2017年12月—2022年9月收治的695例MS患者的资料,运用潜在类别分析和隐结构分析得出中医证候,并利用上述结果对每例患者进行辨证分型,确定MS患者中医证候类型。结果本研究纳入的症状及体征共9044频次,排名前10的高频症状、体征分别为口干多饮(77.70%)、乏力(60.58%)、苔腻(59.14%)、视物模糊(54.68%)、脉滑(53.96%)、脉弦(52.09%)、苔白(48.92%)、肢体麻木(43.60%)、苔黄(39.71%)、肢体发凉(36.40%)。依据潜在类别分析结果,确定了695例MS患者的证素要点,病性证素包括气虚、痰湿、湿热、气滞、阴虚、火热、津液伤,病位证素主要在肝、脾、肺、肾,695例患者主要可分为以虚证为主、以实证为主、虚实夹杂3类人群。通过对695例MS患者症状、体征的隐结构模型进行分析,确立6个基础证候,分别为肝阳上亢证、脾虚湿蕴证、肾阴阳两虚证、热盛伤津证、气虚血瘀证、肝胃郁热证。结合专业知识,对695例MS患者的四诊信息进行全面整合,在潜在类别分析及隐结构分析的基础上,对患者进行二次辨证,最终得到出现频率>1%的证候类型共20个,以肝郁脾虚、湿热内蕴证(12.66%)出现频次最高。结论MS的病机复杂、证候类型分布广泛,但总体来看,以肝郁脾虚、湿热内蕴证最为常见,临床上在分证论治的基础上,也要注意结合应用健脾疏肝、清热化浊之法。Objective To analyze the distribution of traditional Chinese medicine patterns in metabolic syndrome(MS),with the aim of deriving the attributes and characteristics of patterns in patients with MS more accurately and finely.Methods The data of 695 MS patients admitted to Dongfang Hospital,Beijing University of Chinese Medicine from December 2017 to September 2022 were retrospectively analyzed to derive traditional Chinese medicine patterns using latent class analysis and latent structure analysis,and the above results were used to identify the pattern type of each patient according to differentiation of syndromes,to determine the traditional Chinese medicine pattern types of MS patients.Results A total of 9,044 times of the symptoms and signs were included in this study,and the top 10 high⁃frequency symptoms and signs were dry mouth and polydipsia(77.70%),fatigue(60.58%),greasy fur(59.14%),blurred vision(54.68%),slippery pulse(53.96%),wiry pulse(52.09%),white fur(48.92%),numbness of the limbs(43.60%),yellow fur(39.71%),and cold limbs(36.40%).Based on the result of the latent class analysis,this study determined the main pattern elements of 695 patients with MS.The pathological pattern elements included qi deficiency,phlegm⁃dampness,dampness⁃heat,qi stagnation,yin deficiency,fire⁃heat,and impairment of body fluids;the pathological pattern elements were mainly located in liver,spleen,lung,and kidney;the 695 patients could be classified into three main groups:predominantly deficiency syndrome,predominantly excess syndrome,and deficiency syndrome accompanied with excess syndrome.Through analyzing the latent structure model of the symptoms and signs of 695 patients with MS,six basic syndromes were established,which were the syndromes of hyperactivity of liver yang,deficiency in the spleen with dampness retention,deficiency of both kidney yin and yang,consumption of body fluids due to intense heat,blood stasis due to qi deficiency,and stagnation of liver qi with stomach heat.Combined with the theory of Chinese

关 键 词：代谢综合征 潜在类别分析 隐结构分析 肝郁脾虚证 湿热内蕴证 

分 类 号：R259[医药卫生—中西医结合]