本文選題：腎虛痰濕 + 肥胖��； 參考：《山東中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:中醫(yī)是經(jīng)驗(yàn)醫(yī)學(xué)的產(chǎn)物,與西醫(yī)學(xué)客觀化的診斷方式不同,中醫(yī)對(duì)于疾病的診斷界定常具有主觀性,較為模糊。多囊卵巢綜合征(polycystic ovarian syndrome,PCOS)是育齡期婦女中廣泛存在的疾病,肥胖是PCOS的常見癥狀,中醫(yī)對(duì)肥胖的診斷界定方法主要以望診為主,此方法具有一定的不確定性。中醫(yī)的肥胖內(nèi)涵尚需進(jìn)行量化、客觀化研究。目的:探究腎虛痰濕證PCOS患者的肥胖癥狀與西醫(yī)學(xué)肥胖診斷標(biāo)準(zhǔn)的內(nèi)涵差異,發(fā)掘腎虛痰濕證PCOS患者的肥胖癥狀與西醫(yī)肥胖診斷標(biāo)準(zhǔn)間的異同,并總結(jié)出腎虛痰濕證PCOS肥胖的人體測(cè)量學(xué)特征,為中醫(yī)辨證提供依據(jù)。方法:通過對(duì)就診于山東中醫(yī)藥大學(xué)附屬醫(yī)院中西醫(yī)結(jié)合生殖與遺傳中心的133例(包含71例觀察組與62例對(duì)照組)PCOS患者進(jìn)行臨床觀察并收集其人體測(cè)量學(xué)指標(biāo),填寫臨床病例觀察表及四診評(píng)價(jià)表,將所有數(shù)據(jù)錄入Microsoft Excel數(shù)據(jù)庫(kù),并使用SPSS 20.0進(jìn)行統(tǒng)計(jì)學(xué)分析:對(duì)原始資料進(jìn)行分類并進(jìn)行描述性統(tǒng)計(jì);使用kappa檢驗(yàn)測(cè)試測(cè)量指標(biāo)與腎虛痰濕證PCOS患者肥胖間的一致性;篩檢試驗(yàn)檢驗(yàn)各指標(biāo)與望診法的貼合度,并據(jù)此繪制ROC曲線;將出現(xiàn)頻率超過60%的癥狀與各測(cè)量指標(biāo)行二分類Logistic回歸檢驗(yàn)其與測(cè)量指標(biāo)的相關(guān)性。結(jié)果:1.經(jīng)Kappa一致性檢驗(yàn)分析,腰圍、腰身比診斷與中醫(yī)望診的腎虛痰濕證PCOS肥胖癥狀高度一致(kappa0.8),腰臀比與中醫(yī)望診的腎虛痰濕證PCOS肥胖癥狀的一致性尚可(kappa0.4),體重指數(shù)(Body Mass Index,BMI)與中醫(yī)望診的腎虛痰濕證PCOS肥胖癥狀的一致性則較差(kappa0.4)(P0.05)。2.篩檢試驗(yàn)中各指標(biāo)與中醫(yī)望診的腎虛痰濕證PCOS肥胖癥狀的符合程度依次為:腰身比(96.99%)腰圍(96.24%)腰臀比(70.94%)BMI(70.46%)。腰身比與腰圍的檢驗(yàn)靈敏度最高(94.37%)。3.對(duì)一致性較好的腰圍、腰身比、腰臀比以望診法為金標(biāo)準(zhǔn),繪制ROC曲線,其中腰身比的符合度最高,腰圍其次,腰臀比次之。4.在觀察組患者的所有常見癥狀中,舌苔厚膩、脈滑與四個(gè)測(cè)量學(xué)指標(biāo)無明顯相關(guān)性(P0.05),舌胖有齒痕與腰臀比具有相關(guān)性(P=0.022),與其余三個(gè)指標(biāo)無明顯相關(guān)性(P0.05)。結(jié)論:1.腰身比、腰圍對(duì)肥胖的診斷界值與腎虛痰濕證PCOS肥胖癥狀判斷較為準(zhǔn)確,推斷腎虛痰濕證PCOS肥胖特點(diǎn)與西醫(yī)學(xué)中心性肥胖較為吻合。2.經(jīng)過篩檢試驗(yàn)得知,腰身比與腰圍作為腎虛痰濕證PCOS肥胖望診的判定更有參考意義。3.ROC曲線下四個(gè)測(cè)量學(xué)指標(biāo)對(duì)于腎虛痰濕證PCOS患者的風(fēng)險(xiǎn)預(yù)測(cè)值分別為:腰臀比=0.86,腰圍=78.5cm,腰身比=0.478,BMI=21.29kg/m2。4.腰臀比與腎虛痰濕證PCOS患者舌胖有齒痕具有相關(guān)性。
[Abstract]:Background: Chinese medicine is the product of empirical medicine, which is different from the objective diagnosis of western medicine. Chinese medicine is often subjective and fuzzy in the diagnosis of diseases. Polycystic ovarian syndrome (PCOS) is a common disease in women of childbearing age. Obesity is a common symptom of PCOS. The connotation of obesity in traditional Chinese medicine still needs to be quantified and objectively studied. Objective: to explore the difference between the obesity symptoms of PCOS patients with kidney deficiency and phlegm dampness syndrome and the diagnostic criteria of obesity in western medicine, and to explore the similarities and differences between the obesity symptoms of PCOS patients with kidney deficiency and phlegm dampness syndrome and the diagnostic standards of obesity in western medicine. The anthropometric characteristics of PCOS obesity with kidney deficiency and phlegm dampness syndrome were summarized, which provided basis for TCM syndrome differentiation. Methods: a total of 133 patients with PCOS (71 cases in observation group and 62 cases in control group) in the Center of Reproductive and genetic Integration of traditional Chinese Medicine and Western Medicine, affiliated to Shandong University of traditional Chinese Medicine, were studied and their anthropometric indexes were collected. Filling out the clinical case observation form and the evaluation form of four diagnoses, entering all the data into the Microsoft Excel database, and using SPSS 20.0 for statistical analysis: classifying the original data and carrying out descriptive statistics; Kappa test was used to test the consistency between the measurement index and obesity in PCOS patients with kidney deficiency and phlegm dampness syndrome, and screening test was used to test the adherence degree of each index to the inspection method, and to draw the ROC curve accordingly. The correlation between symptoms with more than 60% frequency and each measurement index was tested by two classification Logistic regression. The result is 1: 1. By Kappa consistency analysis, waist circumference, The obese symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) diagnosed by waist to body ratio are highly consistent with those of traditional Chinese medicine (TCM). The obesity symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) with waist-to-hip ratio are consistent with those of traditional Chinese medicine (TCM). The body Mass index (BMI) and the visceral syndrome of kidney deficiency and phlegm dampness in traditional Chinese medicine (TCM) are similar to those of traditional Chinese medicine. The consistency of obesity symptoms in PCOS was less than that in kappa 0.4 and P0.05. 2. In the screening test, the degree of conformance between the indexes and the obesity symptoms of kidney deficiency and phlegm dampness syndrome (PCOS) was as follows: waist to body ratio was 96.99) waist circumference was 96.24.4) waist to hip ratio was 70.94 and BMI70.46. Waist ratio and waist circumference of the highest sensitivity of 94.37. 3. For the waist circumference, waist-to-waist ratio and waist-to-hip ratio with good consistency, the ROC curve was drawn according to the method of inspection, in which the waistline ratio was the highest, the waist circumference was the second, and the waist-to-hip ratio was the second. 4. In all the common symptoms of the observation group, the tongue coating was thick and greasy, there was no significant correlation between the vein slip and the four measuring indexes (P 0.05), the tongue fat with teeth mark and the waist hip ratio (WHR) were correlated with P0. 022, and there was no significant correlation with the other three indexes (P 0. 05). Conclusion 1. The ratio of waist to body, waist circumference in the diagnosis of obesity and kidney deficiency phlegm dampness syndrome (PCOS) were more accurate. The characteristics of PCOS obesity in kidney deficiency and phlegm dampness syndrome were consistent with the central obesity in western medicine. 2. The screening test shows that, The ratio of waist to body and waist circumference are more important for the diagnosis of PCOS obesity with kidney deficiency and phlegm dampness syndrome. 3. The risk prediction values under the ROC curve for PCOS patients with kidney deficiency and phlegm dampness syndrome are: waist to hip ratio 0.86, waist circumference 78.5 cm, waist to body ratio 0.478BMI21.29kgm2.4. There was a correlation between waist-hip ratio and tongue and fat teeth mark in PCOS patients with kidney deficiency and phlegm dampness syndrome.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R271.9

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