135例代谢综合征患者主要证型及其典型相关症状、体征分析——一项基于证素辨证学及潜在类别分析的临床研究  

Analysis of Major Syndromes and Their Typical Related Symptoms and Signs in 135 Patients with Metabolic Syndrome:A Clinical Study Based on Syndrome Element Differentiation and Latent Class Analysis

作　　者：王桐 江铭倩 米丽芬 沈姗怡 夏淑洁 李灿东[1] WANG Tong;JIANG Mingqian;MI Lifen;SHEN Shanyi;XIA Shujie;LI Candong(Fujian University of Traditional Chinese Medicine,Fuzhou,350122;People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine)

机构地区：[1]福建中医药大学,福建省福州市350122 [2]福建中医药大学附属人民医院

出　　处：《中医杂志》2025年第4期376-381,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82204977);福建中医药大学青年科技创新人才培育计划(XQC2023002)。

摘　　要：目的探索代谢综合征患者的典型证型及其高诊断价值症状、体征特点。方法采集135例代谢综合征患者的中医四诊信息资料,运用证素辨证法及潜在类别分析法(LCA)得出患者主要中医证型,在此证型基础上分析症状并构建二元Logistic回归模型,确定其具有高诊断价值的症状、体征。结果135例代谢综合征患者涉及症状、体征总计163个,出现频次共1749次;提取证素共23项,出现频次总计367次,其中频次≥10次的有8项,合计出现323次,占总频次的88.01%,包括病位证素分别为肾(48次)、脾(14次)、胃(14次)等,病性证素分别为痰(71次)、阴虚(64次)、湿(57次)、热(42次)、气虚(13次)。LCA根据证素将135例代谢综合征患者分成2类人群,区分两类人群的证素特征为湿、痰,组合形成痰湿证为其主要证型。基于痰湿证筛选出9个高频症状、体征,分别为形体肥胖(39次)、舌苔腻(38次)、脉滑(33次)、舌苔白(31次)、嗜食肥甘厚味(30次)、小便特多(30次)、倦怠乏力(29次)、脉弦(25次)、舌暗红(25次)。进一步将这9个症状、体征结合LCA分类结果构建二元Logistic回归模型,最终确认形体肥胖、舌苔腻、倦怠乏力、舌苔白4个症状、体征是代谢综合征患者出现痰湿证的独立影响因素(P<0.05)。结论代谢综合征患者以痰湿证为主要证型,形体肥胖、舌苔腻、倦怠乏力、舌苔白为诊断代谢综合征患者痰湿证的典型相关症状、体征。Objective To explore the typical syndromes and their characteristic of symptoms and signs with high diagnostic value in patients with metabolic syndrome(MS).Methods Traditional Chinese medicine(TCM)diagnostic information was collected from 135 MS patients.Syndrome element differentiation and latent class analysis(LCA)were applied to identify the major TCM syndromes in MS patients.Symptoms were analyzed based on the differentiated syndromes,and a binary logistic regression model was constructed to determine symptoms and signs with high diagnostic value.Results A total of 135 MS patients were included,involving 163 symptoms and signs with a total frequency of 1749;twenty-three syndrome elements were extracted,367 times frequency in total,among which 8 syndrome elements occurred≥10 times with 323 frequencies(88.01%of the total).These included locationrelated elements such as kidney(48 times),spleen(14 times),and stomach(14 times),and nature-related elements such as phlegm(71 times),yin deficiency(64 times),dampness(57 times),heat(42 times),and qi deficiency(13 times).Based on LCA,the 135 patients were categorized into two groups distinguished by the syndrome elements of dampness and phlegm,forming the"phlegm-dampness syndrome"as the major syndrome type.Nine highfrequency symptoms and signs associated with the phlegm-dampness syndrome were identified,i.e.obesity(39times),greasy coating(38 times),slippery pulse(33 times),white coating(31 times),preference for fatty and heavy foods(30 times),excessive urination(30 times),fatigue and lack of strength(29 times),wiry pulse(25times),and dark red tongue(25 times).A binary logistic regression model was constructed combining these nine symptoms and signs with the LCA classification results,ultimately identifying obesity,greasy coating,fatigue and lack of strength,and white coating as independent factors associated with the phlegm-dampness syndrome in MS patients(P<0.05).Conclusion The major TCM syndrome in MS patients is phlegm-dampness syndrome,and obesity,greasy coating,f

关 键 词：代谢综合征 证素辨证学 潜在类别分析 痰湿证 

分 类 号：R259[医药卫生—中西医结合]