基于因子分析和聚类分析的痉挛性斜颈患者中医证型的横断面研究  

Distribution of Traditional Chinese Medicine Patterns in Patients with Spasmodic Torticollis Based on Factor Analysis and Cluster Analysis:A Cross-sectional Study

作　　者：李进阳 李华南[1] 刘新明 王君实 王海腾[1] 王建伍 王金贵[1] LI Jinyang;LI Huanan;LIU Xinming;WANG Junshi;WANG Haiteng;WANG Jianwu;WANG Jingui(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin,300381)

机构地区：[1]天津中医药大学第一附属医院/国家中医针灸临床医学研究中心,天津市300381

出　　处：《中医杂志》2024年第15期1586-1592,共7页Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局高水平中医药重点学科建设项目(2023ZDXK002);国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄工程)(885022);天津中医药大学第一附属医院“拓新工程”基金(院ZD202105,院YB202118)。

摘　　要：目的 分析痉挛性斜颈患者中医证候规律,为规范化辨证及临床治疗提供参考。方法 2022年6月至2023年12月在天津中医药大学第一附属医院痉挛性斜颈门诊及肌张力障碍病房开展横断面研究,通过现场问卷方式规范采集198例痉挛性斜颈患者的一般情况资料(性别、年龄、病程及类型)和中医四诊资料(症状、舌象及脉象),对获取信息进行描述性频数分析、因子分析和聚类分析,并结合临床资料归纳出主要的中医证候分布情况。结果 198例痉挛性斜颈患者中男性89例(44.95%)、女性109例(55.05%),平均年龄(40.70±0.96)岁,平均病程(24.78±2.32)个月。共统计出296项症状/体征,累计出现频次为6756次,其中出现频率≥20%的症状/体征共计58项,前三位为项背拘急(83.84%)、病情与情志相关(74.75%)及急躁易怒(72.73%)。对58项症状/体征进行因子分析,结果显示因子旋转在51次迭代后收敛,最终得出20个公因子,累积贡献率为64.03%。痉挛性斜颈的病位证素前三位肝、经络、筋骨,病性证素前三位为气滞、血瘀和阴虚。对20个公因子聚类分析结果显示,中医证型主要为肝风内动证、肝肾阴虚证、痰浊阻滞证及邪壅经络证。198例患者中肝风内动证81例、肝肾阴虚证60例、邪壅经络证37例及痰浊阻滞证20例。不同性别、年龄段、病程患者中医证型分布差异无统计学意义(P>0.05)。结论 痉挛性斜颈病位以肝为主,中医证型多为肝风内动证、肝肾阴虚证、痰浊阻滞证及邪壅经络证。Objective To analyze the traditional Chinese medicine(TCM)patterns in patients with spasmodic torticollis and provide reference for standardized differentiation and clinical treatment.Methods A cross-sectional study was conducted in the spasmodic torticollis outpatient clinic and dystonia ward of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June 2022 to December 2023.The general information including gender,age,duration of disease and type,and the TCM four examinations data such as symptoms,tongue manifestation and pulse manifestation of 198 patients with spasmodic torticollis were obtained by means of on-site questionnaires.Descriptive frequency analysis,factor analysis,and cluster analysis were performed,and the distribution of major TCM patterns were summarized based on the clinical information.Results A total of 198 patients with spasmodic torticollis were included,of which 89(44.95%)were male and 109(55.05%)were female,with an average age of 40.70±0.96 years and an average course of disease of 24.78±2.32 months.A total of 296 symptoms/signs were obtained,with a cumulative frequency of 6756 times,of which 58 symptoms/signs had a frequency≥20%,and the top three were neck and back stiffness(83.84%),condition related to emotions(74.75%)and irritability(72.73%).Factor analysis of 58 symptoms/signs showed that factor rotation converged after 51 iterations,resulting in 20 common factors with a cumulative contribution of 64.03%.The top three syndrome elements related to the location of the disease were liver,channels,tendons and bones,and those related nature of the disease were dominated by qi stagnation,blood stasis and yin deficiency.The cluster analysis of the 20 common factors showed that the main TCM patterns were internal stirring of liver wind syndrome,liver-kidney yin deficiency syndrome,turbid phlegm obstruction syndrome,and pathogen congested in the channels syndrome.Among the 198 patients,81 were diagnosed with internal stirring of liver wind syndrome,60 with

关 键 词：痉挛性斜颈 中医证型 证素 因子分析 聚类分析 

分 类 号：R274.9[医药卫生—中西医结合]