發(fā)布時間：2018-06-25 08:06

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

【摘要】：背景:囿于歷史條件限定,中醫(yī)對癥狀的判定偏于主觀、模糊,肥胖即是其中的癥狀之一,并為中西醫(yī)公認(rèn)的多囊卵巢綜合征(polycystic ovarian syndrome,PCOS)的常見癥狀。中醫(yī)辨證將肥胖責(zé)之于痰濕,脾虛及腎虛均是導(dǎo)致痰濕的常見病機(jī)。臨床上,中醫(yī)對肥胖的判定以目測望診為主,帶有不確定性,如何將傳統(tǒng)中醫(yī)目測法的評價(jià)標(biāo)準(zhǔn)轉(zhuǎn)變?yōu)榱炕捎^的指標(biāo)是亟待解決的問題。而以往大多研究在涉及這一領(lǐng)域時,多以西醫(yī)診斷中體質(zhì)量指數(shù)(Body Mass Index,BMI)為標(biāo)準(zhǔn),并將其簡單的移植進(jìn)中醫(yī)辨證依據(jù)中。中西醫(yī)肥胖內(nèi)涵有“置換”之嫌,有必要對中西醫(yī)肥胖概念內(nèi)涵進(jìn)行辨析。目的:通過研究脾虛痰濕證PCOS肥胖癥狀的客觀量化指標(biāo),為臨床診斷提供新的思路,并為中西醫(yī)肥胖癥狀內(nèi)涵的辨析提供客觀的參考依據(jù)。方法:收集95例脾虛痰濕證PCOS患者及80例非肥胖PCOS患者的基本信息、中醫(yī)四診信息及相關(guān)測量結(jié)果,填寫病例觀察表,建立數(shù)據(jù)庫,錄入收集數(shù)據(jù),然后通過SPSS軟件進(jìn)行Kappa一致性檢驗(yàn)、篩檢試驗(yàn)、受試者工作特征曲線(receiver operating characteristic curve,ROC曲線)統(tǒng)計(jì)分析,從而得出結(jié)論。結(jié)果:1、經(jīng)Kappa一致性統(tǒng)計(jì),結(jié)果顯示腰圍(waist circumference,WC)、腰身比(waist-to-height ratio,WHtR)與脾虛痰濕證望診判定的肥胖一致性較好。2、經(jīng)篩檢試驗(yàn)分析,WC的靈敏度及陽性預(yù)測率最高,分別為94.74%、100%,表明經(jīng)WC篩檢為肥胖的患者中,患脾虛痰濕證PCOS的概率為94.74%,WHtR、BMI、腰臀比(waist-to-hip ratio,WHpR)未表現(xiàn)出明顯優(yōu)勢。3、對于脾虛痰濕證PCOS患者,ROC曲線分析所得各測量指標(biāo)的曲線下面積分別為:BMI(0.997)WHtR(0.995)WC(0.990)體重(0.972)WHpR(0.762)。其中BMI、WHtR、WC的ROC曲線下面積均大于0.99,統(tǒng)計(jì)學(xué)方面沒有明顯差異,皆能較好的預(yù)測中醫(yī)肥胖,其適宜切點(diǎn)分別為22.39、0.485、78.5cm,臨床可以此作為診斷脾虛痰濕證PCOS肥胖的界值。4、所研究對象育齡期婦女為主,職業(yè)以企業(yè)職工為主,文化程度初中及以下最多,其次為本科及以上,月經(jīng)延遲情況以2年內(nèi)為主,癥狀除肥胖外以月經(jīng)后期最為常見。結(jié)論:1、對于中西醫(yī)肥胖癥狀的辨別而言,西醫(yī)WC、WHtR診斷下的肥胖與脾虛痰濕證PCOS肥胖一致。可見脾虛痰濕證PCOS的肥胖更偏向于以WC、WHtR增大為突出特征的中心型肥胖。2、篩檢試驗(yàn)分析得出,經(jīng)WC篩檢為肥胖的患者中,患脾虛痰濕證PCOS的概率最高,因此WC可能更適用于脾虛痰濕證PCOS患者的篩檢。另外,WHtR、BMI、WHpR未表現(xiàn)出明顯優(yōu)勢。3、因ROC分析得出的BMI、WHtR、WC曲線下面積均0.99,統(tǒng)計(jì)學(xué)方面沒有明顯差異,所以此三項(xiàng)指標(biāo)對于脾虛痰濕證PCOS的肥胖在適宜切點(diǎn)下皆有較好的風(fēng)險(xiǎn)預(yù)測。此結(jié)果亦說明脾虛痰濕證PCOS肥胖以人體中下部肥胖為特點(diǎn),與西醫(yī)學(xué)中心型肥胖特征較為貼合。在診斷切點(diǎn)方面,以WC78.5cm,WHtR0.485,BMI22.39為靈敏度和特異度較適宜的界值�？蔀榻窈笈R床中進(jìn)行客觀量化的診斷指標(biāo)提供參考。
[Abstract]:Background: due to the limitation of historical conditions, the judgment of TCM symptoms is subjective and fuzzy. Obesity is one of the symptoms, and it is a common symptom of polycystic ovary syndrome (polycystic ovarian) recognized by Chinese and western medicine. TCM syndrome differentiation will be responsible for obesity phlegm dampness, spleen deficiency and kidney deficiency are common causes of phlegm dampness. In clinic, the judgment of obesity in TCM is based on visual diagnosis, with uncertainty, how to change the evaluation standard of traditional Chinese medicine visual test into a significant quantitative index is an urgent problem to be solved. In the past, most of the researches in this field were based on the standard of body Mass Index BMI (BMI) in western medicine diagnosis, and transplanted it into TCM syndrome differentiation. The connotation of obesity in Chinese and western medicine has the suspicion of "replacement", it is necessary to differentiate the connotation of obesity in traditional Chinese and western medicine. Objective: to study the objective quantitative indexes of obesity symptoms of PCOS with spleen deficiency and phlegm dampness syndrome, to provide a new idea for clinical diagnosis, and to provide an objective reference for the analysis of the connotation of obesity symptoms in traditional Chinese and western medicine. Methods: the basic information of 95 PCOS patients with spleen deficiency and phlegm dampness syndrome and 80 non-obese PCOS patients were collected. Then the statistical analysis of Kappa consistency test, screening test and (receiver operating characteristic curve is carried out by SPSS software, and the conclusion is drawn. Results: 1. According to Kappa consistency statistics, the results showed that waist circumference WC, waist-to-height ratio and phlegm dampness syndrome had better consistency of obesity. The sensitivity and positive predictive rate of WC were the highest by screening test. 94.74 and 100, respectively, indicating that those who were screened by WC as obese, The probability of PCOS with spleen deficiency and phlegm dampness syndrome was 94.74 and the WHR did not show obvious superiority. The area under the curve of each measure index was: waist-to-hip: (0.997) WHTR (0.995) WC (0.990) BW (0.972) WHPR (0.762) for PCOS patients with spleen deficiency and phlegm dampness syndrome. The area under ROC curve of BMIA WHtRX WC is larger than 0.99, there is no significant difference in statistics, all of them can predict obesity in TCM. The suitable cutting point was 22.39 ~ 0.485 ~ 78.5 cm, which could be used as the cutoff value of PCOS in diagnosis of spleen deficiency and phlegm dampness syndrome. The subjects of study were mainly women of childbearing age, the occupation was mainly enterprise workers, the education level was the most in junior middle school and below, the next was undergraduate course and above. Menstrual delay occurred mainly within 2 years, and the symptoms were most common in late menstruation except obesity. Conclusion: 1, for the differentiation of obesity symptoms of traditional Chinese and western medicine, the obesity diagnosed by WCU WHtR is consistent with PCOS of spleen deficiency and phlegm dampness syndrome. It can be seen that the obesity of PCOS with spleen deficiency and phlegm dampness is more inclined to the central obesity, which is characterized by the increase of WCU WHtR. The screening test shows that the probability of PCOS with spleen deficiency and phlegm dampness syndrome is the highest among those who are obese by WC screening. Therefore, WC may be more suitable for screening PCOS patients with spleen deficiency and phlegm dampness syndrome. In addition, WHT RV BMIP WHpR did not show obvious advantage. Because the area of BMIT RV WC curve obtained by ROC analysis was 0.99, there was no significant difference in statistics, so these three indexes could predict the risk of obesity of PCOS with spleen deficiency and phlegm dampness syndrome under the appropriate cutting point. The results also showed that the obesity of spleen deficiency and phlegm dampness syndrome PCOS was characterized by obesity in the middle and lower part of human body, which was close to the characteristics of central obesity in western medicine. The sensitivity and specificity of WC78.5 cm-1 WHtR0.485 BMI22.39 were suitable for the diagnosis of cutoff point. It can be used as a reference for the objective quantitative diagnosis in the future.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.75

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