基于因子分析与聚类分析的757例儿童肝豆状核变性中医证候研究  

Study on the traditional Chinese medicine syndromes in 757 cases of children with hepatolenticular degeneration based on factor analysis and cluster analysis

作　　者：花代平 汪瀚[1,2] 宣巧玉 孙兰婷 忻凌[1] 殷馨 杨文明[1,2] HUA Daiping;WANG Han;XUAN Qiaoyu;SUN Lanting;XIN Ling;YIN Xin;YANG Wenming(The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China;Key Laboratory of Xin′an Medicine,Ministry of Education,Hefei 230038,China)

机构地区：[1]安徽中医药大学第一附属医院,合肥230031 [2]新安医学教育部重点实验室

出　　处：《北京中医药大学学报》2025年第3期303-311,共9页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金区域创新发展联合基金项目(No.U22A20366);安徽省中医药科技攻关专项项目(No.202303a07020004);2024年高水平传承人才建设项目(皖中医药发展秘〔2024〕1号);全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)。

摘　　要：目的基于因子分析与聚类分析,探究儿童肝豆状核变性(又称“威尔逊病”,WD)的中医证候分布规律。方法回顾性收集2018年11月—2023年11月就诊于安徽中医药大学第一附属医院757例儿童WD患者的一般资料(性别、入院年龄、发病年龄、病程、临床分型、西医临床症状、家族史)和中医四诊信息(症状、体征),运用因子分析与聚类分析进行儿童WD中医证候研究。结果757例儿童WD患者中,男483例、女274例;中位入院年龄12.58岁,中位发病年龄8.33岁,中位病程24.37个月;临床分型中,肝型506例,脑型133例,混合型99例,其他型19例;36.46%患儿无临床症状(转氨酶升高或铜生化异常);有明确家族史177例,有疑似家族史10例。中医四诊信息共43个,频率前10位的依次为神疲乏力、小便黄赤、动作迟钝、食欲不振、面色晦暗、语言謇涩、口角流涎、形体消瘦、手足颤动、脘腹胀满。儿童WD病位证素以肝为主,涉及脾、肾;病性证素以湿、热、阴虚多见。依据因子分析和聚类分析得出5种中医证候,依次为湿热内蕴证(265例、35.01%),肝肾阴虚证(202例、26.68%),肝郁脾虚证(185例、24.44%),气血两虚证(79例、10.44%),脾肾阳虚证(26例、3.43%)。结论儿童WD中医证候以湿热内蕴证、肝肾阴虚证、肝郁脾虚证为主,病位以肝为主,病性本虚标实、虚实夹杂。临床治疗儿童WD宜从肝论治,兼顾脾、肾。Objective To explore the distribution of traditional Chinese medicine(TCM)syndromes in children with hepatolenticular degeneration(Wilson disease,WD)based on factor analysis and cluster analysis.Methods From November 2018 to November 2023,general information(gender,age of admission,age of onset,course of disease,clinical staging,Western medicine clinical symptoms,and family history)and TCM four-examination informations(symptoms and signs)were retrospectively collected from 757 cases of children with WD at the First Affiliated Hospital of Anhui University of Chinese Medicine,and factor analysis and cluster analysis were used to investigate TCM syndromes in children with WD.Results A total of 757 children with WD were included,of which 483 were male and 274 were female;the median age at admission was 12.58 years,the median age at onset was 8.33 years,and the median course of disease was 24.37 months;clinical typing result indicated 506 cases of hepatic type,133 cases of brain type,99 cases of mixed-type,and 19 cases of other type;36.46%of the children had no clinical symptoms(elevated aminotransferases or abnormalities in copper biochemistry);a total of 177 cases had a definite family history,and 10 cases had a suspected family history.Forty-three TCM four-examination information were obtained,with the top 10 in descending order being feeling listless and weak,brown urine,slow action,inappetence,dim complexion,slurred speech,angular salivation,body weight loss,hand and foot tremors,and abdominal fullness.In children with WD,the syndrome element of disease location was primarily characterized by the liver,involving the spleen and kidney,and the syndrome elements of disease nature were characterized by dampness,heat,and yin deficiency.Based on factor analysis and cluster analysis,five TCM syndromes were derived,which were,in order,syndrome of dampness-heat accumulation(265 cases,35.01%),syndrome of yin deficiency of the liver and kidney(202 cases,26.68%),syndrome of liver hyperactivity with spleen deficiency(185 case

关 键 词：肝豆状核变性 儿童 证候 因子分析 聚类分析 

分 类 号：R259[医药卫生—中西医结合]