对4 734例精神分裂症患者的中医证候分布规律的多中心研究
Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study
- 北京中医药大学学报 2023年46卷第10期 页码：1422-1430
- 作者机构：
1.北京中医药大学第三附属医院 北京 100029
2.北京市朝阳区第三医院
3.首都医科大学附属北京安定医院
4.北京回龙观医院
5.北京市大兴区心康医院
6.北京市昌平区中西医结合医院
7.北京市石景山区精神卫生保健所
8.清华大学垂杨柳医院
9.北京市延庆区精神病医院
10.北京市平谷区精神病医院
11.中国中医科学院广安门医院
12.北京中医药大学东直门医院
- 作者简介：
唐启盛，男，博士，主任医师，教授，博士生导师，岐黄学者
# 孙文军，男，博士，主任医师，教授，博士生导师，主要研究方向：中医药防治神经精神疾病，E-mail：doctorsunwenjun@126.com
- 基金信息：北京市自然科学基金项目(7222274);首都卫生发展科研专项(2022－2－7035);国家中医药管理局岐黄学者项目(10400633210001)
DOI：10.3969/j.issn.1006-2157.2023.10.014
中图分类号： R277.7纸质出版日期：2023-10-30，
网络出版日期：2023-07-10，
收稿日期：2023-05-30，
- 稿件说明：
移动端阅览
唐启盛, 孙文军, 张毅杰, 等. 对4 734例精神分裂症患者的中医证候分布规律的多中心研究[J]. 北京中医药大学学报, 2023,46(10):1422-1430.
TANG Qisheng, SUN Wenjun, ZHANG Yijie, et al. Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(10):1422-1430.
唐启盛, 孙文军, 张毅杰, 等. 对4 734例精神分裂症患者的中医证候分布规律的多中心研究[J]. 北京中医药大学学报, 2023,46(10):1422-1430. DOI： 10.3969/j.issn.1006-2157.2023.10.014.
TANG Qisheng, SUN Wenjun, ZHANG Yijie, et al. Distribution rule of traditional Chinese medicine patterns in 4, 734 schizophrenia patients: a multicenter study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(10):1422-1430. DOI： 10.3969/j.issn.1006-2157.2023.10.014.
摘要
目的
2
采取大样本、多中心的横断面研究方法，探讨精神分裂症患者的中医证候分布规律。
方法
2
2020年5月—2021年4月，在北京市12个分中心(北京中医药大学第三附属医院、北京市朝阳区第三医院、首都医科大学附属北京安定医院、北京回龙观医院、北京市大兴区心康医院、北京市昌平区中西医结合医院、北京市石景山区精神卫生保健所、清华大学垂杨柳医院、北京市延庆区精神病医院、北京市平谷区精神病医院、中国中医科学院广安门医院、北京中医药大学东直门医院)招募精神分裂症患者。共纳入精神分裂症患者4 734例，男性2 529例，女性2 205例，平均年龄50.81岁。通过中医证候学量表、阳性和阴性精神症状评定量表、四诊资料，评价患者精神状态并记录症状，填写《精神分裂症中医证候观察表》。构建症状关系网络图，从中提取证候靶位及证候要素。然后将证候靶位和证候要素应证组合，形成基础证。分别通过关联规则、贝叶斯网络、聚类分析对基础证进行证候提取，最后汇总3种方法得出的证候类型，结合中医理论和专家组意见，同类合并，提取共同的证候。
结果
2
运用关联规则构建了162项症状之间的关系网络图，提取了16个基础证。关联规则提取了痰火扰神、心肝火旺、气滞血瘀、阴虚火旺、肾虚肝郁、痰蒙神窍、脾肾阳虚、心脾两虚、痰气郁结9个证候，聚类分析提取了心肝火旺、痰火伤阴、气滞血瘀、阴亏血少、脾肾阳虚、痰湿内阻、心脾两虚、肾气亏虚、胆气亏虚9个证候，贝叶斯网络提取了痰火扰神、心肝火旺、阴虚火旺、气滞血瘀、瘀热互结、肾虚肝郁、痰蒙神窍、脾肾两虚、心脾两虚、心肾不交和肝肾亏虚11个证候。经过汇总，提取了3种方法重合的痰火扰神、心肝火旺、气滞血瘀、阴虚火旺、痰蒙神窍、心脾两虚、脾肾阳虚和肾虚肝郁8个证候类型。精神分裂症的临床症状包括阴性症状(2 893例，占61.11%)和阳性症状(1 841例，占38.89%)，前者属中医学“癫证”范畴，证候为脾肾阳虚(22.94%)、痰蒙神窍(17.79%)、心脾两虚(13.98%)、肾虚肝郁(6.40%)；后者属中医学“狂证”范畴，证候为痰火扰神(12.63%)、气滞血瘀(11.03%)、阴虚火旺(10.25%)、心肝火旺(4.99%)。
结论
2
本研究探索了精神分裂症的中医证候规律，总结了常见的8个证候类型，为中医药论治精神分裂症提供了辨证基础。
Abstract
Objective
2
We aimed to find the distribution rule of traditional Chinese medicine(TCM) patterns of schizophrenia patients from the result of a large-sample
multicenter
cross-sectional study.
Methods
2
From May 2020 to April 2021
we recruited schizophrenic patients in the following 12 sub-centers in Beijing: The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine
The Third Hospital of Chaoyang District
Beijing Anding Hospital of Capital Medical University
Beijing Huilongguan Hospital
Daxing Xinkang Hospital
Changping Hospital of Integrated Chinese and Western Medicine
Shijingshan Mental Health Care Institute
Chuiyangliu Hospital of Tsinghua University
Yanqing District Psychiatric Hospital
Pinggu District Psychiatric Hospital
Guang'anmen Hospital of China Academy of Chinese Medical Sciences
and Dongzhimen Hospital of Beijing University of Chinese Medicine. In total
4
734 schizophrenic patients(2
529 men and 2
205 women with an average age of 50.81 years) were included
and their mental symptoms were evaluated using the TCM Pattern Scale
Positive and Negative Syndrome Scale
and the four diagnostic method (inspection
listening and smelling
inquiry
and palpation and pulse taking). After finishing the Schizophrenic TCM Pattern Observation Form
the distribution of the patients′ TCM patterns was analyzed through the following steps: (Ⅰ) building a network diagram of all symptoms to extract the pattern locations and elements using association rules; (Ⅱ) combining the pattern locations with the pattern elements to form basic pattern
using the method of association rules
and Bayesian network
cluster analysis; and (Ⅲ) summarizing the patterns according to TCM theories and TCM expert consensus
and selecting the same patterns as the patterns of schizophrenia.
Results
2
Association rules were used to construct a relationship network diagram of 162 symptoms
and 16 basic TCM pattern were extracted. Among them
(Ⅰ) association rules extracted nine TCM patterns(phlegm-fire disturbing mind
hyperactivity of heart-liver fire
stagnation of qi and blood stasis
hyperactivity of fire due to yin deficiency
kidney deficiency and liver depression
spirit confused by phlegm
yang deficiency of the spleen and kidney
deficiency of both the heart and spleen
and phlegm-qi stagnation with binding); (Ⅱ) cluster analysis extracted nine patterns(hyperactivity of heart-liver fire
phlegm fire burning yin
stagnation of qi and blood stasis
yin deficiency and blood insufficiency
yang deficiency of the spleen and kidney
stagnation of phlegm-dampness
deficiency of both the heart and spleen
deficiency of kidney qi
and deficiency of bile qi); and (Ⅲ) the Bayesian network extracted 11 patterns(phlegm-fire disturbing mind
hyperactivity of heart-liver fire
hyperactivity of fire due to yin deficiency
stagnation of qi and blood stasis
intermingled phlegm and heat
kidney deficiency and liver depression
spirit confused by phlegm
deficiency of both the spleen and kidney
deficiency of both the heart and spleen
disharmony between the heart and kidney
and liver-kidney deficiency). Finally
eight common patterns were summarized
including phlegm-fire disturbing mind
hyperactivity of heart-liver fire
stagnation of qi and blood stasis
hyperactivity of fire due to yin deficiency
spirit confused by phlegm
deficiency of both the heart and spleen
yang deficiency of the spleen and kidney
and kidney deficiency and liver depression.The clinical features of schizophrenic patients included negative symptoms(2
893 cases
61.11%) and positive symptoms(1
841 cases
38.89%). The former belongs to the TCM "epilepsy syndrome" category
and the patterns of yang deficiency of the spleen and kidney(22.94%)
spirit confused by phlegm(17.79%)
deficiency of both the heart and spleen(13.98%)
and kidney deficiency and liver depression(6.40%) are involved. The latter belongs to the TCM "manic psychosis syndrome" category
and the patterns of phlegm-fire disturbing mind(12.63%)
stagnation of qi and blood stasis(11.03%)
hyperactivity of fire due to yin deficiency(10.25%)
and hyperactivity of heart-liver fire(4.99%) are involved.
Conclusion
2
This study may provide a reliable basis for forming plans for TCM diagnosis and treatment of schizophrenia
which can be guided by the 8 TCM patterns from 4.734 patients.
关键词
精神分裂症证候关联规则贝叶斯网络聚类分析
Keywords
SchizophreniaTCM patternsassociation rulesBayesian networkcluster analysis
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