原发性失眠症中医证候群筛选的研究

刘东生等

[摘要] 目的 探讨原发性失眠症的中医证候群特点，分析其诊断要点。 方法 通过收集原发性失眠患者的四诊信息，采用系统聚类分析的方法归纳出原发性失眠的中医证候群，从而确定原发性失眠的证候诊断要点。 结果 原发性失眠的中医证候分布特点主要包括4个证型：肝郁脾虚、阴虚火旺、痰热扰心、心虚胆怯，其中肝郁脾虚为主要类型。 结论 筛选证候标准与专家诊断结果一致性较好，老年患者以肝郁脾虚证型为主，而年轻患者则以阴虚火旺、痰热扰心型为主。

[关键词] 原发性失眠；中医证候；聚类分析；诊断标准

[中图分类号] R256.23 [文献标识码] A [文章编号] 1674-4721（2015）02（a）-0102-04

Study on syndrone screening of syndrome of traditional Chinese medicine about primary insomnia

LIU Dong-sheng LIAN Xin-fu YUAN Shao-ying ZHANG Xian-wei CHEN Xin HUANG Xiao-feng

Department of the Fifth Medicine，Zhuhai Hospital of Guangdong Province Traditional Chinese Medical Hospital，Zhuhai 519015，China

[Abstract] Objective To study the characteristics of syndrome of traditional Chinese medicine about primary insomnia，and analyze the main points of diagnosis. Methods The four diagnostic information in patients with primary insomnia was collected and summarized the primary insomnia in traditional Chinese medicine syndrome by the method of system clustering analysis，in oeder to determine the syndrome diagnosis of primary insomnia. Results The distribution of traditional Chinese medicine syndromes of primary insomnia mainly included 4 types of syndrome：liver stagnation and spleen deficiency，hyperactivity of fire due to Yin deficiency，phlegm heat disturbance of the heart， afraid cowardice，which is the main type of liver stagnation and spleen deficiency. Conclusion Syndrome screening criteria and expert diagnosis has better consistency.Liver stagnation and spleen deficiency syndromes is the main syndromes in elderly patients， hyperactivity of fire due to Yin deficiency syndromes is the main syndromes in young patients.

[Key words] Primary insomnia；Syndrome of traditional Chinese medicine；Cluster analysis；Diagnostic criteria

失眠症是指睡眠的始发和睡眠维持发生障碍，致使睡眠质量不能满足个体需要而明显影响患者白天活动的一种睡眠障碍。失眠症的诊断目前应用较多的是国际疾病分类第10版（ICD-10）中的定义，其诊断要点包括以下3点：入睡困难；持续睡眠障碍或睡眠后没有恢复感，导致明显的不适或影响了日常生活；每周3次或以上并持续至少1个月。其中由各种疾病或使用药物等因素引起的失眠归类为继发性失眠；无明确诱因者归类为原发性失眠症。中医学将该病归属于“目不瞑”“不得眠”“不寐”等范畴。本研究主要采用系统聚类分析的方法，对诊断为原发性失眠症患者证候进行聚类分析，筛选其中证候特点，研究其证候分布，进而研究确定其证型辨证的客观指标、依据。

1 资料与方法

1.1 一般资料