进展期胃癌患者脾虚证等级的计量诊断研究

目的:研究进展期胃癌脾虚程度不同时,临床症征和血液指标之间的相关性,对建立脾虚证计量诊断方法进行探索。方法:采用中医症状积分法进行脾虚证等级分组,方差分析比较各组血液指标的差别,运用多类判别分析法建立进展期胃癌脾虚证等级判别函数。结果:289例患者中非脾虚证组99例,脾虚证组190例,其中轻度脾虚组120例,中度脾虚组70例,29项血液指标中有19项存在显著性差异,经过判别筛选,神疲乏力、食欲减退、食后腹胀、消瘦、水肿和白细胞数、血清白蛋白、碱性磷酸酶、IgG、α1球蛋白10个参数获选,由此建立进展期胃癌脾虚证等级判别函数式,对289份病例进行回代判别,有23例判错,总回代符合率达到92.0%,具有较为满意的判别效果。结论:应用中医症征和血液指标相结合的计量分析方法,具有判断中医证候等级程度的临床意义,为进展期胃癌脾虚证的计量诊断提供客观依据。

Study on Measurable Diagnosis of Grades of Spleen -deficiency Syndrome in Patients with Advanced Gastric Cancer

Objective: To study the correlation between symptoms of spleen-deficiency syndrome and blood examinations of advanced gastric cancer,and to explore the method of the measurable diagnosis on spleen-deficiency syndrome.Method:To divide patients into deferent spleen-deficiency degrees with integration method.To compare the blood examinations' results differences with variance analysis,and to establish the judgment formulas by Fisher discrimination analyses.Results:289 patients were divided into three groups,non-spleen-deficiency group(n=99),light-spleen-deficiency group(n=120) and medium-spleen-deficiency group(n=70).19 items of all the examinations were showed the significance difference among the three groups.The values of most of the parameters analyzed increased in accordance with Spleen-asthenia syndrome degree,among these parameters,weary,anorexia,abdominal-flatulence,marasmus, edema,leukocyte,serum albumin,AKP IgG and α_(1)globulin were demonstrated to be relatively valuable indices.Then a diagnosis discrimination model was set up,and samples rechecked by the model showed a concordance rate of 92%.Conclusion: The quantitative evaluation of symptoms and examinations of advanced gastric cancer can provide reproducible data for differential diagnosis of the Grade of TCM syndrome.The discrimination model established here may be of measurable diagnostic value.