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[1]王艷,張開偉,陳海霞,等.基于聚類分析的肩痛癥中醫(yī)證候研究[J].中醫(yī)正骨,2021,33(09):38-43.
　WANG Yan,ZHANG Kaiwei,CHEN Haixia,et al.Research on traditional Chinese medicine syndromes of shoulder pain based on clustering analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(09):38-43.
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基于聚類分析的肩痛癥中醫(yī)證候研究
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年09期
頁碼:
38-43
欄目:
調(diào)查研究
出版日期:
2021-09-20

文章信息/Info

Title:
Research on traditional Chinese medicine syndromes of shoulder pain based on clustering analysis
作者:
王艷1; 張開偉2; 陳海霞2; 楊砥2; 費冀2; 孫權(quán)2
(1.貴州中醫(yī)藥大學,貴州 貴陽 550025; 2.貴州中醫(yī)藥大學第一附屬醫(yī)院,貴州 貴陽 550001)
Author(s):
WANG Yan1; ZHANG Kaiwei2; CHEN Haixia2; YANG Di2; FEI Ji2; SUN Quan2
1.Guizhou University of Traditional Chinese Medicine,Guiyang 550025,Guizhou,China 2.The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,Guizhou,China
關(guān)鍵詞:
肩痛;  證候;  聚類分析
Keywords:
shoulder pain;  symptom complex;  cluster analysis
摘要:
目的:探討肩痛癥的中醫(yī)證候分型及其分布特征。方法:制定肩痛癥中醫(yī)證候臨床調(diào)查表,對符合入選標準的肩痛癥患者的中醫(yī)證候進行調(diào)查,采集患者的中醫(yī)望、聞、問、切四診信息。將采集的中醫(yī)四診信息進行0、1編碼數(shù)據(jù)轉(zhuǎn)換,采用主成分分析方法對處理好的數(shù)據(jù)進行降維處理,采用K-Means算法對降維后的樣本數(shù)據(jù)進行聚類分析,采用輪廓系數(shù)評估聚類效果。肩痛癥中醫(yī)證候要素分布及各中醫(yī)證型的證候要素分布采用頻數(shù)分析。不同性別、年齡段之間肩痛癥中醫(yī)證型分布的組間比較均采用χ2檢驗,檢驗水準α=0.05。結(jié)果:①數(shù)據(jù)聚類結(jié)果。初始聚類后,279例肩痛癥患者的基本數(shù)據(jù)被分成3類,即風寒濕型、瘀滯型、氣血虧虛型,但風寒濕型仍可進行拆分,且聚集性沒有另外兩類的效果好。經(jīng)第2次聚類后,風寒濕型被拆分出一種新類型即濕熱型。第2次聚類的輪廓系數(shù)(0.876)較第1次聚類的輪廓系數(shù)(0.774)提高了約10%,聚類效果明顯提升。②肩痛癥中醫(yī)證候要素分布。279例肩痛癥患者中,肩痛、肩部壓痛、肩關(guān)節(jié)活動障礙出現(xiàn)頻率均為100%。③肩痛癥各中醫(yī)證型的證候要素分布。279例肩痛癥患者的中醫(yī)證候要素經(jīng)聚類分析后,被分為4類證候,分別為氣血虧虛型、濕熱型、風寒濕型和瘀血型。剔除低于15%的證候要素后,氣血虧虛型肩痛癥的證候要素中肩關(guān)節(jié)活動障礙、肩部壓痛、氣短懶言、四肢乏力、脈細澀出現(xiàn)頻率均為100%; 濕熱型肩痛癥的證候要素中肩關(guān)節(jié)活動障礙、肩部壓痛、脈濡數(shù)(滑數(shù))出現(xiàn)頻率均為100%; 風寒濕型肩痛癥的證候要素中肩關(guān)節(jié)活動障礙、肩部壓痛、四肢沉重、脈弦滑出現(xiàn)頻率均為100%; 瘀滯型肩痛癥的證候要素中肩關(guān)節(jié)活動障礙、肩部壓痛、脈弦緊(弦澀)出現(xiàn)頻率均為100%。④不同性別中醫(yī)證型分布。279例肩痛癥患者中,男性患者各中醫(yī)證型占比由高至低依次為瘀滯型、氣血虧虛型、濕熱型、風寒濕型,女性患者各中醫(yī)證型占比由高至低依次為氣血虧虛型、瘀滯型、濕熱型、風寒濕型; 男女間中醫(yī)證型分布的差異無統(tǒng)計學意義(χ2=5.672,P=0.129)。⑤不同年齡段中醫(yī)證型分布。279例肩痛癥患者中,年齡<45歲的患者各中醫(yī)證型占比由高至低依次為濕熱型、風寒濕型、瘀滯型,年齡45～54歲的患者各中醫(yī)證型占比由高至低依次為瘀滯型、濕熱型、風寒濕型、氣血虧虛型,年齡55～64歲的患者各中醫(yī)證型占比由高至低依次為氣血虧虛型、瘀滯型、濕熱型、風寒濕型,年齡65～74歲的患者各中醫(yī)證型占比由高至低依次為氣血虧虛型、瘀滯型、濕熱型、風寒濕型,年齡>74歲的患者各中醫(yī)證型占比由高至低依次為氣血虧虛型、瘀滯型、濕熱型; 不同年齡段之間中醫(yī)證型分布的差異有統(tǒng)計學意義(χ2=129.962,P=0.000)。結(jié)論:肩痛癥的中醫(yī)證型除氣血虧虛型、瘀滯型、風寒濕型外,還存在濕熱型; 這些中醫(yī)證型在不同性別患者間的分布并沒有差異,但在不同年齡段患者間的分布有差異,45歲以下患者最常見濕熱證,45～54歲患者最常見瘀滯證,54歲以上患者最常見氣血虧虛證。
Abstract:
Objective:To explore the classification of traditional Chinese medicine(TCM)syndromes of shoulder pain and their distribution characteristics.Methods:A clinical questionnaire was developed for investigating the TCM syndromes of patients who met the inclusion criteria for shoulder pain,and the information was collected via four examinations including inspection,listening and smelling,inquiry and pulse feeling and palpation and then converted into 0 or 1 coded data.The principal component analysis was conducted to reduce the dimension of the processed data,which were then subjected to K-Means clustering analysis,followed by silhouette coefficient-based evaluation for the clustering effect.The distribution of TCM syndrome elements of shoulder pain and element distribution of each TCM syndrome were subjected to frequency analysis.The χ2 test was employed to compare the TCM syndrome element distribution of shoulder pain among different genders and age groups,with the inspection level set at α=0.05.Results:①Data clustering results.As revealed by initial clustering,the basic data of 279 patients with shoulder pain were clustered into three categories,namely wind-cold-dampness type,blood-stasis type and qi-blood deficiency type.The first type could be further sub-clustered,but the clustering effect was not as good as those of the other two.In the second-order clustering,the wind-cold-dampness type was sub-clustered into a dampness-heat type,with the silhouette coefficient(0.876)increasing by 10 percent in comparison with 0.774 of the first-order clustering,indicating an improved clustering effect.②Distribution of TCM syndrome elements of shoulder pain.In 279 patients with shoulder pain,the occurrence frequencies of shoulder pain,shoulder tenderness and shoulder joint movement disorder were all 100%.③Element distribution of each TCM syndrome of shoulder pain.The clustering analysis of TCM syndrome elements in 279 patients with shoulder pain yielded four clusters,namely,the qi-blood deficiency type,dampness-heat type,wind-cold-dampness type and blood-stasis type.Following the elimination of syndrome elements less than 15%,the occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,shortness of breath,laziness to speak,limb weakness and thready-unsmooth pulse in patients with shoulder pain due to qi-blood deficiency syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness and soggy rapid(slippery and rapid)pulse in patients with shoulder pain due to dampness-heat syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,limb heaviness and wiry and slippery pulse in patients with shoulder pain differentiated into wind-cold-dampness syndrome were all 100%.The occurrence frequencies of shoulder joint movement disorder,shoulder tenderness,and wiry and tight(wiry and unsmooth)pulse in the ones with shoulder pain resulting from blood-stasis syndrome were all 100%.④Distribution of TCM syndromes between males and females.The TCM syndromes of male and female patients with shoulder pain were separately ranked in a descending order by proportion as follows:blood-stasis type,followed by qi-blood deficiency type,dampness-heat type and wind-cold-dampness type for male patients; while qi-blood deficiency type,followed by blood-stasis type,dampness-heat type and wind-cold-dampness type for females.There was no statistical significance in the distribution of TCM syndromes between male patients and female patients(χ2=5.672, P=0.129).⑤Distribution of TCM syndromes in different age groups.The TCM syndromes of shoulder pain patients in different age groups were separately ranked in a descending order by proportion as follows:dampness-heat type,followed by wind-cold-dampness type and blood-stasis type for those aged less than 45 years old; blood-stasis type,followed by dampness-heat type,wind-cold-dampness type and qi-blood deficiency type for those aged from 45 to 54 years old; qi-blood deficiency type,followed by blood-stasis type,dampness-heat type and wind-cold-dampness type for those aged from 55 to 74 years old; while qi-blood deficiency type,followed by blood-stasis type and dampness-heat type for those aged over 74 years old.Statistically significant differences were observed in the distribution of TCM syndromes among different age groups(χ2=129.962,P=0.000).Conclusion:In addition to qi-blood deficiency type,blood-stasis type and wind-cold-dampness type,there is also dampness-heat type for shoulder pain.The distribution of these TCM syndromes does not vary significantly between males and females,but existing statistical significance among different age groups,with the dampness-heat syndrome most frequently found in patients aged less than 45 years old,the blood-stasis syndrome in those aged from 45 to 54 years old,and the qi-blood deficiency syndrome in those aged over 54 years old.

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備注/Memo

備注/Memo:
基金項目:貴州省衛(wèi)生健康委科學技術(shù)基金項目(gzwjkj2020-1-123)
通訊作者:張開偉 E-mail:[email protected]
更新日期/Last Update: 1900-01-01