胃癌中医证候多元剖析.docVIP

胃癌中医证候多元剖析 　　摘要：目的 探索胃癌的中医证候构成及其分布规律。方法 在多中心、大样本临床流行病学调查基础上采集767例胃癌患者四诊及临床资料，建立胃癌中医证候数据库，采用因子分析和聚类分析方法探讨其证候构成及分布规律。结果 胃癌症状以乏力、消瘦、头晕等全身非特异性表现和上腹不适、嗳气、饱胀或稍食即胀、疼痛、泛酸、纳呆等局部表现为主，舌偏红、苔腻，脉细或弦。剔除症状太少和无证可辨者92例，最后675例进入多元分析。初次因子分析筛选出25个证候变量，再次因子分析得到特征根1.0的因子10个，累积贡献率为60.5%；进一步对10个公因子积分进行K-means聚类分析发现聚为7类时最符合临床，其中第1～7类的患者人数分别为165、82、90、79、88、95和76。结合专业知识对主要公因子进行分析，分别命名为脾胃气滞型（24.44%）、气血两虚型（12.15%）、脾气亏虚型（13.33%）、瘀血内阻型（11.70%）、痰湿内蕴型（13.04%）、脾胃虚寒型（14.07%）、胆胃失和型（11.41%）。结论 多元统计分析结果提示，胃癌病位在胃，与脾、肝、胆关系密切，总的病机为本虚标实，正虚为气、血、阳气不足，邪实为气滞、痰湿、瘀血为患。 　　关键词：胃癌；证型；聚类分析；多元分析 　　DOI：10.3969/j.issn.1005-5304.2016.10.005 　　中图分类号：R273.52 文献标识码：A 文章编号：1005-5304（2016）10-0016-05 　　Abstract： Objective To explore the composition and distribution law of TCM syndromes in gastric cancer. Methods Based on the multicenter and large-sample clinical epidemiological investigation， the four methods of diagnosis of and clinical materials of 767 cases of gastric cancer were collected， and the database of TCM syndromes in gastric cancer was establish. Factor analysis and clustering analysis were used to explore composition and distribution law of TCM syndromes in gastric cancer. Results Gastric cancer symptoms mainly included fatigue， weight loss， dizziness and other non-specific systemic manifestation， and epigastria discomfort， belching， fullness or eating just a little swelling， pain， acid regurgitation， loss of appetite and other local manifestations. At the same time， the red tongue， moss greasy， pulse fine or string and other traditional Chinese medicine signs were also included. Eliminating 92 cases with too little symptoms， 675 cases were under multivariate analyzed. 25 syndrome variables were selected after initial factor analysis， again through factor analysis 10 factors with eigenvalues more than 1.0 were obtained and the cumulative contribution rate was 60.5%. Through further K-means clustering analysis on 10 common factor integrals， it was found that when all the cases were clustered into 7 classes c