支气管哮喘患者中医四诊信息调查及验证性因子分析

【关键词】 ,验证性因子分析

［摘要］目的：收集支气管哮喘患者中医四诊信息，进行证候分类。方法：随机调查430例支气管哮喘患者，详细记录四诊信息，用Amos软件建立数据模型，进行验证性因子分析（confirmatory factor analysis, CFA）。结果：行四因子、五因子及六因子分析，其中六因子分析结果与临床实际相一致。结论：按六因子分析结果排序，以标准回归系数0.4作为主次证界值，将支气管哮喘分为寒饮伏肺证、痰热蕴肺证、风痰阻肺证、肺肾气虚证及脾气不足证等5大类证候。

　　［关键词］哮喘; 四诊; 证候分类; 验证性因子分析

　　Investigation and confirmatory factor analysis of information collected with the four diagnostic methods in patients with bronchial asthma

　　　ABSTRACT Objective: To investigate the information acquired through the four diagnostic methods of traditional Chinese medicine in patients with bronchial asthma, and to classify the syndrome types. Methods: Four hundred and thirty patients with bronchial asthma were randomly investigated. The information acquired through the four diagnostic methods was recorded and the database was established by Amos software, and then the data were analyzed by confirmatory factor analysis (CFA). Results: After analyzing the data with 4 factors, 5 factors and 6 factors, we found that the results of CFA with 6 factors were in accordance with clinical practical experience. Conclusion: According to the results of CFA with 6 factors and with the standard regression coefficient 0.4 as primary and secondary critical points, the syndromes in patients with bronchial asthma can be classified into 5 types, which are syndromes of cold fluid retained in lung, phlegmheat obstructing lung, windphlegm blocking lung, qi deficiency of lung and kidney and qi deficiency of spleen.

　　KEY WORDS asthma; four diagnostic methods; symptom complex; confirmatory factor analysis

　　支气管哮喘是呼吸系统的常见病、多发病，属于中医学“哮证”、“哮病”等范畴。目前该病的中医辨证分型主要有国家颁布标准，中医教材分型标准，专著分型标准及各地各家的经验分型等［1］，传统的四诊合参仍是主要的分型手段。这些分型方法大多为经验性总结，定性成分较多，缺乏规范的定量标准，因而不利于总结临床疗效及推广治疗经验，更不利于新药的研制与开发［2］。本研究按流行病学设计方法，随机调查430例支气管哮喘患者，收集中医四诊信息，进行验证性因子分析（confirmatory factor analysis, CFA），给每项辨证结果赋以分值，得出哮喘量化的辨证标准，现将结果报道如下。

　　1资料与方法

　　1.1临床资料 江苏省中医院、兴化市中医院、常州市中医院呼吸科住院或门诊患者，符合支气管哮喘的`诊断标准［3,4］，共430例。其中男207例，女223例；平均年龄(45.92±14.07)岁；平均病程(11.14±10.75)年；其中处于发作期的患者304例，缓解期患者126例。

　　1.2调查方法 按统一的现场调查表格进行病例收集，按住院或门诊顺序随机收取。中医四诊信息的收集采用中医望、闻、问、切的方法，按无、轻、中、重四级，分别赋予分值，即无：0分；轻：1分；中：2分；重：3分。每例患者均由1名高年资住院医师或主治医师详细客观地记录其一般情况及四诊信息，然后由1名主治医师或上级医师审核。