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基于數(shù)據(jù)挖掘的亞健康多維特征研究

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【摘要】:背景: 世界衛(wèi)生組織的一項(xiàng)全球性調(diào)查顯示,真正健康的人僅占5%,患有疾病的人占20%,而75%的人處于健康和患病之間的過渡狀態(tài),世界衛(wèi)生組織將其稱之為“第三狀態(tài)”,我國稱之為“亞健康狀態(tài)”。在2010年中國亞健康學(xué)術(shù)研討會(huì)上,專家們預(yù)測(cè)中國目前處于亞健康狀態(tài)的人群已達(dá)70%。而亞健康狀態(tài)是疾病發(fā)生前的過渡階段,如不及時(shí)加以干預(yù),將有可能進(jìn)一步發(fā)展為疾病,從而增加社會(huì)的醫(yī)療負(fù)擔(dān)?梢妬喗】狄殉蔀槲覈粋(gè)不容忽視的公共衛(wèi)生問題。 中醫(yī)學(xué)以其“整體觀念”“辨證論治”的思想,在亞健康狀態(tài)的干預(yù)方面具有很大優(yōu)勢(shì)。隨著亞健康研究的開展,亞健康的概念與診斷已較為規(guī)范,并形成了《亞健康中醫(yī)臨床指南》,規(guī)范了亞健康的概念及相關(guān)診斷方法,但對(duì)亞健康狀態(tài)的干預(yù)尚未形成針對(duì)性、系統(tǒng)性的方法。筆者認(rèn)為,這是由于亞健康狀態(tài)的表現(xiàn)特征眾多,包括不適癥狀、生活方式、中醫(yī)體質(zhì)、心理狀態(tài)等多個(gè)方面,且不同的特征處于量變積累、相互影響的過程中,表現(xiàn)或多或少,或重或輕,這使到亞健康的特征不易把握,干預(yù)方向難以準(zhǔn)確,故尚未形成針對(duì)性、系統(tǒng)性的方法,療效也因此參差不齊。有鑒于此,加強(qiáng)亞健康狀態(tài)的多維特征研究,對(duì)其特征進(jìn)行分析、歸納顯得非常必要。 目的: 通過橫斷面的流行病學(xué)調(diào)查,了解亞健康人群多維特征的分布情況。利用數(shù)據(jù)挖掘技術(shù),結(jié)合臨床知識(shí),對(duì)亞健康多維特征進(jìn)行簡化、歸納,探索特征之間的縱向重要性關(guān)系和橫向關(guān)聯(lián)性關(guān)系等。這將有利于進(jìn)一步認(rèn)識(shí)亞健康特征,為制定系統(tǒng)性、針對(duì)性的干預(yù)方向提供思路。 方法: 采用國家十一五科技支撐計(jì)劃《亞健康狀態(tài)的中醫(yī)辨識(shí)與分類研究》課題組研制的《個(gè)體身心健康調(diào)查量表》,于2008年5月-2009年5月對(duì)來自華東、華北、華南、西南9家合作單位(廣東省中醫(yī)院、炎黃東方(北京)健康科技有限公司、解放軍總醫(yī)院亞健康研究所、成都中醫(yī)藥大學(xué)附屬醫(yī)院、上海中醫(yī)藥大學(xué)附屬龍華醫(yī)院、中國中醫(yī)科學(xué)院廣安門醫(yī)院、南京中醫(yī)藥大學(xué)附屬醫(yī)院、浙江省中醫(yī)院、重慶市中醫(yī)院)的體檢人員進(jìn)行健康狀態(tài)辨識(shí)及多維特征的流行病學(xué)調(diào)查,建立亞健康狀態(tài)多維特征數(shù)據(jù)庫。首先,對(duì)亞健康狀態(tài)多維特征進(jìn)行描述性分析,形成第一級(jí)亞健康多維特征池。采用單因素分析,篩選出健康人群與亞健康人群的區(qū)別特征,形成第二級(jí)亞健康多維特征池。采用聚類分析、結(jié)合臨床知識(shí)對(duì)第二級(jí)亞健康多維特征池的不適癥狀維度,生活方式維度進(jìn)行簡化、歸納,形成第三級(jí)亞健康多維特征池。然后,利用決策樹模型,分別對(duì)三個(gè)不同級(jí)別的亞健康多維特征池進(jìn)行建模,形成三個(gè)亞健康特征縱向關(guān)系模型,結(jié)合臨床知識(shí)對(duì)三個(gè)決策樹模型的診斷特性進(jìn)行比較,選出較為優(yōu)化的決策樹模型和多維特征池。接著,利用關(guān)聯(lián)規(guī)則模型,對(duì)較為優(yōu)化的多維特征池進(jìn)行分析,形成亞健康特征橫向關(guān)系模型。最后,結(jié)合臨床知識(shí)對(duì)上述兩個(gè)模型進(jìn)行綜合的分析解讀。 結(jié)果: 一共收集,符合納入標(biāo)準(zhǔn)、不符合排除標(biāo)準(zhǔn)樣本4086例,其中健康人群1716例(占49.13%),亞健康人群1777例(占50.87%)。依據(jù)文獻(xiàn)研究結(jié)果,將亞健康多維特征歸納為六大維度,分別是不適癥狀特征、人口學(xué)特征、生活方式特征、中醫(yī)體質(zhì)特征、社會(huì)心理特征、生存質(zhì)量特征。共收集六大維度特征228個(gè),其中不適癥狀特征117個(gè)、人口學(xué)特征28個(gè)、生活方式特征38個(gè)、中醫(yī)體質(zhì)特征9個(gè)、社會(huì)心理特征27個(gè)、生存質(zhì)量特征9個(gè),形成第一級(jí)亞健康多維特征池。采用單因素分析,篩選出健康人群與亞健康人群的區(qū)別特征共197個(gè),其中不適癥狀特征94個(gè)、人口學(xué)特征28個(gè)、生活方式特征33個(gè)、中醫(yī)體質(zhì)特征9個(gè)、社會(huì)心理特征25個(gè)、生存質(zhì)量特征8個(gè),形成第二級(jí)亞健康多維特征池。采用聚類分析、結(jié)合臨床知識(shí)對(duì)第二級(jí)亞健康多維特征池的不適癥狀、生活方式維度進(jìn)行簡化歸納,共得出特征96個(gè),其中不適癥狀特征13個(gè),人口學(xué)特征22個(gè),生活方式特征19個(gè),中醫(yī)體質(zhì)特征9個(gè),社會(huì)心理特征25個(gè),生存質(zhì)量特征8個(gè),形成第三級(jí)亞健康多維特征池。 利用決策樹模型,對(duì)三個(gè)不同級(jí)別的亞健康多維特征池進(jìn)行建模,第一級(jí)特征池決策樹模型與第二級(jí)特征池決策樹模型完全相同,其診斷符合率為72.5%,對(duì)于亞健康狀態(tài)的靈敏度為75.8%,特異度為69.1%,陽性預(yù)測(cè)值為71.8%,陰性預(yù)測(cè)值為73.4%,ROC曲線下面積為0.72。第三級(jí)特征池決策樹模型其診斷符合率為76.2%,對(duì)于亞健康狀態(tài)的靈敏度為77.2%,特異度為75.1%,陽性預(yù)測(cè)值為76.2%,陰性預(yù)測(cè)值為76.1%,ROC曲線下面積為0.76。統(tǒng)計(jì)結(jié)果提示,三個(gè)特征池決策樹模型相對(duì)于參考線均有診斷意義(P0.05),第三級(jí)特征池決策樹模型的曲線下面積比第一、二級(jí)特征池決策樹模型大,且存在統(tǒng)計(jì)學(xué)差異(P0.05),故選擇較為優(yōu)化的第三級(jí)特征池決策樹模型作為亞健康特征縱向重要性關(guān)系模型。再利用關(guān)聯(lián)規(guī)則模型,對(duì)較為優(yōu)化的第三級(jí)亞健康多維特征池進(jìn)行分析,形成亞健康特征橫向關(guān)系模型。共得出關(guān)聯(lián)規(guī)則142條,最低支持度為50.08%,最高支持度為85.20%,最低置信度為90.08%,最高置信度為95.57%,形成亞健康特征橫向關(guān)聯(lián)關(guān)系模型。 結(jié)論: 結(jié)果表明亞健康人群的多維特征眾多,根據(jù)文獻(xiàn)研究及流行病學(xué)調(diào)查結(jié)果,可分為不適癥狀特征、人口學(xué)特征、生活方式特征、中醫(yī)體質(zhì)特征、社會(huì)心理特征、生存質(zhì)量特征,共六大維度。在臨床知識(shí)基礎(chǔ)上,結(jié)合單因素分析、聚類分析對(duì)亞健康多維特征進(jìn)行簡化、歸納,并利用決策樹模型、關(guān)聯(lián)規(guī)則模型對(duì)亞健康多維特征的縱向、橫向關(guān)系進(jìn)行探索,可以為臨床干預(yù)亞健康狀態(tài)提供證據(jù)與思路:亞健康人群的干預(yù)體系應(yīng)以中醫(yī)體質(zhì)為中心開展,對(duì)于偏頗體質(zhì)人群,可針對(duì)其偏頗體質(zhì)進(jìn)行干預(yù),且偏頗質(zhì)人群在干預(yù)體質(zhì)的同時(shí)應(yīng)注意加強(qiáng)良好的飲食習(xí)慣宣教與脾胃的調(diào)養(yǎng)。此外,偏頗體質(zhì)人群還較容易合并人際關(guān)系敏感的心理異常,應(yīng)注意及時(shí)排查,并結(jié)合職業(yè)特性進(jìn)行疏導(dǎo)。對(duì)于平和質(zhì)人群,雖然沒有出現(xiàn)體質(zhì)的偏頗,但容易出現(xiàn)氣虛、陰虛的中醫(yī)證候特征,可對(duì)其進(jìn)行干預(yù)。并且應(yīng)重視良好的飲食習(xí)慣宣教和結(jié)合人群所處的地域、性別特性。無論體質(zhì)偏頗與否,血虛、腎膀胱的證候要素特征比較容易被兼夾,需要在干預(yù)時(shí)注意。
[Abstract]:Background: A global survey by the World Health Organization shows that the real health population accounts for only 5%, people with a disease account for 20%, while 75% are in a transitional state between health and illness, and the World Health Organization calls it a "the third state", which is called the "sub-health state" . At the 2010 Chinese sub-health academic seminar, experts predicted that the population currently in sub-health has reached 70 %. The sub-health status is the transitional phase before the disease occurs. If the intervention is not carried out in time, it is possible to further develop the disease as a disease, thus increasing the medical negative of the society The sub-health has become a public health question that can't be ignored in our country In the sub-health state, the concept and diagnosis of sub-health have been standardized and the sub-health Chinese medicine is formed. The guideline>, the concept of sub-health and the related diagnosis method, but the intervention of sub-health state has not formed a targeted and systematic way. In many aspects, such as the physical and mental state of the doctor, and the different characteristics are in the process of quantitative accumulation and mutual influence, it is more or less, heavy or light, which makes it difficult to grasp the characteristics of sub-health, and the intervention direction is difficult to be accurate, so it has not formed the pertinence and systematicness. In view of the above, the multi-dimensional character of sub-health state is strengthened, and its characteristics are analyzed, and it is concluded that it is not It is often necessary . Purpose: cross-section According to the epidemiological investigation, the distribution of the multi-dimensional characteristics of the sub-health population is known. The data mining technology is combined with the clinical knowledge to simplify the sub-health multi-dimensional characteristics, to sum up, to explore the relationship between the longitudinal importance and the cross-correlation between the features, etc. This will be beneficial to the further To recognize sub-health characteristics and to make a systematic and targeted work predirection Methods: to adopt the national five-year scientific and technological support plan the study of the individual physical and mental health questionnaire developed by the research group, and May-2,2008 In May,009,9 cooperation units from East China, North China, South China, and Southwest China (Guangdong Central Hospital, Yanhuang Dongfang (Beijing) Health and Technology Co., Ltd., Sub-health Research Institute of PLA General Hospital, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine and Shanghai The health status identification and the epidemiological investigation of the multi-dimensional characteristics of the physical examination personnel of the Affiliated Hospital of the Chinese Medical University, the Guangan Men Hospital of the Chinese Academy of Chinese Medicine, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, the Central Hospital of Zhejiang Province and the Central Hospital of Chongqing, and the establishment of sub-health status First, a descriptive analysis of the multi-dimensional characteristics of sub-health state is carried out to form a first-order sub-health multi-dimensional feature pool, The method comprises the following steps: using cluster analysis, combining clinical knowledge to the discomfort symptom dimension and the living mode dimension of the second-level sub-health multi-dimensional feature pool, and inducing and forming a third-level sub-sub-health multi-dimensional feature pool; then, using the decision tree model, the sub-health multi-dimensional characteristic pool is respectively used for three different levels of sub-sub-health multi-dimensional characteristic pool, The health multi-dimensional characteristic pool is modeled to form three sub-sub-health characteristic longitudinal relationship models, the diagnosis characteristics of the three decision tree models are compared with the clinical knowledge, and the optimized decision tree model and the multi-dimensional characteristic pool are selected. analyzing the multi-dimensional characteristic pool to form a sub-health characteristic transverse relation model, and finally, combining the clinical knowledge to the two model entry Analysis and interpretation of the comprehensive analysis of the line. Results: The total collection, compliance with the inclusion criteria, and the exclusion criteria were not met in 4086 cases, of which the healthy person 1716 cases (49.13%) and 1777 (50.87%) of sub-health population were divided into six dimensions according to the results of the literature. The characteristics of physical characteristics, social and psychological characteristics and quality of life of the Chinese medicine were collected. The characteristics of six dimensions were collected. Among them, there were 117 symptoms,28 demographic characteristics,38 life styles,9 physical features,9 social cores. The first-stage sub-sub-health multi-dimensional characteristic pool was formed by using the single-factor analysis, and the differences between the healthy population and the sub-health population were analyzed. Among them, there were 94 non-appropriate symptoms,28 demographic characteristics,33 life-style features, and the traditional Chinese medicine. The characteristics of 9,25 and 8 life-quality features of the second-level sub-health multi-dimensional feature pool were formed by cluster analysis and combined with the clinical knowledge, and the characteristics of discomfort and life style of the second-level sub-health multi-dimensional feature pool were simplified and summarized, and the characteristics of the two-level sub-health multi-dimensional characteristic pool were obtained. 96 of them, including 13 of the symptoms,22 in the demography,19 in the lifestyle,9 in the constitution of the Chinese medicine,25 in the social psychology and 8 in the quality of life. and forming a third-stage sub-health multi-dimensional feature pool, The first-level feature pool decision tree model is the same as the decision tree model of the second-level feature pool, the diagnostic coincidence rate of the first-level feature pool is 72.5%, the sensitivity to sub-health state is 75.8%, the specificity is 69.1%, and the positive predictive value is 71.8%, the negative predictive value was 73.4%, and the area under the ROC curve was 0.72. The diagnostic accuracy of the decision tree model was 76.2%, 77.2% for sub-health status, 75.1% for specificity, 76.2% for positive predictive value and 76.1% for negative predictive value. The area of the curve under the curve is 0.76. The statistical results indicate that the decision tree model of the three feature pools has a diagnostic significance with respect to the reference line (P0.05). The lower area of the decision tree model of the third-level feature pool is lower than the first and the second-order characteristic pool decision tree model. At the same time, there is a statistical difference (P0.05). Therefore, the decision tree model of the third-level characteristic pool is selected as the model of the longitudinal importance of sub-health. The third-level sub-health multi-dimensional feature pool is analyzed to form a sub-health feature transverse relationship model. The association rule 142 is obtained. The minimum degree of support is 50.08%, the highest degree of support is 85.20%, the minimum confidence is 90.08%, and the highest confidence is 95.57. %, shape Conclusion: The results show that the multi-dimensional characteristics of sub-health population are many. According to the study of the literature and the epidemiological survey, it can be divided into the characteristics of discomfort, the characteristics of demography and the characteristics of life style. Based on the clinical knowledge, the multi-dimensional characteristics of sub-health are simplified and summarized, and the decision tree model and the association rule model are used. The research on the longitudinal and transverse relation of the sub-health multi-dimensional features can provide evidence and thought for the sub-health state of the clinical intervention: the intervention system of sub-health population should be carried out in the center of the constitution of the Chinese medicine, In the group of biased constitution, it is possible to intervene with the biased constitution, and the biased population should pay attention to the strengthening of good eating habits and the adjustment of the spleen and stomach. In addition, the biased constitution population is more likely to be combined with the sensitive psychological abnormality of the human relationship, and should be paid attention to timely discharge. For peaceful and qualitative people, although there is no bias of body constitution, it is easy to have the characteristics of traditional Chinese medicine syndrome with qi deficiency and yin deficiency, and can be used for intervention. It should pay attention to good eating habits, education and the combination of people. The geographical and gender characteristics of the place. No matter whether the body is biased or not, the blood deficiency, the syndrome of the kidney and the bladde
【學(xué)位授予單位】:廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2012
【分類號(hào)】:R749.99

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8 饒旺福;;中醫(yī)體質(zhì)與臨床用藥[A];江西省第五次中西醫(yī)結(jié)合神經(jīng)科學(xué)術(shù)交流會(huì)論文集[C];2011年

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10 呂翠田;;“三因制宜”在亞健康防治中的體現(xiàn)[A];中華中醫(yī)藥學(xué)會(huì)第三屆中醫(yī)方證基礎(chǔ)研究與臨床應(yīng)用學(xué)術(shù)研討會(huì)論文集[C];2010年

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2 記者 章關(guān)春 通訊員 鄭純勝 殷延鳳;老人免費(fèi)享中醫(yī)體質(zhì)辨識(shí)服務(wù)[N];中國中醫(yī)藥報(bào);2011年

3 ;你屬于婦科亞健康嗎[N];保健時(shí)報(bào);2005年

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5 范英;探究“情感亞健康”[N];中國新聞出版報(bào);2004年

6 張東風(fēng);預(yù)防亞健康 關(guān)鍵在教育[N];中國中醫(yī)藥報(bào);2004年

7 本報(bào)記者 郭曉斌;用傳統(tǒng)醫(yī)學(xué)戰(zhàn)勝亞健康[N];陜西日?qǐng)?bào);2008年

8 沈陽軍區(qū)裝備部車船工化部 景慶維;預(yù)防裝備亞健康[N];解放軍報(bào);2009年

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