支氣管哮喘患者中醫四診資訊調查及驗證性因子分析

【關鍵詞】 ,驗證性因子分析

［摘要］目的：收集支氣管哮喘患者中醫四診資訊，進行證候分類。方法：隨機調查430例支氣管哮喘患者，詳細記錄四診資訊，用Amos軟體建立資料模型，進行驗證性因子分析（confirmatory factor analysis, CFA）。結果：行四因子、五因子及六因子分析，其中六因子分析結果與臨床實際相一致。結論：按六因子分析結果排序，以標準迴歸係數0.4作為主次證界值，將支氣管哮喘分為寒飲伏肺證、痰熱蘊肺證、風痰阻肺證、肺腎氣虛證及脾氣不足證等5大類證候。

［關鍵詞］哮喘; 四診; 證候分類; 驗證性因子分析

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

支氣管哮喘是呼吸系統的常見病、多發病，屬於中醫學“哮證”、“哮病”等範疇。目前該病的中醫辨證分型主要有國家頒佈標準，中醫教材分型標準，專著分型標準及各地各家的經驗分型等［1］，傳統的四診合參仍是主要的分型手段。這些分型方法大多為經驗性總結，定性成分較多，缺乏規範的定量標準，因而不利於總結臨床療效及推廣治療經驗，更不利於新藥的研製與開發［2］。本研究按流行病學設計方法，隨機調查430例支氣管哮喘患者，收集中醫四診資訊，進行驗證性因子分析（confirmatory factor analysis, CFA），給每項辨證結果賦以分值，得出哮喘量化的辨證標準，現將結果報道如下。

1資料與方法

1.1臨床資料 江蘇省中醫院、興化市中醫院、常州市中醫院呼吸科住院或門診患者，符合支氣管哮喘的`診斷標準［3,4］，共430例。其中男207例，女223例；平均年齡(45.92±14.07)歲；平均病程(11.14±10.75)年；其中處於發作期的患者304例，緩解期患者126例。

1.2調查方法 按統一的現場調查表格進行病例收集，按住院或門診順序隨機收取。中醫四診資訊的收集採用中醫望、聞、問、切的方法，按無、輕、中、重四級，分別賦予分值，即無：0分；輕：1分；中：2分；重：3分。每例患者均由1名高年資住院醫師或主治醫師詳細客觀地記錄其一般情況及四診資訊，然後由1名主治醫師或上級醫師稽核。