【作者】 肖冰；

【导师】 赵长鹰；

【作者基本信息】 暨南大学 ， 中西医结合临床， 2005， 硕士

【摘要】 目的:初步实现肝硬化中医常见证候的计量诊断及探讨肝硬化的用药规律。 方法: 1.采用文献学的方法,运用分析、归纳等逻辑思维,在明确纳入标准及排除标准的基础上,较全面地收集近10年的中医、中西医结合学术刊物中有关治疗肝硬化的病案及部分名老中医治疗肝硬化专著中的病案,对病案中肝硬化患者中医四诊信息及用药进行归纳、整理。 2.数据预处理:数据(证候、症状、体征、药名)的规范化描述。 3.建立数据库:数据输入数据库,本库的内容包括性别、年龄、证型、症状、体征、方药。按证型、症状、体征、方药的有无,有者记为“1”,无者记为“0”。主要使用SPSS11.0进行条目的编码、数据录入、数据管理和统计分析。 4.统计分析:运用X~2检验对收集到的证型数据进行统计处理,结合中医理论对统计结果进行分析,得出肝硬化的常见证候。运用Logistic逐步回归分析得到常见证候的特征性症状、体征。 5.在此基础上运用最大似然法得出肝硬化常见证候的计量诊断表,确定诊断阈值。 6.运用频数、排序等统计方法,对病案中治疗肝硬化的用药进行归纳、整理,从用药归类、高频次用药、低频次用药、常见证型的用药、用药特点等角度探讨中医治疗肝硬化的用药规律, 结果:通过对收集的604例肝硬化病案涉及的8个证候、100项症状体征进行统计分析,得到肝硬化常见的6个证候,建立了肝硬化常见6个证候的计量诊断表,并进一步简化成诊断计分表。经初步检验,该表具有较好的诊断效果,诊断总符合率为76.33%;对562例病案中涉及的313味中药进行统计分析,初步总结出中医治疗肝硬化的用药规律。 结论:肝气郁结证、血瘀阻络证、湿热内蕴证、肝肾阴虚证、脾肾阳虚证、脾虚湿盛证是肝硬化常见的中医基本证候。本课题所建立的肝硬化常见中医证候计量诊断表具有如下几个特点:(1)更具临床实用价值;(2)基础工作扎实;(3)症状、体征的相关因素赋分更能反映其对应中医基本证候的实际贡献值;(4)更客更多还原

【Abstract】 Objective: To initially realize quantitative diagnosis of frequent TCM syndrome ofhepatocirrhosis and study the principle of herbs used by TCM treatment.Methods:1.On the base of the including and excluding specific criterion, the method ofdocumentics and logical thinking of analysis and induction etc. were used to collectthe hepatocirrhosis cases from the periodicals of Traditional Chinese Medicine andChinese and Western Medicine and part of the monographes writing by the renownedand old doctors of Traditional Chinese Medicine. We concluded and trimedinformation of four diagnosis methods and using medicine.2.Pretreatment the data: To describe the data(TCM Syndromes, symptom, physicalsign, the name of herbs) normally.3.Establish database: Datebase was established and all data were arranged, input,managed and Stst analysed by SPSS 11.0 statistics package. The database includedsex, age, TCM Syndromes, symptom, pysical sign and herb. If there is the data, wemarked it " 1" . When the data didn’t appear , we marked it "0" .4.Stst analysis: Chi-square test was used to study the TCM Syndromes data.Combining with the theory of Traditional Chinese Medicine we elicited the frequentTCM syndrones of hepatocirrhosis and analysed the results. Logistic regressionanalysis was used to analyse the characteristic symptoms and physical signs whichwere selected out.5.With this groundwork, we used the method of maximum likelihood and establishedthe diagnostic score table of the frequent TCM syndrones of hepatocirrhosis andconfirmed the critical diagnostic score.6.Stat measure of frequence and compositor and so on were used to classify the herbsof treating hepatocirrhosis which were extracted from the monographes writing by thespecialists, and we elicited the rules of prescription.Rusults: We investigated 604 cases and got 8 TCM syndromes, 100 signs andsymptoms. We used the statistical ways and got 6 frequent TCM syndrones of hepatocirrhosis and established the diagnostic score table of the frequent TCM syndrones of hepatocirrhosis. Using the table, the diagnostic coincidence rate was 76.33%. It shows that the table can provide the satisfactory effect for diagnosis of the frequent TCM syndrones of hepatocirrhosis. We investigated 562 cases and got 313 herbs, and sumed up the regularity of prescription of treating hepatocrirrhosis. Conclusion: The primary TCM syndrones of hepatocirrhosis are the sydromes of liver qi stagnation > stagnant blood ^ dampness-heat in the spleen -. deficiency of yin of both liver and kidney n deficiency of yang of both spleen and kidney and accumulation of damp due to spleen deficiency. The diagnostic score table of the frequent TCM syndrones of hepatocirrhosis has several characters, for example:(l)It has more applied and clinical value;(2)The basic work was well-knit;(3)The symptoms and signs were endued scores which could reflect the actual contribution to the corresponding TCM syndrones of hepatocirrhosis;(4)It is more external and more canonical.Chi-square test combining with the experience of the renowned and old doctors of Traditional Chinese Medicine was used to study the regularity of prescription of treating hepatocrirrhosis. It provided the consult and evidence for formulating the new herbs and clinical application.更多还原