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1、中国中西医结合杂志2009年11月第29卷第11期CJITWM,November2009,Vol.29,No.11·993·慢性乙型肝炎患者肝胆湿热证和肝郁脾虚证的决策树诊断模型初探11212李梢张宁波李志红丁皓叶永安摘要目的建立基于临床数据的慢性乙肝患者典型证候的诊断模型,探索与慢性乙肝典型证候相关的症状、体征和实验室指标组合。方法对1004例慢性乙肝患者进行证候学调查和实验室检测,包括88项症状、舌脉象、20项体征和14项实验室指标。然后选取典型证候的临床数据,联合采用Logistic回归、决策树、贝叶斯网络方法进行数据分析,构建能够有效区分
2、不同证候的诊断模型。结果1004例慢性乙肝患者中最为典型的证候为肝胆湿热证(340例,占33186%)与肝郁脾虚证(366例,占36145%)。首先采用Logistic回归分析得到具有统计学意义的16项症状与体征及3项实验室指标,然后采用决策树方法构建能够区分肝胆湿热证、肝郁脾虚证的诊断模型(辨证诊断准确率=74136%),发现苔白、淡红舌、巩膜黄染、两目干涩、丙氨酸转氨酶(ALT)和HBeAg是鉴别两证型的有效指标组合。采用贝叶斯网络分析的结果也验证了上述指标的重要性。结论本文建立了一种能够有效判别慢性乙肝患者肝胆湿热证、肝郁脾虚证的决策树诊断
3、模型,为将基于经验的中医辨证转向基于数据模型的辨证提供了方法,有助于促进证候的客观化诊断。关键词慢性乙型肝炎;决策树;诊断模型;中医证候DecisionTreeDiagnosticModelofGan2danDamp2heatSyndromeandGan2stangnancyPi2deficiencySyndromeinPatientswithChronicHepatitisBLIShao,ZHANGNing2bo,LIZhi2hong,etalDepartmentofAu2tomation,TsinghuaUniversity,Beijing(
4、100084)ABSTRACTObjectiveToestablishaclinicaldatabasedpracticaldiagnosticmodelforChinesemedicinesyndromedifferentiationinpatientswithchronichepatitisB(CHB),bywayofseekingacombinationofsymp2toms,signsandlaboratorycriteriaassociatedwiththetypicalsyndromesofthedisease.MethodsAsyn
5、droma2tologicandlaboratoryinvestigationon88symptoms,20signs,and14laboratoryindexes,wasconductedin1004CHBpatients.TheclinicaldataoftypicalsyndromeswereselectedandanalyzedusingLogisticregressionanalysis,decisiontreeandBayesiannetworkanalysisincombinationtoestablishadiagnosticmo
6、delforeffective2lyidentifyingthetypicalsyndromesinCHB.ResultsThemosttypicalsyndromesrevealedinthe1004CHBpa2tientsweretheGan2dandamp2heatsyndrome(340patients,accountingfor33186%)andtheGan2stagnancywithPi2deficiencysyndrome(366patients,36145%).Basedontheclinicaldatafrompatients
7、withthetwosyn2dromes,16symptoms/signsand3laboratoryindicators,providedwithstatisticalsignificance,wereselectedu2singLogisticregressionanalysis.Then,adiagnosticmodelfordifferentialthetwosyndromes,whichwasprovedtohaveanaccuratediagnosicrateof74136%,wasformedbydecisiontreemethod
8、.Itwasfoundthatwhitetonguecoating,lightredtongue,yellowsclera,eyedry
