结构方程模型在慢性萎缩性胃炎中医证候分型中应用

目的分析结构方程模型有别于传统的因子分析的特点,利用结构方程模型探讨西医病名慢性萎缩性胃炎的中医证候分型规律及其可行性。方法采用临床流行病学/DME的方法采集慢性萎缩性胃炎病人的中医宏观四诊信息和胃镜病理特征资料,根据病例特征的多维指标和中医先验理论建立合适的结构方程模型,并拟合模型,考核其合理性。结果运用专业的先验经验模型和模式修正指标确定最终专业模型,模型主要适配考核指标合理,模型可接受;202个慢性萎缩性胃炎病例的22个辨证相关指标,抽取了四个潜在因变量,分别对应于中医的四个常见证型:脾胃湿热证、肝胃不和证、脾胃虚弱证和胃阴不足证,并与相应显性症状相关,四个潜在因变量都受一个潜在自变量影响,而潜在自变量反应了慢性萎缩性胃炎的共有性质。结论慢性萎缩性胃炎最常见的中医证型有四个,并分别与相应症状相联系,其联系的强弱有差别;疾病的共有症状主要为胃脘痛和纳差,基本符合中医临床实际;结构方程模型分析表明,该方法用于解释特定疾病下的中医证的存在和测量方法是可行的。

The Applicability of Structural Equation Model in Syndrome Classification for Chronic Atrophic Gastritis

Objective The advantage of SEM had been revealed compared by traditional factor analysis.The regularity of syndrome classification for chronic atrophic gastritis(CAG)had been discussed by SEM and feasibility of SEM in CAG had been showed.Methods Epidemiological method was adopted to collect the information of the CAG patients based on the four diagnostic method and data of the pathological features of the disease based on gastroscope examination.Structural equation models were built by means of multidimensional indexes of disease feature and apriorism.Results The final professional model which was accepted and reasonable on fitting index was conformed by professional and prior experience model and model modification indices.Among the 22 indexes of syndrome differentiantion,4 potential dependent variables were extracted,Corresponding respectively to the four common syndromes:damp heat of the spleen and stomach,incoordination between the liver and stomach,deficiency of th spleen and stomach and deficiency of stomach yin,which were respectively correlated to the information of dominant four diagnostic methods.Each of the four dependent variables was affected by a potential independent variable,which reflected the common property of CAG.Conclusion There are four most common CAG syndromes correlated to the corresponding syndrome differentiation indexes,with differences in the intensity of their correlation.In the study,the common symptoms are epigastric pain and poor appetite,which conforms to the reality of TCM syndromes of specific diseases and the method of their measurement.