本文選題：脾虛證 + 唾液淀粉酶活性比值��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:在以往脾虛證計(jì)量化診斷和微觀辨證研究的基礎(chǔ)上,將脾虛患者通過"脾虛證診斷計(jì)分表"得到的診斷分值、"脾虛證四診資料登記表"積分值與"唾液淀粉酶活性比值(salivaryalpha-amylase,sAA)"及"尿木糖排泄率"兩個(gè)脾虛證經(jīng)典微觀指標(biāo)進(jìn)行相關(guān)分析,將脾虛證主要的癥狀與經(jīng)典微觀指標(biāo)進(jìn)行多元線性回歸分析,得出特定的癥候組合,以探討脾虛證主客觀指標(biāo)之間的關(guān)系,以促進(jìn)宏觀辨證與微觀辨證的結(jié)合。方法:一、文獻(xiàn)研究:通過查閱、分析整理資料,對(duì)"唾液淀粉酶活性比值"及"尿木糖排泄率"與脾虛證之間的既往研究資料進(jìn)行整理。二、臨床試驗(yàn)研究:(一)本研究病例來自于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院脾胃病科門診及住院部就診的患有慢性淺表性胃炎(chronic superficial gastritis,CSG)且中醫(yī)辨證為脾虛證的患者。(二)制定"脾虛四診資料的登記表",仔細(xì)記錄納入研究患者的癥狀以及體征,并根據(jù)"脾虛證診斷計(jì)分表"對(duì)其進(jìn)行量化評(píng)分。(三)對(duì)納入研究的脾虛患者進(jìn)行唾液、尿液樣本的采集,并及時(shí)按照實(shí)驗(yàn)步驟及方法進(jìn)行"唾液淀粉酶活性比值"及"尿木糖排泄率"的檢測(cè)工作。(四)用IBM SPSS Statistics Version 19.0統(tǒng)計(jì)軟件對(duì)收集的臨床、實(shí)驗(yàn)室數(shù)據(jù)進(jìn)行分析處理。對(duì)年齡比較采用單因素方差分析,性別比較采用卡方檢驗(yàn)。對(duì)脾虛證主要癥狀進(jìn)行聚類分析,將一組數(shù)據(jù)按照本身的內(nèi)在規(guī)律較合理的分為幾類,使數(shù)據(jù)分析結(jié)果更具客觀性;將脾虛證診斷計(jì)分值及四診資料積分結(jié)合兩個(gè)經(jīng)典微觀指標(biāo)進(jìn)行相關(guān)分析,求出相關(guān)系數(shù),以表現(xiàn)變量之間數(shù)量變化的相關(guān)程度;對(duì)脾虛證主要癥狀結(jié)合兩個(gè)經(jīng)典微觀指標(biāo)進(jìn)行多元逐步回歸分析,由多個(gè)自變量的最優(yōu)組合共同來預(yù)測(cè)或估計(jì)因變量,求出回歸系數(shù)及回歸方程,并進(jìn)行相關(guān)系數(shù)的顯著性檢驗(yàn)。結(jié)果:一、聚類分析結(jié)果:"脾虛四診資料的登記表"的癥狀組合中:形寒肢冷、食欲減退、大便稀爛、胃痛、肢體倦怠、脘脹這八個(gè)癥狀可聚為一類,性質(zhì)比較接近,而噯氣、泛酸、口干口苦、痛連兩脅這四個(gè)癥狀未能與上述典型脾虛表現(xiàn)聚成一類,考慮不同的虛實(shí)證候,其內(nèi)在規(guī)律的不同而不能聚成一類。二、相關(guān)分析結(jié)果:sAA活性比值與尿木糖排泄率呈正相關(guān),有統(tǒng)計(jì)學(xué)差異;脾虛診斷計(jì)分與四診資料積分呈顯著正相關(guān),有統(tǒng)計(jì)學(xué)差異;兩個(gè)微觀指標(biāo)與脾虛證診斷計(jì)分值有一定的線性關(guān)系,但無(wú)統(tǒng)計(jì)學(xué)差異;兩個(gè)微觀指標(biāo)與四診資料積分均呈負(fù)相關(guān),有統(tǒng)計(jì)學(xué)差異。體現(xiàn)兩個(gè)經(jīng)典的微觀指標(biāo)在脾虛證的診斷及對(duì)病情的評(píng)估上有一定的臨床意義。三、多元逐步回歸結(jié)果:脾虛患者sAA活性比值與脾虛主要癥狀中的脘脹、肢體倦怠、食欲減退關(guān)系較為密切,呈負(fù)相關(guān),提示隨sAA活性比值下降,脾虛患者更容易出現(xiàn)脘脹、肢體倦怠、食欲減退的癥狀;脾虛患者尿木糖排泄率與脾虛主要癥狀中的噯氣、食欲減退、腹痛綿綿關(guān)系較為密切,呈負(fù)相關(guān),提示隨木糖排泄率下降,提示脾虛患者更容易出現(xiàn)噯氣、食欲減退、腹痛綿綿的癥狀。結(jié)論:一、聚類分析結(jié)果顯示:脾虛患者中肢體倦怠、大便稀爛、惡心、形寒肢冷、食欲減退、胃痛、脘脹這八個(gè)癥狀可聚為一類,均為脾虛失運(yùn),脾陽(yáng)不足的體現(xiàn),而噯氣、泛酸、口干口苦、痛連兩脅這四個(gè)癥狀未能與前面癥狀聚成一類,且均為肝胃不和之體現(xiàn),提示脾虛患者中,不同的虛實(shí)證候表現(xiàn)不能聚成一類。二、相關(guān)分析結(jié)果顯示:(一)sAA活性比值與尿木糖排泄率呈正相關(guān),說明大部分脾虛患者,sAA活性比值與尿木糖排泄率均有不同程度的下降,符合既往研究結(jié)果,提示脾虛患者的兩個(gè)微觀指標(biāo)存在一定的內(nèi)在聯(lián)系;(二)脾虛診斷計(jì)分值與四診資料積分呈顯著正相關(guān),說明該表對(duì)脾虛證的診斷有較高的準(zhǔn)確性、敏感性、特異性之余,其分值對(duì)臨床患者病情的評(píng)估有一定的借鑒意義,同時(shí)提示該表選定的脾虛癥狀指標(biāo)較為典型;(三)sAA活性比值、尿木糖排泄率兩個(gè)微觀指標(biāo)與脾虛證診斷計(jì)分值有一定的線性關(guān)系,但無(wú)統(tǒng)計(jì)學(xué)差異;(四)sAA活性比值、尿木糖排泄率兩個(gè)微觀指標(biāo)與四診資料積分均呈負(fù)相關(guān),有統(tǒng)計(jì)學(xué)差異,提示隨著兩個(gè)微觀指標(biāo)的下降,患者癥狀積分增高,脾虛的程度逐步加重,可初步窺探出兩個(gè)微觀指標(biāo)在脾虛患者中的診斷意義及等級(jí)相關(guān)關(guān)系,也反映了脾虛患者脾胃虛損的一面。三、多元逐步回歸結(jié)果顯示:(一)脾虛患者sAA活性比值與脾虛主要癥狀中的脘脹、肢體倦怠、食欲減退關(guān)系較為密切,呈負(fù)相關(guān),提示脘脹、肢體倦怠同時(shí)出現(xiàn)時(shí),更能反映sAA活性比值的變化,即sAA比值越小,脾虛患者越容易表現(xiàn)出脘脹、肢體倦怠、食欲減退的癥狀。(二)脾虛患者尿木糖排泄率與脾虛主要癥狀中的噯氣、食欲減退、腹痛綿綿關(guān)系較為密切,均呈負(fù)相關(guān),提示尿木糖排泄率越低,脾虛患者越容易出現(xiàn)噯氣、食欲減退、腹痛綿綿的癥狀。考慮無(wú)論是副交感神經(jīng)的偏亢致使脾虛患者應(yīng)急能力低下,還是因患者小腸吸收能力低下,在廣泛的脾虛范疇中,均可致脾運(yùn)化失職的諸多表現(xiàn)。
[Abstract]:Objective: on the basis of quantitative diagnosis and microscopic syndrome differentiation of spleen deficiency syndrome, the diagnosis score of spleen asthenia patients through the "score table of spleen deficiency syndrome diagnosis", "salivaryalpha-amylase, sAA" and "urine sugar excretion rate" are the two classic microscopic indexes of spleen deficiency syndrome The main symptoms of spleen deficiency syndrome and the classic microscopic index were analyzed by multiple linear regression analysis to obtain the specific syndrome combination to explore the relationship between the subjective and objective indexes of the spleen deficiency syndrome, and to promote the combination of the macroscopic syndrome differentiation and the microscopic syndrome differentiation. Sex ratio "and" and "urine sugar excretion rate" between the previous study of the spleen deficiency syndrome. Two, clinical trial study: (1) the case from the First Affiliated Hospital of the Guangzhou University of Chinese Medicine, the spleen and stomach department outpatient and inpatient department of the patients with chronic superficial gastritis (chronic superficial gastritis, CSG) and the TCM syndrome differentiation of the spleen Patients with deficiency syndrome. (two) establish a "Registration Form for the four diagnosis of spleen deficiency syndrome", carefully record the symptoms and signs of the patients studied, and carry out quantitative score according to the "spleen deficiency syndrome diagnosis score scale". (three) take saliva and urine samples for the spleen asthenia patients in the study, and carry out "saliva starch" in time according to the experimental procedures and methods. Enzyme activity ratio "and" urine sugar excretion rate "detection work. (four) use IBM SPSS Statistics Version 19 statistical software to analyze the collected clinical data and laboratory data. The age comparison of single factor analysis of variance, sex comparison with chi square test. The main symptoms of spleen deficiency syndrome were cluster analysis, a group of data according to the data The inherent laws of the system are divided into several kinds, which make the result of data analysis more objectivity, and combine the score of the spleen deficiency syndrome diagnosis and the four diagnosis data integral combined with two classical microscopic indexes to analyze the correlation coefficient to show the correlation degree between the variable number of variables, and to combine the main symptoms of the spleen deficiency syndrome with two classical microscopes. Multiple stepwise regression analysis was carried out. The regression coefficient and regression equation were obtained from the optimal combination of multiple independent variables. The regression coefficient and regression equation were obtained and the correlation coefficient was tested. The eight symptoms of pain, body tiredness and distention can be grouped into one class, and the properties are close, and the four symptoms of belching, pantothenic acid, dry mouth, pain and two flank can not come together with the typical spleen deficiency, considering the different syndromes of deficiency and reality, and their internal rules can not be grouped into a class. Two, the correlation analysis results: sAA activity ratio and urine wood There was a positive correlation between the sugar excretion rate and the statistical difference. There was a significant positive correlation between the diagnosis score of spleen deficiency and the data integral of four diagnosis. There was a linear relationship between the two micro indexes and the score value of the spleen deficiency syndrome diagnosis, but there was no statistical difference. The two micro indexes were negatively correlated with the four diagnosis material integral, and there were two statistical differences. The classical microcosmic index has certain clinical significance in the diagnosis of spleen deficiency syndrome and the evaluation of the disease. Three, multiple stepwise regression results: the ratio of sAA activity to spleen asthenia is more closely related to the main symptoms of spleen deficiency, the relationship between the body burnout and anorexia is more closely related, the ratio of the sAA activity decreases, and the spleen asthenia is more likely to appear in the stomach. The symptoms of swelling, burnout and loss of appetite; the urine sugar excretion rate of the spleen asthenia and the main symptoms of spleen asthenia in the main symptoms of belching, anorexia and abdominal pain are more closely related, showing a negative correlation with the decrease of the excretion rate of xylose, suggesting that the patients with spleen deficiency are more likely to appear belching, anorexia and abdominal pain. In the patients with spleen deficiency, the eight symptoms of body burnout, stool, nausea, cold limb cold, anorexia, stomachache and distention can be gathered into one class, which are the embodiment of spleen deficiency and spleen yang deficiency, and the four symptoms of belching, pantothenic acid, dry mouth and two flank symptoms fail to come together with the front symptoms, and all are the manifestation of liver stomach disharmony, suggesting spleen asthenia. In the patients, the symptoms of different deficiency and solid syndromes could not be gathered into a class. Two, the results of correlation analysis showed that (1) the ratio of sAA activity was positively correlated with the excretion rate of urine xylose, indicating that the ratio of sAA activity and urinary xylose excretion rate decreased in most of the spleen asthenia patients, which accords with previous research results, suggesting that the two microscopic indexes of spleen asthenia are stored. (two) there is a significant positive correlation between the score of the spleen deficiency diagnosis and the integration of the four diagnosis data, which indicates that the table has a high accuracy, sensitivity and specificity for the diagnosis of spleen deficiency syndrome, and the score has certain reference significance for the evaluation of the clinical patient's condition. (three) the index of spleen deficiency symptoms selected in the table is more typical. There was a linear relationship between the sAA activity ratio and the two microcosmic indexes of urine xylose excretion rate and the score of the spleen deficiency syndrome diagnosis, but there was no statistical difference. (four) the ratio of sAA activity, the two microscopic indexes of urine xylose excretion rate were negatively correlated with the four diagnosis data integral, and there were statistical differences, suggesting that with the decrease of the two microscopic indexes, the symptom integral of the patients was marked. The degree of spleen deficiency increased gradually, and the diagnostic significance and grade correlation of the two microscopic indexes in spleen asthenia were detected, and the deficiency of spleen and stomach in spleen asthenia patients was also reflected. Three, multiple stepwise regression results showed: (1) sAA activity ratio of spleen asthenia with spleen asthenia in the main symptoms of abdominal distention, body burnout, anorexia. The relationship is more close and negative correlation, suggesting that the abdominal distention, when the body burnout simultaneously appears, can reflect the change of the sAA activity ratio, that is, the smaller the ratio of sAA, the more easily the spleen asthenia patients show the symptoms of abdominal distention, burnout, and anorexia. (two) the urine sugar excretion rate of spleen deficiency patients and the main symptoms of spleen asthenia, anorexia and abdominal pain continuous pass. The lower the urinary xylose excretion rate, the lower the urine sugar excretion rate, the more easy the patients with spleen deficiency to appear belching, anorexia and abdominal pain. Considering whether the hyperactivity of the parasympathetic nerve causes the low emergency ability of the spleen asthenia, or the low intestinal absorption capacity of the patients, it can cause the loss of spleen in the spleen deficiency. Many performance of the job.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R241

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