基于复杂系统建模方法的慢性胃炎常见证型主症特征选择研究  

Study on the Selection of Primary Symptoms for Common Syndrome Types in Chronic Gastritis by Complex System Modeling Method

作　　者：郭本琼 刘怡[1] 徐玮斐 刘晏[2] 颜建军[3] 刘国萍[1] GUO Ben-Qiong;LIU Yi;XU Wei-Fei;LIU Yan;YAN Jian-Jun;LIU Guo-Ping(School of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai Key Laboratory of Health Identification and Assessment,Shanghai 201203,China;Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;School of Mechanical and Power Engineering,East China University of Science and Technology,Shanghai 200237,China)

机构地区：[1]上海中医药大学中医学院,上海市健康辨识与评估重点实验室,上海201203 [2]上海中医药大学附属市中医医院,上海200071 [3]华东理工大学机械与动力工程学院,上海200237

出　　处：《广州中医药大学学报》2024年第12期3321-3330,共10页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81873236,81270050,30901897);上海市卫健委面上项目(编号:202340166);上海市健康辨识与评估重点实验室建设项目(编号:13DZ2261000)。

摘　　要：【目的】应用复杂系统建模方法,探讨慢性胃炎常见证型的主症特征,为慢性胃炎中医证候诊断的客观化研究提供思路。【方法】通过综合运用随机森林、互信息、粗糙集、近邻传播聚类、判别分析等方法,综合分析慢性胃炎常见证型如湿浊中阻证、脾胃气虚证、脾胃虚寒证、肝郁气滞证、肝胃郁热证的症状群,挖掘症状和证型之间、症状与症状之间的关系。通过判别分析交互验证法与受试者工作特征曲线下面积(AUC)值对慢性胃炎主症的诊断效果进行评价。【结果】湿浊中阻证的正相关特异性症状为苔腻、齿痕舌、苔厚、胖大舌,负相关鉴别症状为舌色红、苔薄、苔黄(预测准确率为79.2%,AUC值为0.868);脾胃气虚证的正相关特异性症状为乏力、苔白、齿痕舌、唇色淡白、便溏,负相关鉴别症状为苔腻、舌色红(预测准确率为75.5%,AUC值为0.830);脾胃虚寒证的正相关特异性症状为肢冷/手足欠温、胃脘喜暖、苔薄,未见负相关鉴别症状(预测准确率为79.2%,AUC值为0.836);肝郁气滞证的正相关特异性症状为因情绪而加重、胁胀或痛、嗳气,负相关鉴别症状为乏力、苔腻(预测准确率为74.1%,AUC值为0.818);肝胃郁热证的正相关特异性症状为舌色红、胁胀或痛、唇色红,负相关鉴别症状为苔腻、苔白、苔厚(预测准确率为79.9%,AUC值为0.845)。慢性胃炎常见证候中正相关特异性症状病位要素主要涉及脾、胃、肝,病性要素主要涉及湿浊、气虚、血虚、寒湿、阳虚、气滞、热。【结论】通过综合运用复杂系统方法筛选得到的慢性胃炎常见证型主症特征与中医理论、临床实践、既往诊断标准基本一致。舌象、唇象特征在主症中的占比最大,提示舌诊、唇诊对于慢性胃炎中医证型的诊断具有重要意义。Objective To investigate the primary symptoms of the common syndrome types in chronic gastritis through complex system modeling method,thus to provide evidence for the objectivity of the differentiation of traditional Chinese medicine(TCM)syndrome in chronic gastritis.Methods The complex system modeling methods of random forest,mutual information,rough sets,affinity propagation clustering and discriminant analysis were comprehensively used to screen the primary symptoms for the diagnosis of common syndrome types in chronic gastritis,such as syndrome of damp turbidity obstruction in the middle energizer,syndrome of spleen and stomach qi deficiency,syndrome of deficiency-cold in spleen and stomach,syndrome of liver depression and qi stagnation,and syndrome of stagnated heat in liver and stomach.And then the relationship between symptoms and syndromes types,and the relationship between symptoms and symptoms were mined.The diagnostic efficiency of the primary symptoms of chronic gastritis was evaluated by the discriminant analysis interactive validation method and the area under the receiver operating characteristic curve(AUC).Results The specific symptoms positively correlated with the syndrome of damp turbidity obstruction in the middle energizer were greasy coating,toothmarked tongue,thick coating and enlarged tongue,while red tongue,thin coating and yellow coating were the identification symptoms negatively correlated with the syndrome,and their prediction accuracy was 79.2%with the AUC value being 0.868.The specific symptoms positively correlated with the syndrome of spleen and stomach qi deficiency were weakness,white coating,tooth-marked tongue,pale lip,and loose stools,while the identification symptoms negatively correlated with the syndrome were greasy moss and red tongue,and their prediction accuracy was 75.5%with the AUC value being 0.830.The specific symptoms positively correlated with the syndrome of deficiency-cold in spleen and stomach were cold limbs,preference of warmth in the epigastrium,and thin co

关 键 词：慢性胃炎 湿浊中阻证 脾胃气虚证 脾胃虚寒证 肝郁气滞证 肝胃郁热证 主症 舌象 唇象 

分 类 号：R259.733[医药卫生—中西医结合]