【作者】 殷庆梅；

【导师】 张琪；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2007， 硕士

【摘要】 目的：探讨高血压病中医辩证的计量化指标，为高血压病的临床中医辩证提供定量方法。方法：1．参照《中药新药临床研究指导原则（试行）》2002版有关高血压病的中医证候诊断标准进行辨证，得到肝火亢盛、阴虚阳亢、痰湿壅盛、阴阳两虚四类证型。同时将原始的四诊资料按虚实分类。肝火亢盛、痰湿壅盛证为实，阴虚阳亢、阴阳两虚证为虚。2．分别建立高血压病中医辨证计量诊断的判别函数式。应用SPSS11.5统计软件中Fisher’s线性多元逐步判别分析，反复调整Entry和Removal值，得到四类证型和虚实证型回代符合率最高的判别函数式。将原资料逐个代入已建立的判别函数式，与原诊断标准对比，评价该函数式的效能。结果：1．四类证型的判别函数式及验证结果：Y₁=-401.161+289.459X₃₀+283.644X₁₁₄-4.065X₁₁₅-4.773X₁₁₆+37.677X₁₃₇+2.572X₁₄₃-0.581X₁₄₈+1.032X₁₈₁+1.657X₂₀₂+1.887X₂₂₈；Y₂=-388.511+306.143X₃₀+241.429X₁₁₄-4.565X₁₁₅-5.857X₁₁₆+35.073X₁₃₇+1.574X₁₄₃-0.575X₁₄₈+1.101X₁₈₁-1.652X₂₀₂+2.119X₂₂₈；Y₃=-386.325+283.087X₃₀+271.961X₁₁₄-3.176X₁₁₅-4.387X₁₁₆+42.445X₁₃₇+1.037X₁₄₃-0.641X₁₄₈+1.045X₁₈₁-0.413X₂₀₂+2.239X₂₂₈；Y₄=-364.925+329.280X₃₀+174.998X₁₁₄-4.043X₁₁₅-6.172X₁₁₆+26.443X₁₃₇+1.503X₁₄₃-0.392X₁₄₈+0.915X₁₈₁-0.613X₂₀₂+1.141X₂₂₈其中X₃₀代表身高、X₁₁₄代表红细胞压积（Hct）、X₁₁₅代表红细胞聚集指数（EAI）、X₁₁₆代表红细胞刚性指数（TK）、X₁₃₇代表apoal、X₁₄₃代表尿IgG、X₁₄₈代表电轴°、X₁₈₁代表动态血压SBP夜平均压、X₂₀₂代表侧壁基底段心肌运动速度、X₂₂₈代表下壁基底段心肌运动距离。四类证型判别分析函数的方差分析结果P值为0.000，判别函数式有效；评价该判别函数式的诊断效能，总判别正确率为92.7％，交互验证符合率为89.0％。2．虚实类证型的判别函数式及验证结果：Y₁=-279.070-2.682X₈-7.582X₉₁+8.497X₁₁₂+4.127X₁₁₅+2.856X₁₁₆+3.709X₁₃₃+38.796X₁₃₇+11.759X₁₄₄+28.610X₁₆₀+0.476X₁₇₈+157.468X₁₈₆+6.265X₂₀₂+401.252X₂₂₅；Y₂=-245.121-0.009X₈+1.293X₉₁+4.515X₁₁₂+1.920X₁₁₅+1.540X₁₁₆+1.620X₁₃₃+28.836X₁₃₇+8.102X₁₄₄+12.995X₁₆₀+0.605X₁₇₈+187.937X₁₈₆+3.224X₂₀₂+349.327X₂₂₅其中X₈代表文化程度、X₉₁代表心脏杂音、X₁₁₂代表高切全血比粘度（ηb）之浓度、X₁₁₅代表红细胞聚集指数（EAI）、X₁₁₆代表红细胞刚性指数（TK）、X₁₃₃代表甘油三酯、X₁₃₇代表apoal、X₁₄₄代表尿转铁蛋白、X₁₆₀代表室早有无、X₁₇₈代表SBPmax、X₁₈₆代表动态血压SBP夜昼比、X₂₀₂代表侧壁基底段心肌运动速度、X₂₂₅代表前壁中间段心肌到最大位移的时间。虚实类判别分析函数方差分析结果P值为0.000，判别函数式有效；评价该判别函数式的诊断效能，总判别正确率为100.0％，交互验证符合率为98.8％。结论：1．采用多元逐步判别分析方法得到的高血压病计量诊断的判别函数式对临床高血压的中医辨证具有较好的诊断效能。2．比较两种判别函数式，虚实类判别分析函数比四类判别分析函数结果更稳定，具有一定的临床应用价值。更多还原

【Abstract】 Objective: To quantify the results of ordinary clinical index,then define a formula to evaluateits clinical value in diagnosing different TCM syndromes of Essential Hypertension.Methods: 1. According to the Guide Book of New TCM Pharmaceutic Clinical Research（2002edition）, all patients were classified into 4 types:the Liver-Fire exuberant syndrome,thephlegm-dampness abundant,Yin-deficiency and yang-hyperactivity syndrome and Yin-yangdual deficiency syndrome. Then all patients of 4 types were classified into Xu and Shi types:Liver-Fire exuberant and the phlegm-dampness abundant labeled Shi,Yin-deficiency andyang-hyperactivity syndrome and Yin-yang dual deficiency syndrome labeled Xu.2. Appling the SPSS11.5 software and the approaches of discriminant, taking 4 types and XuShi types as grouping variable respectively, using stepwise method, displaying Fisher’s functioncoefficients,choosed Entry and Removal time after time, and the most efficient formulas andvalidation results was defined. The diagnostic efficiency of the formula in diagnosingsyndromes was evaluated by validate the background data.Results:1.The formulas of 4 types defined by discriminant:Y₁=-401.161+289.459X₃₀+283.644X₁₁₄-4.065X₁₁₅-4.773X₁₁₆+37.677X₁₃₇+2.572X₁₄₃-0.581X₁₄₈+1.032X₁₈₁+1.657X₂₀₂+1.887X₂₂₈;Y₂=-388.511+306.143X₃₀+241.429X₁₁₄-4.565X₁₁₅-5.857X₁₁₆+35.073X₁₃₇+1.574X₁₄₃-0.575X₁₄₈+1.101X₁₈₁-1.652X₂₀₂+2.119X₂₂₈;Y₃=-386.325+283.087X₃₀+271.961X₁₁₄-3.176X₁₁₅-4.387X₁₁₆+42.445X₁₃₇+1.037X₁₄₃-0.641X₁₄₈+1.045X₁₈₁-0.413X₂₀₂+2.239X₂₂₈;Y₄=-364.925+329.280X₃₀+174.998X₁₁₄-4.043X₁₁₅-6.172X₁₁₆+26.443X₁₃₇+1.503X₁₄₃-0.392X₁₄₈+0.915X₁₈₁-0.613X₂₀₂+1.141X₂₂₈Theindexes of diagnosis of EH: height (X₃₀), Hct (X₁₁₄), EAI (X₁₁₅), TK (X₁₁₆),apoal (X₁₃₇), urine IgG (X₁₄₃), ECG axis(X₁₄₈), 24 ABPM SBPmean night (X₁₈₁), Myocardialvelocity of lat basal segment(X₂₀₂), Myocardial distance of ing basal segment(X₂₂₈). Test of Wilk’s Lambda Functions display the Chi-square significance were 0.000 and theformula of 4 types were efficient. 92.7% of original grouped cases correctly classified.In crossvalidation, 89.0% of cross-validated grouped cases correctly classified.2. The formula of Xu and Shi types defined by discriminant:Y₁=-279.070-2.682X₈-7.582X₉₁+8.497X₁₁₂+4.127X₁₁₅+2.856X₁₁₆+3.709X₁₃₃+38.796X₁₃₇+11.759X₁₄₄+28.610X₁₆₀+0.476X₁₇₈+157.468X₁₈₆+6.265X₂₀₂+401.252X₂₂₅;Y₂=-245.121-0.009X₈+1.293X₉₁+4.515X₁₁₂+1.920X₁₁₅+1.540X₁₁₆+1.620X₁₃₃+28.836X₁₃₇+8.102X₁₄₄+12.995X₁₆₀+0.605X₁₇₈+187.937X₁₈₆+3.224X₂₀₂+349.327X₂₂₅The indexes of diagnosis of EH: education（X₈）, heart souffle(X₉₁), Highηb(X₁₁₂),EAI(X₁₁₅), TK (X₁₁₆),TG(X₁₃₃), apoal (X₁₃₇), TRF (X₁₄₄),premature ventricular beats (X₁₆₀),24 ABPM SBPmax(X₁₇₈),24 ABPM SBP d/n ratio (X₁₈₆), Myocardial velocity of lat basalsegment(X₂₀₂), Time of ant mid segment(X₂₂₅).Test of Wilk’s Lambda Functions display the Chi-square significance were 0.000 and theformula of Xu and Shi types were efficient. 100% of original grouped cases correctlyclassified.In cross validation, 98.8% of cross-validated grouped cases correctly classified.Conclusion:1. Based on the ordinary clinical data, a discriminatory function formula for quantitative TCMdifferential diagnosis was established by using the multivariate stepwise analysis model.2.The validation results of Xu Shi types and 4 types showed that the discriminatory functionformula for quantitative Xu and Shi diagnosis of EH possessed rather high diagnosticefficiency and was worthy of clinical use.更多还原