本文選題：膝骨性關(guān)節(jié)炎 + 證候　； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：研究目的:基于“真實(shí)世界”的臨床研究方法,在采集膝骨性關(guān)節(jié)炎(knee osteoarthritis,KOA)臨床癥狀、體征及中醫(yī)四診等信息的基礎(chǔ)上,運(yùn)用SPSS24.0軟件和復(fù)雜網(wǎng)絡(luò)Liquorice軟件進(jìn)行分析、歸納、總結(jié),明確其證候特點(diǎn),為研究KOA臨床證候標(biāo)準(zhǔn)奠定基礎(chǔ),以期為中醫(yī)臨床辨證論治KOA提供基于“真實(shí)世界”的循證醫(yī)學(xué)支持。研究方法:基于“真實(shí)世界”的臨床研究方法,在文獻(xiàn)調(diào)研的基礎(chǔ)上,系統(tǒng)總結(jié)KOA證候的研究方法和思路,根據(jù)國家中醫(yī)藥管理局“十一五”重點(diǎn)�？茀f(xié)作組膝痹病(膝骨性關(guān)節(jié)炎)的中醫(yī)臨床路徑,以及中華人民共和國中醫(yī)藥行業(yè)標(biāo)準(zhǔn)(中醫(yī)內(nèi)科、中醫(yī)骨傷科病證診斷療效標(biāo)準(zhǔn)ZY/T001.1-94),以中國中醫(yī)科學(xué)院望京醫(yī)院骨科臨床實(shí)際運(yùn)行病歷信息采集為基礎(chǔ),通過臨床專家“頭腦風(fēng)暴法”,篩選出有關(guān)KOA證候分析需要采集的臨床信息,制成KOA門診電子病歷模板信息采集點(diǎn)問卷統(tǒng)計表,并經(jīng)過具有高級職稱的30位中醫(yī)證候?qū)W領(lǐng)域?qū)＜艺撟C達(dá)成專家共識,確定臨床信息采集點(diǎn)。運(yùn)用臨床科研共享系統(tǒng)客觀、真實(shí)、實(shí)時采集2014年9月18日至2016年4月26日,經(jīng)中國中醫(yī)科學(xué)院望京醫(yī)院骨關(guān)節(jié)一科、骨關(guān)節(jié)二科、骨關(guān)節(jié)三科、骨關(guān)節(jié)四科和骨傷綜合科的高年資醫(yī)生診療且符合納入標(biāo)準(zhǔn)的門診或住院病例。將收集的病例信息建成數(shù)據(jù)庫,運(yùn)用Excel軟件進(jìn)行數(shù)據(jù)清洗和邏輯核查,形成證候信息矩陣。基于中國中醫(yī)科學(xué)院廣安門醫(yī)院數(shù)據(jù)挖掘平臺進(jìn)行數(shù)據(jù)統(tǒng)計分析,計算出各癥的分布頻率(各癥分布頻率=每個癥的定量分總和/樣本量,*100%),取分布頻率高于或等于5%的中醫(yī)癥狀,運(yùn)用SPSS24.0軟件系統(tǒng)聚類分析總結(jié)其證候特點(diǎn),并運(yùn)用Liquorice復(fù)雜網(wǎng)絡(luò)分析各癥之間的關(guān)聯(lián)性,形成證候信息分類群,對其主癥和兼癥進(jìn)行歸納總結(jié),依據(jù)中醫(yī)病證分類與代碼(GB/T15657-1995)、中醫(yī)基礎(chǔ)理論術(shù)語(GB/T20348-2006)、中醫(yī)病證診斷療效標(biāo)準(zhǔn)(ZY/T001.1.94),結(jié)合中醫(yī)骨科學(xué)領(lǐng)域和中醫(yī)證候?qū)W領(lǐng)域?qū)＜艺撟C,達(dá)成專家共識,形成證候的判定和描述,進(jìn)而形成KOA的證候特點(diǎn),為本病的證候分類、辨證治療提供基于循證醫(yī)學(xué)的科學(xué)、統(tǒng)一的參考依據(jù)。研究結(jié)果:1納入門診或住院病例803例,根據(jù)剔除標(biāo)準(zhǔn),剔除病例27例,納入分析776例,男性166例,女性610例,男女比例為1:3.67,最小年齡22歲,最大年齡92歲,平均年齡61.26± 11.53歲。2運(yùn)用SPSS24.0聚類分析和主成分分析得出三大類證候信息群:G1組(瘀血閉阻):雙下肢肌肉萎縮,舌底脈絡(luò)色紅,可見迂曲,勞累后發(fā)熱,苔黃白相兼,舌紅,頭暈眼花,脈澀,苔膩。G2組(寒濕凝滯):下肢酸楚,下肢畏寒,腰膝酸軟,下肢無力,脹痛,酸痛,畏寒,脈滑,脈濡,胖大。G3組(肝腎虧虛):盜汗,苔白,舌淡紅,苔薄。3運(yùn)用頻數(shù)統(tǒng)計方法根據(jù)所包含的三大類證候信息權(quán)重對入組病例進(jìn)行分類:以G1組證候信息為主的G1組(482例);以G2組證候信息為主的G2組(208例);以G3組證候信息為主的G3組(11例)。統(tǒng)計分析發(fā)現(xiàn)入組病例多為證候相兼,將各組證候信息權(quán)重相等的歸為G4組(75例)。4運(yùn)用Liquorice復(fù)雜網(wǎng)絡(luò)分析,結(jié)合聚類分析結(jié)果,形成各組主癥、兼癥分類群,經(jīng)中醫(yī)骨科學(xué)領(lǐng)域和中醫(yī)證候?qū)W領(lǐng)域?qū)＜艺撟C,根據(jù)G4組的主要癥狀、體征及舌脈象并結(jié)合臨床,將其歸入G3組,最后判定證候:776例KOA患者中醫(yī)證候多為證候相兼,其主要證候分類情況為:以瘀血閉阻為主的為最多,占62.11%;以寒濕凝滯為主的占26.80%;以肝腎虧虛為主的占11.08%。研究結(jié)論:1膝骨性關(guān)節(jié)炎證候主要分為瘀血閉阻、寒濕凝滯、肝腎虧虛三種。其中瘀血閉阻類型最為常見。2膝骨性關(guān)節(jié)炎患者多為證候相兼,以主證為主,兼見他證。3膝骨性關(guān)節(jié)炎三類主要證候的判定描述:瘀血閉阻型:患膝刺痛,關(guān)節(jié)僵硬,痛有定處。舌暗紅,苔薄,舌底脈絡(luò)可見迂曲,脈澀或脈弦。寒濕凝滯型:患膝酸痛或脹痛,屈伸不利,下肢酸楚,或腫脹,下肢沉重,遇風(fēng)寒濕后加重,畏寒,腰膝酸軟,舌淡紅,苔白膩,脈濡滑或脈沉遲。肝腎虧虛型:患膝隱隱作痛,屈伸不利,腰膝酸軟,頭暈眼花,耳鳴,或盜汗,或勞累后加重,舌淡紅,苔薄,脈細(xì)。形成的各組證候判定描述能夠更好的為臨床醫(yī)生在診療過程中判斷KOA患者證候類型提供理論上的參考依據(jù)。
[Abstract]:Research objective: Based on the "real world" clinical research method, on the basis of collecting the information of knee osteoarthritis (KOA) clinical symptoms, signs and four diagnosis of traditional Chinese medicine, SPSS24.0 software and complex network Liquorice software are used to analyze, summarize, make clear the characteristics of the syndrome, and lay a foundation for the study of the standard of the clinical syndrome of KOA. In order to provide evidence based evidence-based medical support based on "real world" for clinical syndrome differentiation and treatment of KOA in traditional Chinese medicine. Research methods: Based on the "real world" clinical research method, the research methods and ideas of KOA syndrome are systematically summarized on the basis of literature research. According to the "11th Five-Year" key specialist cooperative group of the State Administration of traditional Chinese medicine (TCM) The clinical path of traditional Chinese medicine of knee arthralgia (knee osteoarthritis), as well as the standard of People's Republic of China traditional Chinese medicine (traditional Chinese medicine, ZY/T001.1-94), based on the collection of medical records in the Department of orthopedics, Wangjing Hospital of the Chinese Academy of science of traditional Chinese medicine, is based on the "brainstorming method" by clinical experts. The clinical information needed to be collected for the KOA syndrome analysis was selected, and the questionnaire statistics table of the information collection point of the KOA outpatient medical record template was made, and the expert consensus was reached through the expert argument of 30 TCM syndromes with advanced titles, and the clinical information collection system was determined by the clinical science and research sharing system. The real time collection of 2014 9 From 18 to April 26, 2016, the data of the collected case information were completed and the data were cleaned and logically carried out by Excel software through the medical department of the bones and joints of the Wangjing Hospital, the two families of the bone joints, the three families of bone joints, the four families of bone joints and the integrated orthopedics department of the Chinese Academy of Chinese medicine. Verification, form the syndrome information matrix. Based on the data mining platform of the Guanganmen Hospital of Chinese Academy of science of traditional Chinese medicine (Chinese Academy of Chinese Medicine) data analysis and analysis, the distribution frequency of each disease is calculated (the frequency of each disease = the quantitive sum / sample amount of each disease, *100%), taking the traditional Chinese medicine symptoms higher than or equal to 5% of the distribution frequency, and using the SPSS24.0 software system to cluster analysis The characteristics of syndromes are summarized, and Liquorice complex network is used to analyze the association between the syndromes, form the classification group of syndrome information, summarize the main symptoms and concurrent symptoms, according to the classification and code of the TCM syndrome and the code (GB/T15657-1995), the basic theory of traditional Chinese medicine (GB/ T20348-2006), the standard of TCM syndrome diagnosis effect (ZY/T001.1.94), and the combination of traditional Chinese medicine (TCM), and the TCM syndrome diagnosis effect standard (ZY/T001.1.94). Expert argument in the field of Department of orthopedics and TCM syndrome, reach the consensus of experts, form the judgement and description of syndrome, and then form the syndrome characteristics of KOA, classify the syndromes of the disease, and provide the science based on evidence-based medicine and a unified reference basis. The results are: 1 included in 803 cases of outpatient or hospitalized cases, and eliminated according to the elimination standard. 27 cases were included, including 776 cases, 166 male and 610 female. The ratio of male and female was 1:3.67, the minimum age was 22 years, the maximum age was 92 years old. The average age was 61.26 + 11.53 years old, and the average age was 61.26 + 11.53 years old. SPSS24.0 cluster analysis and principal component analysis were used to get three groups of syndrome information groups: G1 group (blood stasis blocking): double lower limbs muscle atrophy, tongue bottom vein color red, tortuous and labor. After tired fever, white and white, tongue red, dizziness, pulse, and greasy.G2 group (cold dampness stagnation): lower extremities, lower limbs cold, low back and knee soft, weakness of the lower limbs, pain, pain, cold, pulse, pulse, fat and big.G3 group (liver and kidney deficiency): night sweats, moss white, lingual red,.3 use frequency statistics method based on the weight of the three major syndrome information weights included Group cases were classified as group G1 (482 cases) based on G1 syndrome information, G2 group with G2 syndrome information as the main group (208 cases) and group G3 (11 cases) based on G3 group syndrome information. Statistical analysis found that the group cases were mostly syndromes, and the weight phase of each group of syndromes were classified as G4 group (75 cases) with Liquorice complex network analysis. According to the results of cluster analysis, the main symptoms and syndromes of each group were formed by experts in the field of bone science of traditional Chinese medicine and TCM syndrome. According to the main symptoms, signs, tongue and pulse images of group G4 and combined with clinical, it was classified into group G3, and the syndromes of 776 cases of KOA patients were diagnosed as syndromes and the main syndromes were classified as blood stasis. The main blood closed obstruction was the most, accounting for 62.11%, 26.80% of the cold dampness stagnation, with the liver and kidney deficiency mainly in 11.08%. research conclusion: 1 knee osteoarthritis syndromes were mainly divided into blood stasis closure, cold dampness stagnation and three kinds of liver and kidney deficiency, among which the most common type of.2 knee osteoarthritis was syndrome phase and the main syndrome was main syndrome. And see his identification of the three main syndromes of.3 knee osteoarthritis: stagnation of the knee, stiff joints and pain. The tongue is dark red, the tongue is thin, and the bottom of the tongue is tortuous, pulse or pulse. The cold dampness and stagnation: knee pain or distending pain, bad flexion and extension, poor lower limb, heavy lower limbs, aggravation after wind and cold dampness, cold, waist The knee is soft, the tongue is pale and greasy, the vein is moistening or the pulse is late. The liver and kidney deficiency type: the knee is hidden pain, the flexion and extension are unfavorable, the waist and the knees are soft, the dizziness, the tinnitus, or the sweating, the tongue light red, the thin tongue and the vein. The symptoms of the KOA patients can be judged better by the clinicians in the process of diagnosis and treatment. A theoretical basis for reference.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9

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