基于潜类别结构方程及灰色马尔可夫模型的寻常型银屑病的证候演变及预测的研究

Psoriasis vulgaris (PV) is a chronic inflammatory skin disease and manifests erythematic scaly. It is above ninety five percent among the four types psoriasis. There are approximately a number of Zheng reported in psoriatic patients in traditional Chinese medicine (TCM). Systematic data collection and proper analysis for the classification of psoriasis vulgaris has been lacking at present. It is unclear about the evolution between the Zhengs and transition among the Zhengs. Therefore, to explore the correlation between the Zhengs according to systematic data collection of psoriasis vulgaris classification for standardization and regulation of Zheng . The transition of Zheng status is related with effect and prognosis in traditional Chinese medicine, and it is the core of prevention theory in TCM. This study aims are: 1. To explore the classification and correlation of Zhengs of psoriasis vulgaris based on systematic data collection. Firstly, systematic literature review, and applying Delphi method will be to get the psoriasis experts’ agreement. The symptoms and sings of patients with psoriasis vulgaris is investigated. To obtain the objective Zheng classification according to latent class analysis, and latent class constructure equation model is applied to detect the correlation and regulation among the Zhengs further study. 2. To predict the transition of Zheng status and different stages of psoriatic patients which applying gray- markov forecasting model. This study provides the medicine-based evidence of treatment and prevention which reveals the relationship within multi-dimensional evolution in Zhengs and detect the transition status.

寻常型银屑病是一种慢性炎症性红斑鳞屑类皮肤病，在银屑病分型中占95%以上。目前中医寻常型银屑病的证候缺乏系统的数据收集，还存在较多分型，且证候之间的演变关系及证候的状态转移关系尚不清楚。因此需要探讨通过寻常型银屑病的数据收集系统化达到证候规范化和标准化，从而揭示证候之间的相关关系。证候状态的转移关系中医治疗疗效及预后，也是中医预防理论的核心。本项目将：1.系统收集寻常型银屑病数据，系统文献回顾、从专家咨询开始到临床患者症状和体征调查，应用潜类别分析得出客观的证候分型，进一步做结构方程模型以获得证候间的演变关系及发展规律；2.应用灰色马尔可夫预测模型对寻常型银屑病证候及疾病分期进行预测。本研究将深入揭示寻常型银屑病证候间的多维变化及状态转移，提供寻常型银屑病中医提高治疗疗效和预防的证据。

项目背景：目前中医寻常型银屑病中医证候分型较多而复杂，多数是研究者们的经验及判断而来。中医寻常型银屑病的证候标准化研究需要系统的从文献到专家咨询研究，最终收集于患者症状和体征构成的数据和分析的研究，.主要研究内容：1.中医寻常型银屑病证候标准化的研究：系统化研究（1）寻常型银屑病中医症状和体征的文献定性加定性研究，使用cluster analysis 及频数分析等统计方法对40年的寻常型银屑病中医文献进行分析，得出96个症状和体征；（2）专家咨询法（Delphi study）将含有96个寻常型银屑病症状和体征的问卷以电子邮件的方式发送给全国来自上海、北京、黑龙江、四川、广东、云南省的30位皮肤科专家，通过三轮的专家咨询及数据分析，最终形成60项寻常型银屑病症状和体征的标准问卷用于临床寻常型银屑病患者的调查研究；（3）收集临床412例寻常型银屑病患者的中医症状和体征调查问卷，分别使用潜类别方程模型的代表方法factor analysis he latent analysis做寻常型银屑病的中医证候分型及演变，最终得出四个寻常型银屑病中医证候：湿热证、血热证及阴虚血燥证、血瘀证。2.对2007年-2018年的云南中医药大学第一附属医院皮肤科病房寻常型银屑病各证候进行统计分析，应用灰色马尔科夫模型对2019-2021年的皮肤科病房证候变化进行预测，2019年为湿热证、2020年为血热证，2021年为阴虚血燥证为主要收治证型。为中医寻常型银屑病疾病预防及控制提供循证学依据。