【摘要】：目的:利用SEM結(jié)構(gòu)方程模型探討胃癌術(shù)前的中醫(yī)證候分型與相關(guān)生物學(xué)指標(biāo)之間的聯(lián)系。方法:以胃癌患者術(shù)前的中醫(yī)四診信息和實(shí)驗(yàn)室檢測指標(biāo)(如血常規(guī)、肝腎功、腫瘤標(biāo)志物、CT、MRI等)為自變量,通過探索性因子分析構(gòu)建中醫(yī)辨證初始模型,后以中醫(yī)證型為潛變量,以四診信息及檢測指標(biāo)為外顯變量,驗(yàn)證生物學(xué)指標(biāo)與辨證標(biāo)準(zhǔn)之間的對應(yīng)關(guān)系的SEM結(jié)構(gòu)方程模型。結(jié)果:(1)胃癌術(shù)前個(gè)體綜合辨證模型中各證型的鑒別性指標(biāo)及預(yù)測性指標(biāo)主要為:(1)肝郁脾虛證:NEU、頭暈、心率、精神緊張、焦慮、心下痞滿、脈弱、尿膽原8個(gè)指標(biāo);(2)脾虛證:嘈雜不適、食欲不振、形體消瘦、GB、胃脘喜溫5個(gè)指標(biāo);(3)肝胃不和證:舌質(zhì)淡、噯氣反酸、胃脘痛有定處、TP4個(gè)指標(biāo)。(2)胃癌術(shù)前群體綜合辨證中各證型的鑒別性指標(biāo)及預(yù)測性指標(biāo)主要為:(1)氣血兩虛證:焦慮、食欲不振、形體消瘦、胃脘隱痛、心下痞滿、腹部壓痛、舌質(zhì)淡、面色萎黃、嘈雜不適、頭暈、苔薄白、四肢無力、胃脘痛有定處、胃脘喜按、語聲低弱、脈弱、卡氏評分、BUN18個(gè)指標(biāo);(2)肝胃不和證:氣短、噯氣反酸、心煩、呃逆、LDH、CREA、DBIL、AST、TBA9個(gè)指標(biāo);(3)肝郁脾虛證:腹腔引流液為黃綠色膽汁樣液體、多夢、心悸、精神緊張、胸脘脹悶、胃脘喜溫、IBIL7個(gè)指標(biāo);(4)肝胃虛寒證:喜熱飲、痛竄胸脅、胸脅苦滿、胃脘喜溫、胃脘疼痛、胃脘喜按、語聲低弱、RBC8個(gè)指標(biāo)。結(jié)論:構(gòu)建并驗(yàn)證了胃癌術(shù)前的個(gè)體和群體的辨證模型,并通過模型擬合的優(yōu)劣驗(yàn)證了含有相關(guān)生物指標(biāo)的辨證標(biāo)準(zhǔn),為其它疾病及潛證辨證標(biāo)準(zhǔn)研究提供科學(xué)的依據(jù)。
[Abstract]:Objective: to investigate the relationship between TCM syndrome classification and related biological indexes of gastric cancer by using SEM structural equation model. Methods: taking the four diagnosis information of traditional Chinese medicine (TCM) and laboratory detection indexes (such as blood routine, liver and kidney function, tumor markers, CT,MRI, etc.) as independent variables, the initial model of TCM syndrome differentiation was constructed by exploratory factor analysis, and then the SEM structural equation model of the corresponding relationship between biological indexes and syndrome differentiation criteria was verified by using TCM syndrome type as latent variable and four diagnosis information and detection index as explicit variables. Results: (1) the discriminant indexes and predictive indexes of each syndrome type in the comprehensive syndrome differentiation model of gastric cancer before operation were as follows: (1) liver depression and spleen deficiency syndrome: NEU, dizziness, heart rate, mental tension, anxiety, subcardiac fullness, pulse weakness, urine gallbladder source, (2) spleen deficiency syndrome: noisy discomfort, anorexia, body wasting, GB, stomach febrile 5 indexes; (3) liver and stomach discord syndrome: tongue is light, belching acid regurgitation, stomachache has fixed place, TP4 index. (2) Identification index and predictive index of each syndrome type in preoperative group syndrome differentiation of gastric cancer are as follows: (1) deficiency of qi and blood: anxiety, loss of appetite, emaciation of body, epigastric pain, full of heart, abdominal tenderness, pale tongue, yellow complexion, noise discomfort, dizziness, thin and white moss, weakness of extremities, (1) deficiency of qi and blood: anxiety, loss of appetite, emaciation of body, epigastric pain, abdominal tenderness, pale tongue, yellowness of face, noise discomfort, dizziness, thin and white moss, weakness of limbs, Stomachache has fixed place, stomach epigastric press, low voice, weak pulse, Karschner score, BUN18 index; (2) liver and stomach disharmony syndrome: shortness of breath, belching acid regurgitation, upset, hiccup, LDH,CREA,DBIL,AST,TBA9 index; (3) liver depression and spleen deficiency syndrome: abdominal drainage fluid is yellow-green bile-like liquid, dreamy, palpitation, mental tension, chest distension and tightness, stomach epigastric distension and warming, IBIL7 index; (4) liver and stomach deficiency cold syndrome: Xireyin, pain channeling chest threat, chest threat full, stomach epigastric warm, epigastric pain, stomachache press, low voice weak, RBC8 index. Conclusion: the syndrome differentiation model of individual and population before operation of gastric cancer was constructed and verified, and the syndrome differentiation standard containing relevant biological indexes was verified by the fitting of the model, which provided scientific basis for the study of syndrome differentiation standard of other diseases and latent syndrome.
【作者單位】： 陜西中醫(yī)藥大學(xué)附屬醫(yī)院腫瘤三科;陜西中醫(yī)藥大學(xué);武威市中醫(yī)醫(yī)院;甘肅省酒泉地區(qū)醫(yī)院;金昌市人民醫(yī)院;
【基金】：國家自然科學(xué)基金項(xiàng)目(81102561) 陜西省自然科學(xué)基金項(xiàng)目(2014JM2-8158)
【分類號(hào)】：R273

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