基于因子分析与聚类分析的室性早搏证候要素与中医证候特点研究

[目的]探究室性早搏的中医证候要素及分型规律,旨在为临床早期干预室性早搏辨证论治提供参考。[方法] 2018年12月至2022年12月在天津中医药大学第一附属医院等43家医院就诊的室性早搏患者为研究对象,采用“中医证候”“舌象观察表”进行中医临床信息采集,借助SPSS Statistics对临床信息进行因子分析,进而借助SPSS Statistics对提取的公因子进行系统聚类分析,经相关专家评判并结合中医证素分析室性早搏的中医证素规律及其证型分布特点。[结果]本研究共纳入669例患者,采集获得19个临床症状及15个舌象信息,其中常见的临床症状为心悸、胸闷、急躁易怒、失眠、口干等症状;最常见的舌色为舌淡(47.23%);最常见的苔色为苔白(73.09%);最常见的苔质为苔腻(45.59%)。对34个因素进行因子分析,获得12个公因子,室性早搏患者最主要证候要素为火(热),其余依次为阳虚、痰、血虚、水饮、血瘀、气虚、阴虚;病位主要为心,其次为脾、肝、肾、肺。系统聚类分析结果显示,室性早搏的常见证型为痰火扰心证、心脾两虚证、瘀阻心脉证、心阳不振证、阴虚火旺证。[结论]室性早搏中医证候要素以火(热)为主,痰火扰心可能是室性早搏的重要病理因素。

Research on the syndrome elements of premature ventricular contractions and the characteristics of Chinese medicine symptoms based on factor analysis and cluster analysis

[Objective] To explore the elements of traditional Chinese medicine(TCM) syndromes and typing pattern of ventricular premature contraction,aiming to provide reference for clinical early intervention in the identification and the treatment of ventricular premature contraction. [Methods] Patients with ventricular premature contractions who attended 43 hospitals including First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from December 2018 to December 2022 were used for the study,and the clinical information was collected using “TCM syndromes” and “tongue questionnaire”. The common factors were extracted by factor analysis with the help of SPSS statistics,and then the common factors were analyzed by systematic clustering with the help of SPSS statistics. [Results] A total of 669 patients were included in this study,and 19 clinical symptoms and 15 tongue information were collected. The common clinical symptoms were palpitations,chest tightness,impatience and irritability,insomnia,and dry mouth;the most common tongue color was pale tongue(47.23%);the most common moss color was white moss(73.09%);and the most common moss texture was greasy moss(45.59%). Factor analysis was performed on 34 factors,and 12 common factors were obtained. The most predominant syndromes element of ventricular premature contraction was fire(heat),followed by yang deficiency,phlegm,blood deficiency,fluid rheum,blood stasis,qi deficiency,and yin deficiency. The disease location was mainly heart,followed by spleen,liver,kidney,and lung. The results of systematic cluster analysis showed that the common types of ventricular premature contractions were phlegm and fire disturbing the heart,deficiency of both heart and spleen,heart blood stasis obstruction,heart yang deficiency,and yin deficiency and fire hyperactivity. [Conclusion] The TCM syndromes elements of ventricular premature contraction are dominated by fire(heat),and phlegm and fire disturbing the heart may be an important pathological factor of ventricular premature contraction.