本文選題：特發(fā)性疲勞 + 證候要素�。� 參考：《中國(guó)中醫(yī)科學(xué)院》2016年碩士論文

【摘要】：特發(fā)性疲勞以神疲、乏力為主要癥狀,不伴有器質(zhì)性疾病,嚴(yán)重影響患者的生活及工作質(zhì)量、社交活動(dòng)。目前對(duì)于特發(fā)性疲勞,西醫(yī)并無(wú)特效治療,中醫(yī)對(duì)其治療有一定優(yōu)勢(shì)。為進(jìn)一步提高對(duì)特發(fā)性疲勞的防治水平,我們對(duì)證候要素及應(yīng)證組合、疲勞評(píng)價(jià)方法、中醫(yī)治療的療效影響因素進(jìn)行了研究。目的：研究特發(fā)性疲勞的臨床(證候要素及其應(yīng)證組合)特點(diǎn),制定疲勞數(shù)字化評(píng)定量表并通過在臨床研究中試用評(píng)價(jià)量表的臨床應(yīng)用價(jià)值。方法：1.特發(fā)性疲勞證候要素應(yīng)證組合研究：收集2010年至2013年我院疲勞門診患者就診資料,共268例,提取其中的證候要素,采用聚類方法分析證候要素的應(yīng)證組合。2.疲勞數(shù)字化評(píng)定量表研究：參考疼痛量表制定包括體力、記憶力及精神三個(gè)維度的疲勞數(shù)字化評(píng)定量表,采用流調(diào)方式對(duì)142例樣本進(jìn)行調(diào)查,同時(shí)用FS-14量表作為金標(biāo)準(zhǔn)進(jìn)行量表評(píng)估,研究疲勞數(shù)字化評(píng)定量表的敏感度、特異度、準(zhǔn)確度及信度情況。3.疲勞數(shù)字化評(píng)定量表臨床應(yīng)用評(píng)價(jià)：在課題組疲勞癥的隨機(jī)雙盲安慰劑對(duì)照臨床試驗(yàn)中采用本量表進(jìn)行療效評(píng)價(jià)。試驗(yàn)共納入特發(fā)性疲勞患者90例,按照2：1隨機(jī)分為試驗(yàn)組與對(duì)照組,辨證試驗(yàn)組60例,對(duì)照組30例,試驗(yàn)組給予中藥口服,對(duì)照組給予安慰劑口服(成分為試驗(yàn)組1/20的藥物),在使用FS-14量表、中醫(yī)癥狀積分進(jìn)行療效評(píng)價(jià)的同時(shí)采用疲勞數(shù)字化評(píng)定量表進(jìn)行療效評(píng)價(jià),分析以上不同評(píng)價(jià)方法的療效影響因素,FS-14量表與疲勞數(shù)字化評(píng)定量表在評(píng)價(jià)療效方面的相關(guān)性。結(jié)果：1.特發(fā)性疲勞證候要素應(yīng)證組合研究結(jié)果：268例特發(fā)性疲勞男性170例,女性98例,平均年齡33.75±8.46歲。共提取8個(gè)證候要素,出現(xiàn)頻數(shù)由高至低分別為：氣滯246例(91.79%)、氣虛236例(88.06%)、火熱180例(67.16%)、陰虛85例(31.72%)、血虛40例(14.93%)、陽(yáng)虛35例(13.06%)、痰33例(8.58%)、血瘀20例(7.46%)；分別按三分類、四分類、五分類的聚類分析,分3類時(shí),聚類結(jié)果為氣滯化火兼氣虛162例、痰熱郁滯兼氣虛22例、氣機(jī)郁滯兼氣虛84例；分4類時(shí),聚類結(jié)果為氣滯化火兼氣虛痰阻34例、氣滯化火兼氣虛119例、氣滯化火氣陰兩虛83例,氣滯兼氣(陽(yáng))虛32例；分5類時(shí),結(jié)果為氣滯化火氣虛血瘀17例、氣滯化火兼氣虛108例、氣滯化火氣陰兩虛83例、氣滯兼氣(陽(yáng))虛30例、氣滯痰郁化火30例。通過對(duì)各證候要素在每個(gè)證型中的檢出率來(lái)看,氣滯化火兼氣虛的組合在三種分類方法中均為最高,其次是氣機(jī)郁滯兼氣虛,氣滯化火氣陰兩虛。2.疲勞數(shù)字化評(píng)定量表評(píng)價(jià)結(jié)果對(duì)142例樣本調(diào)查,其中男性43例,女性99例,平均年齡32.27±7.69歲。初步篩查排除引起疲勞的器質(zhì)性疾病,其中FS-14量表評(píng)價(jià)符合疲勞診斷122例,健康人20例。根據(jù)約登指數(shù)初步確定疲勞數(shù)字化評(píng)定量表的評(píng)分在7分以上可診斷為疲勞。以FS-14量表作為金標(biāo)準(zhǔn),疲勞數(shù)字化評(píng)定量表的敏感度86%,特異度65%,準(zhǔn)確度83%。52例重測(cè)樣本中,疲勞32例,非疲勞20例,結(jié)果：疲勞數(shù)字化評(píng)定量表的總分相關(guān)系數(shù)為0.83,體力值相關(guān)系數(shù)為0.729,記憶力值相關(guān)系數(shù)為0.76,精神值相關(guān)系數(shù)為0.801,FS-14量表的總分相關(guān)系數(shù)為0.666,體力值相關(guān)系數(shù)為0.801,腦力值相關(guān)系數(shù)為0.357。3.疲勞中醫(yī)治療療效影響因素與疲勞數(shù)字化評(píng)定量表用于療效評(píng)價(jià)試用結(jié)果對(duì)90例中醫(yī)辨證治療特發(fā)性疲勞的隨機(jī)雙盲安慰劑對(duì)照研究發(fā)現(xiàn),試驗(yàn)組中醫(yī)癥狀總積分有效率為93.3%,對(duì)照組中醫(yī)癥狀總積分有效率為70.0%,試驗(yàn)組FS-14量表評(píng)分下降5.27±3.00分,中醫(yī)癥狀積分下降16.23±7.12分,疲勞數(shù)字化評(píng)定量表積分下降6.96±3.79分,對(duì)照組FS-14量表評(píng)分下降3.80±3.23分,中醫(yī)癥狀積分下降10.83±9.78分,疲勞數(shù)字化評(píng)定量表積分下降4.72±3.47分,試驗(yàn)組優(yōu)于對(duì)照組(各個(gè)指標(biāo)P值0.05)。療效影響因素：中醫(yī)癥狀療后積分下降值、疲勞數(shù)字化評(píng)定量表療后積分下降值,FS-14量表療后積分下降值,均和組別(治療方法)、自身基線相關(guān)。疲勞數(shù)字化評(píng)定量表與FS-14量表療效評(píng)定結(jié)果相關(guān)性分析發(fā)現(xiàn),疲勞數(shù)字化評(píng)定量表與FS-14量表總分相關(guān)性較好r=0.624,體力相關(guān)性較好r=0.644,腦力相關(guān)性較低r=0.296。結(jié)論：1.特發(fā)性疲勞的證候要素,出現(xiàn)頻數(shù)較高的有以下八種,由高至低排序?yàn)椋簹鉁�、氣虛、火熱、陰虛、血虛、�?yáng)虛、痰、血瘀。通過對(duì)各證候要素在每個(gè)證型中的檢出率來(lái)看,以氣滯化火兼氣虛的組合出現(xiàn)次數(shù)最高,其次是氣機(jī)郁滯兼氣虛、氣滯化火氣陰兩虛。2.疲勞數(shù)字化評(píng)定量表的診斷能力較好,確定7分以上為其診斷值。疲勞數(shù)字化評(píng)定量表重測(cè)信度高于FS-14量表,說明前后一致性較好,通過與以FS-14量表為金標(biāo)準(zhǔn)的診斷結(jié)果分析,疲勞數(shù)字化評(píng)定量表具備較高敏感度和準(zhǔn)確度,疲勞數(shù)字化評(píng)定量表與FS-14量表在總分及體力分方面的相關(guān)性較好。初步研究結(jié)果可以用于臨床疲勞的初篩與療效評(píng)定。3.中藥治療特發(fā)性疲勞,中藥試驗(yàn)組療效明顯優(yōu)于對(duì)照組,服藥后患者SDS、 SAS、FS-14量表、疲勞數(shù)字化評(píng)定量表評(píng)分均有顯著下降,且與中醫(yī)癥狀改善存在相關(guān)性。中醫(yī)癥狀積分、疲勞數(shù)字化評(píng)定量表積分、FS-14量表積分療效受治療分組及自身基線的影響。
[Abstract]:Idiopathic fatigue is the main symptom of fatigue and fatigue as the main symptom, without organic disease, which seriously affects the life and work quality of the patients and social activities. At present, there is no special treatment for the patients with idiopathic fatigue, western medicine has certain advantages. In order to further improve the prevention and treatment of idiopathic fatigue, we have the syndrome factors and evidence. Combination, the method of fatigue evaluation and the influencing factors of the curative effect of traditional Chinese medicine. Objective: To study the characteristics of the clinical (syndrome elements and combination) of the idiopathic fatigue, to formulate the fatigue digital rating scale and to try the clinical value of the evaluation scale through the clinical study. Method: 1. syndromes of idiopathic fatigue syndrome should be confirmed. Combined study: a total of 268 patients were collected from 2010 to 2013 in our hospital's fatigue outpatient clinic. A total of 268 cases were collected, and the syndrome factors were extracted. The data of the syndrome factors were analyzed by clustering method. The fatigue digital assessment of three dimensions, including physical strength, memory and spirit, was made by the reference pain scale. Table, 142 samples were investigated by flow modulation, and the FS-14 scale was used as the gold standard. The sensitivity, specificity, accuracy and reliability of the fatigue digital rating scale were evaluated by the.3. fatigue digital assessment scale: a randomized, double-blind, placebo-controlled clinical trial of group fatigue. A total of 90 patients with idiopathic fatigue were included in the test. According to 2:1, the test group was randomly divided into the experimental group and the control group. The test group was divided into the experimental group and the control group, the test group was 60 cases, the control group was 30 cases, the experimental group was given the Chinese medicine orally, the control group was given the placebo orally (the component was the test group 1/20), and the symptom score of the Chinese medicine was used in the FS-14 scale. At the same time, the effectiveness evaluation was evaluated by the fatigue digital rating scale, and the effect factors of the different evaluation methods were analyzed. The correlation between the FS-14 scale and the fatigue digital rating scale in the evaluation of the curative effect. Results: 1. the results of the combined study on the syndrome factors of idiopathic fatigue syndrome: 268 cases of idiopathic fatigue men, 170 cases, A total of 98 women, with an average age of 33.75 + 8.46 years, extracted 8 syndrome factors, including 246 cases of Qi Stagnation (91.79%), 236 cases of qi deficiency (88.06%), 180 cases (67.16%), 85 cases of yin deficiency (31.72%), 40 cases of blood deficiency (14.93%), phlegm cases, blood stasis and blood stasis. The cluster analysis was divided into 3 categories: 162 cases of qi stagnation and Qi deficiency, 22 cases of phlegm stagnation and Qi deficiency, 84 cases of qi stagnation and Qi deficiency, 34 cases of qi stagnation and Qi deficiency, 34 cases of qi stagnation and Qi deficiency, 119 cases of qi stagnation and Qi deficiency, 83 cases of qi stagnation and two deficiency, 32 cases of qi stagnation and two deficiency and 32 cases of qi stagnation and Qi deficiency (yang deficiency), and qi stagnation in 5 categories when the result was qi stagnation. 17 cases of qi deficiency and blood stasis, 108 cases of qi stagnation and Qi deficiency, 83 cases of qi stagnation and two deficiency of Qi Yin, 30 cases of qi stagnation and Qi deficiency (Yang) deficiency and 30 cases of qi stagnation and phlegm depression and 30 cases, the combination of qi stagnation fire and Qi deficiency in each syndrome type is the highest among the three kinds of classification methods, followed by qi stagnation and Qi deficiency and qi stagnation. The results of the.2. fatigue digital rating scale were investigated in 142 cases, including 43 males and 99 females, with an average age of 32.27 + 7.69 years. Preliminary screening eliminated organic diseases causing fatigue, of which the FS-14 scale was consistent with 122 Fatigue Diagnosis and 20 healthy persons. The quantitative table was diagnosed as fatigue at more than 7 points. The FS-14 scale was used as the gold standard, the sensitivity of the fatigue digital assessment scale was 86%, the specificity was 65%, the accuracy was 65% in the 83%.52 sample, 32 cases of fatigue and 20 non fatigue. The results were: the total correlation coefficient of the fatigue digital rating scale was 0.83, the correlation coefficient of physical strength was 0.729, memory was 0.729. Memory The correlation coefficient of the force value is 0.76, the correlation coefficient of the mental value is 0.801, the total score correlation coefficient of the FS-14 scale is 0.666, the correlation coefficient of the physical value is 0.801, the correlation coefficient of the mental value is the influence factor of 0.357.3. fatigue in the treatment of Chinese medicine and the fatigue digital rating scale for the treatment of the curative effect of 90 cases of idiopathic fatigue in the treatment of 90 cases of TCM syndrome differentiation. The randomized double blind placebo-controlled study found that the total effective rate of TCM symptom score was 93.3% in the experimental group, the total effective rate of TCM symptoms in the control group was 70%, the FS-14 scale in the experimental group decreased by 5.27 + 3, the symptom score of Chinese medicine was 16.23 + 7.12, the integral of the fatigue digital assessment scale decreased by 6.96 + 3.79, and the control group was evaluated by the FS-14 scale. The score dropped by 3.80 + 3.23 points, the score of TCM symptom decreased by 10.83 + 9.78 points, and the integral of fatigue digital rating scale decreased by 4.72 + 3.47 points. The experimental group was superior to the control group (each index P value 0.05). The influence factors of the curative effect: the integral descending value after the symptom treatment of Chinese medicine, the drop value of the fatigue digital assessment scale after the treatment, and the decrease of the integral after the treatment of the FS-14 scale, The correlation analysis between the fatigue digital assessment scale and the FS-14 scale results showed that the correlation between the fatigue digital rating scale and the total score of the FS-14 scale was better r=0.624, the physical correlation was better r=0.644, and the mental correlation was lower r=0.296. conclusion: 1. syndrome factors of idiopathic fatigue, The high to low frequency of the following eight kinds, from high to low order: Qi stagnation, Qi deficiency, heat, yin deficiency, blood deficiency, Yang deficiency, phlegm, blood stasis. Through the detection rate of each syndrome factor in each type of syndrome, the combination of qi stagnation and Qi deficiency is the highest, followed by qi stagnation and Qi deficiency, qi stagnation and two deficiency of.2. fatigue numbers. The diagnostic ability of the scale was better than that of the FS-14. The retest reliability of the fatigue digital rating scale was higher than that of the FS-14 scale, and the consistency was better. The fatigue digital assessment scale had higher sensitivity and accuracy and the fatigue digital rating scale was higher than the results of the FS-14 scale as the gold standard. The correlation of the total score and the physical strength of the FS-14 scale was better. The preliminary results could be used for the initial screening and evaluation of clinical fatigue..3. was used to treat idiopathic fatigue. The effect of the Chinese medicine test group was obviously superior to the control group. The scores of SDS, SAS, FS-14 and the fatigue number character rating scale were significantly decreased. There was correlation between improvement of medical symptoms. TCM symptom score, fatigue digital rating scale, and FS-14 scale integral curative effect were influenced by treatment group and baseline.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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