摘要
背景 中国传统医学对桥本甲状腺炎并发甲状腺毒症的发生、发展和诊疗已经有了系统的认识,但是目前关于本病人群中医临床症状和证型分布情况研究甚少,国家行业标准中亦缺乏关于本病的证型分布及证候诊断标准的描述.目的 运用因子分析联合聚类分析探讨桥本甲状腺炎并发甲状腺毒症人群临床症状及证型分布规律,为临床辨证提供依据,促进桥本甲状腺炎并发甲状腺毒症证候标准化研究.方法 收集 2020 年 12 月—2021 年 12 月就诊于北京中医药大学东直门医院东城院区、通州院区、北京中医药大学孙思邈医院甲状腺病科门诊符合诊断标准的 171例桥本甲状腺炎并发甲状腺毒症患者,使用《桥本甲状腺炎并发甲状腺毒症中医四诊信息采集表》对症状/体征、舌、脉等四诊信息进行采集,基于因子分析和聚类分析研究桥本甲状腺炎并发甲状腺毒症的症状及证型分布规律.结果 171 例桥本甲状腺炎并发甲状腺毒症患者中男 17 例、女 154 例,平均年龄(39.98±13.30)岁,其中 20～60 岁患者占87.72%.症状分布方面出现频率较高的症状有神疲乏力、心慌心悸、烦躁或急躁易怒,体征有颈前肿大、手指震颤,频率较高的舌象有舌红、舌瘦薄和舌有齿痕,苔质为苔白和苔薄,脉象是脉弦、脉数.收集调查表的 82 个四诊条目因子分析,提取出 25 个公因子,累计方差贡献率为 70.562%,筛选出具有意义的症状 62 项.利用因子分析得到的 25个公因子结果作为变量对其进行R型系统聚类分析,共得到 5 类证候分型,分别是:肝郁痰凝证、阴虚火旺证、脾肾阳虚证、肝郁气滞证、气阴两虚证.结论 桥本甲状腺炎并发甲状腺毒症的基本中医证候可分为肝郁痰凝证、阴虚火旺证、脾肾阳虚证、肝郁气滞证、气阴两虚证.
Abstract
Background Traditional Chinese Medicine(TCM)has a systematic understanding of the occurrence,development,diagnosis and treatment of Hashimoto's thyroiditis complicated with thyrotoxicosis.However,at present,there are few studies on the clinical symptoms and syndrome distribution of TCM in this disease population,and there is also a lack of description of the syndrome distribution and syndrome diagnostic criteria of this disease in the national industry standards.Objective Using factor analysis combine with cluster analysis to explore the distribution of clinical symptoms and syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis,provide a basis for clinical syndrome differentiation and promote the standardization of Hashimoto's thyroiditis complicated with thyrotoxicosis syndrome.Methods From December 2020 to December 2021,171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis who met the diagnostic criteria in the outpatient department of thyroid disease of Dongcheng District,Tongzhou District of Dongzhimen Hospital,Beijing University of Chinese Medicine and Sunsimiao Hospital was collected.The symptoms,signs,tongue,pulse and other four diagnostic information were collected by using the four diagnostic information collection table of Hashimoto's thyroiditis complicated with thyrotoxicosis'.Based on factor analysis and cluster analysis,the symptoms and syndrome distribution of Hashimoto's thyroiditis complicated with thyrotoxicosis were studied.Results Among the 171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis,there were 17 males and 154 females,with an average age of(39.98±13.30)years.Patients aged 20-60 years accounted for 87.72%.The symptoms with high frequency in the distribution of symptoms were fatigue,palpitation,irritability or impatience.Signs were swelling of the neck,finger tremor.The tongue image with higher frequency had red,thin tongue and tooth marks on the tongue.The moss were white and thin.The pulse condition were pulse string and pulse number.Factor analysis of 82 four diagnostic items of the questionnaire was collected,and 25 common factors were extracted.The cumulative variance contribution rate was 70.562%,and 62 meaningful symptoms were screened out.The 25 common factor results obtained by factor analysis were used as variables to perform R-type system cluster analysis,and a total of 5 types of syndrome types were obtained,namely:pattern of phlegm congealing due to liver depression,pattern of yin deficiency with effulgent fire,pattern of yang deficiency in spleen and kidney,pattern of qi stagnation due to liver depression,pattern of dual deficiency of qi and nutrient phases.Conclusion The basic TCM syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis can be divided into pattern of phlegm congealing due to liver depression,pattern of yin deficiency with effulgent fire,pattern of yang deficiency in spleen and kidney,pattern of qi stagnation due to liver depression,pattern of dual deficiency of qi and nutrient phases.
基金项目
陕西省科技厅重点研发项目(2023-ZDLSF-56)
陕西省中医药局项目(2021-GJ-LC002)
陕西省中医药局项目(SZY-KJCYC-2023-074)
陕西省中医药局项目(2022-QCYZH-043)
北京中医药大学孙思邈研究院项目(SSMYJY-3-2021-05)
维普
万方数据