主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2020, Vol. 43 ›› Issue (6): 516-521.doi: 10.3969/j.issn.1006-2157.2020.06.012

• 临床研究 • 上一篇    下一篇

基于隐变量分析的多囊卵巢综合征证候要素评判标准初探*

邢玉1, 鲁秋丹1, 沈凌宇2, 刘海涛3, 佟庆1, 黄海涛1, 仰艳1, 郑凌琦1, 李鸿博1, 肖双双4, 肖慧1, 孙俊建5, 刘艳霞1#   

  1. 1 北京中医药大学东方医院 北京 100078;
    2 北京中医医院顺义医院;
    3 北京市宣武中医医院;
    4 北京市鼓楼中医医院;
    5 北京第一中西医结合医院
  • 收稿日期:2019-10-16 发布日期:2020-07-06
  • 通讯作者: #刘艳霞,女,博士,主任医师,博士生导师,主要研究方向:中医妇科生殖内分泌,E-mail:lyx7028@sina.com
  • 作者简介:邢玉,女,博士,主治医师
  • 基金资助:
    *国家自然科学基金资助项目(No. 81904241),北京中医药大学青年教师资助项目(No. 2018-JYBZZ-JS099)

Preliminary study on diagnostic criteria for polycystic ovary syndrome in terms of pattern elements based on latent variable analysis*

Xing Yu1, Lu Qiudan1, Shen Lingyu2, Liu Haitao3, Tong Qing1, Huang Haitao1, Yang Yan1, Zheng Lingqi1, Li Hongbo1, Xiao Shuangshuang4, Xiao Hui1, Sun Junjian5, Liu Yanxia1#   

  1. 1 Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China;
    2 Department of Gynecology, Beijing Hospital of Traditional Chinese Medicine in Shunyi, Beijing 101300, China;
    3 Department of Gynecology, Xuanwu TCM Hospital Beijing, Beijing100050, China;
    4 Department of Gynecology, Beijing Gulou Hospital of Chinese Medicine, Beijing 100009, China;
    5 Department of Gynecology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, China
  • Received:2019-10-16 Published:2020-07-06
  • Contact: Prof. Liu Yanxia, M.D., Chief Physician, Doctoral Supervisor. Dongfang Hospital, Beijing University of Chinese Medicine. No. 6 District 1, Fangxingyuan, Fangzhuang, Fengtai District, Beijing 100078. E-mail:lyx7028@sina.com
  • Supported by:
    National Natural Science Foundation of China (No. 81904241)

摘要: 目的 初步探讨多囊卵巢综合征(PCOS)中医证候要素评判标准,为PCOS的中医辨证标准的建立提供一定的循证依据。方法 采集518例PCOS患者临床资料;采用隐变量分析法构建模型。并进行一致性检验。结果 模型拟合优度指数及校正拟合优度指数均接近1,模型拟合较好。近似误差均方根为0.063 7,≤0.08,模型可以接受。一致性检验结果显示:肾、肝、脾3个病位类证候要素,具备一个模型中的症状(腰骶酸痛、夜尿多、耳鸣;心情抑郁、急躁易怒、善太息;食少纳呆、食后腹胀、泄泻)即可诊断,与医生辨证相同的概率分别为71.6%、88%及77%。气虚、气滞、痰湿3个病性类证候要素,具备两个模型中的症状(神疲、乏力、自汗;胸闷、胸胁胀痛、乳房胀痛;嗜睡、头蒙如裹、咯痰)即可诊断,与医生辨证一致的概率分别为86.3%、83.2%、80.5%。结论 初步制定PCOS证候要素评判标准:在满足PCOS诊断标准的基础上,肾、肝、脾,具备一个模型中的症状即可诊断,气虚、气滞、痰湿,具备两个模型中的症状即可诊断。

关键词: 多囊卵巢综合征, 证候要素, 横断面研究, 隐变量分析, 结构方程模型

Abstract: Objective To explore the criteria for identifying pattern elements of polycystic ovary syndrome (PCOS), and to provide evidence for setting TCM clinical pattern differentiation criteria for PCOS. Methods Clinical data of 518 PCOS patients were collected. Latent variable analysis was made to establish TCM diagnostic criterion model of PCOS based on pattern element, after which, diagnoses made using the model were compared with clinical diagnoses made by TCM physicians. Results Both goodness of fit index (GFI) and GFI adjusted for degrees of freedom (AGFI) were close to 1, suggesting that the model was well-fitting. The root mean square error of approximation (RMSEA) was 0.063 7, which is≤0.08, indicating that the model was acceptable. The results of consistency test were as follows. TCM diagnosis of the pattern element of disease location or affected zang-fu organ (i.e. kidney, liver, and spleen) could be made when just one symptom in the model manifests itself (i.e. lumbosacral pain, frequent urination at night, and tinnitus for kidney; depression, impatience and irascibility, and frequent or excessive sighing for liver; and poor appetite and digestion, abdominal distention after eating, and diarrhea for spleen, respectively). The rates of consistency between the model diagnosis of disease location and pattern differentiation made by TCM physicians were 71.6%, 88%, and 77% for kidney, liver and spleen, respectively. TCM diagnosis of the pattern element of disease nature (i.e. qi deficiency, qi stagnation, and phlegm-damp) could be made when just two symptoms in one category in the model manifest themselves (i.e. mental fatigue, lack of strength, and spontaneous sweating for qi deficiency; chest tightness, chest and rib-side distending pain, and distending pain of the breasts for qi stagnation; and somnolence, heaviness sensation in the head or dizziness as if the head is wrapped up, and expectoration of phlegm for phlegm-damp, respectively). The rates of consistency between the model diagnosis of disease nature and pattern differentiation made by TCM physicians were 86.3%, 83.2%, and 80.5% for qi deficiency, qi stagnation, and phlegm-damp, respectively. Conclusion The preliminary diagnostic criteria for PCOS based on pattern elements have been set. After meeting basic diagnostic criteria for PCOS, disease locations such as kidney, liver, and spleen can be diagnosed based on just one symptom in the model, and disease nature like qi deficiency, qi stagnation, and phlegm-damp can be diagnosed based on just two symptoms in one category in the model.

Key words: polycystic ovary syndrome, pattern elements, cross-sectional study, latent variable analysis, structural equation modelling

中图分类号: 

  • R271.1