Study for Diagnosing Program of Korean Standard Differentiation of the Symptoms and Signs for the Stroke by Multi Center Trials-
Sae-wook Park, Byung-kab Kang, In-soo Jang
10, Seok Hong
9, Chang-ho Han
8, Jung-nam Kwon
7, Seung-ho Sun
6, Chan-yong Chen
5, Ki-ho Cho
4, Se-jin Park
3, In Lee
2, In-chan Seol
1, Sun-mi Choi
Department of Medical Research, Korea Institute of Oriental Medicine
1
Department of Internal Medicine, College of Oriental Medicine, Daejeon University
2
Department of Internal Medicine, College of Oriental Medicine, Wonkwang University
3
Department of Internal Medicine, Dong Seo Oriental Hospital
4
Department of Internal Medicine, College of Oriental Medicine, Kyung Hee University
5
Department of Internal Medicine, College of Oriental Medicine, Kyung Won University
6
Department of Internal Medicine, College of Oriental Medicine, Sang Ji University
7
Department of Internal Medicine, College of Oriental Medicine, Dong Eui University
8
Department of Internal Medicine, College of Oriental Medicine, Dong Guk University
9
Department of Internal Medicine, College of Oriental Medicine, Dong Shin University
10
Department of Internal Medicine, College of Oriental Medicine, Woo Suk University
Objectives : Standardization of pattern identification for stroke and development of a diagnostic tool for Korean medicine.
Methods : We organized a committee for stroke diagnosis standardization of Korean traditional medicine and submitted the Korean standard differentiation of the symptoms and signs for stroke (KSDSS). We collected cases through a multi-center network consisting of twelve university hospitals and one local hospital. We analyzed the data with discriminant function and logistic regression.
Results : 321 cases were confirmed by diagnosis of medical specialists and residents. They were divided into qi deficiency 30.84%, dampness & phlegm 25.55%, fire & heat 22.43%, eum deficiency 18.69% and blood stasis 2.49%.
The accordance rate between discriminant function and doctor's diagnosis was calculated.
Conclusions : To make a stroke diagnostic program, we must raise the accordance rate between doctor's diagnosis and the program.
Key Words : stroke, standardization, diagnosis, discriminant function.
박세욱, 강병갑, 장인수
10, 홍석
9, 한창호
8, 권정남
7, 선승호
6, 전찬용
5, 조기호
4, 박세진
3, 이인
2, 설인찬
1, 최선미
원 저
서 론
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)
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CRF CRF
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Operation Procedure: )
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연구방법
1.
대상
1)
1 2006 11
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2007 3 ·
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2007 7 502
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2.
한의중풍표준안에 의한 변증분형
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3) 4)
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2007 8 5 2007 8 7
2007 8 29
: , 461-24,
.
(Tel : 042-868-9485, Fax : 042-863-9464, E-mail : [email protected])
(M10527010000-05N2701-00000)
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Logistic (odds
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wsiness, like to lie( )
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결 과
1.
대상중풍환자들의 일반적인 변증 분포
2006 11 2007 7 502
432
321 .
30.84% 25.55%,
22.43%, 18.69%, 2.49%
.(Table 1.)
145 , 176 .
36.55% 26.9%,
22.76%, 11.72%, 3% ,
31.25%
26.14%, 24.43%, 15.34%, 2.84%
.
. (Table 2.) Pattern Identification
Total qi
Defficiency
Dampness&
Phlegm Blood Stasis eum
Defficiency Fire & Heat
N 99 82 8 60 72 321
% 30.84 25.55 2.49 18.69 22.43 100
Sex
Pattern Identification N (% in total/% in each row)
Total qi
Defficiency
Dampness&
Phlegm Blood Stasis eum
Defficiency Fire & Heat
Female 53 39 3 33 17 145
(16.51/36.55) (12.15/26.9) (0.93/2.07) (10.28/22.76) (5.3/11.72) (45.17/100)
Male 46 43 5 27 55 176
(14.33/26.14) (13.4/24.43) (1.56/2.84) (8.41/15.34) (17.13/31.25) (54.83/100)
2.
판별분석
.(Table 3, 4)
68.5% . (Table 4.)
Variables
Discriminant Coefficient qi
Defficiency
Dampness&
Phlegm
Blood Stasis
eum Defficiency
Fire &
Heat fidgeting due to deficiency and insomnia 0.68113 0.72739 1.67212 1.34667 1.29052
Red face 1.71939 1.50933 0.25127 2.20520 3.23854
Head fever 0.01797 0.50755 7.68055 -1.13523 -1.22577
Pink eye -0.78237 -0.46038 0.25625 -0.90262 0.76841
Dry eye 1.87151 0.91859 1.04052 1.79028 0.61256
Halitosis -0.41042 0.99458 0.51865 0.43243 1.18448
Bitter taste -1.12882 -1.00874 0.84424 -0.55690 -0.59599
Thirsty 0.55441 1.03238 2.02815 0.70242 0.56365
Red tongue 3.82145 4.75532 4.88737 4.80627 5.35276
Yello coated tongue 2.14981 2.26494 3.26204 1.64343 2.53750
Chest distress -1.02862 -1.20010 0.07481 -0.41543 -0.53261
Scanty urine 8.17530 7.22885 7.13440 7.51078 6.87242
Dark urine 1.08793 0.95771 0.72103 1.71813 1.06545
Constipation 0.03762 -0.39836 -0.57974 0.38730 0.44117
Surging and fast Pulse in radial A. 7.19207 8.50976 10.23353 8.50018 9.70013 Fever and aversion to heat during fever , 0.29450 0.77602 0.81038 0.13064 1.24808
Heating in hand and foot 1.52329 1.86249 0.92750 0.75368 0.85644
Yellowish complexion 1.03441 2.71542 1.56649 2.34887 1.86596
Heavy head 0.24361 -0.34749 -1.32252 0.15439 -0.70540
Headache with nausea -1.79108 -3.52250 -5.59630 -2.56205 -2.12282
Dizziness with nausea -0.27116 0.51041 -0.98060 -1.54571 0.74656
Wheezing in the throat with sputum 0.90891 1.66319 -0.36592 1.31966 -0.15709
White-coated tongue 3.59425 3.27316 4.02409 2.56798 2.78314
Thickly coated tongue -0.56530 -0.42782 -0.70943 -0.86465 -0.36343
Teeth printed tongue 3.18481 4.81178 3.88975 3.44065 3.79713
Swollen tongue -0.51354 0.23709 0.46616 -0.08223 -0.10628
Nausea 1.84048 2.00844 0.90537 2.15264 0.73610
Borborygmus -2.59011 -1.47026 -1.48588 -1.96632 -0.88125
Slippery pulse 9.35652 11.26693 12.04598 9.46745 9.35092
Drowsiness,like to lie 0.98767 1.18626 0.15894 1.04708 1.21299
Feel powerless & lazy 1.44742 1.28943 0.22310 1.49012 0.07787
Look powerless & lazy 2.04091 1.25171 0.83818 1.40729 1.55737
pale completion 6.22501 3.95522 4.87568 5.38135 4.11148
Reluctance to speak -0.11948 -0.39844 -0.34254 -0.45544 -0.39394
Slightly red tongue
White-coated tongue 5.67086 6.45409 6.13087 6.26420 6.00953
spontaneous sweating -0.13677 -0.06761 -0.58946 -0.05815 -0.28480
faint pulse 9.86619 9.22855 9.47904 8.68649 8.08842
deadly cold hands and feet 0.52143 0.82423 0.46551 0.50383 0.79567
Dark complexion 0.63328 0.54718 -2.12284 3.08975 1.70638
Dark inferior palpebra -0.30487 0.00527 0.75688 -0.29611 0.10440
Purpra in derma 0.16341 -0.44568 0.40134 0.78220 -0.49296
Purple lip 2.37487 2.32149 2.79816 2.05434 1.94764
Site-fixedheadache 1.05106 1.35256 0.63588 1.36838 1.44992
Pricking headache -0.33340 0.50306 -1.33229 -0.96418 -0.78412
Dry mouth 0.43116 0.12909 -0.58967 0.32872 0.53018
Purple & dark tongue 7.24269 10.71669 26.95385 8.70760 7.58717
Purpra in tongue 5.21604 3.63669 5.76320 3.13489 2.41870
Pricking chest pain 0.92542 0.22615 7.65840 -0.93928 0.74268
A pulse coming and going unsmoothly,
like scraping 12.64369 9.56598 29.24105 10.28999 10.81103
Pale face and red zygomaticsite Thirsty 2.29391 2.43288 3.27753 3.32581 2.68768
White mouth, thrush -0.84256 0.02271 -1.22225 -0.60103 0.59545
Dry tongue 1.51235 0.54905 -0.08330 1.86011 0.89060
Bare and red tongue like mirror 3.72370 2.74652 2.50959 4.95504 3.09735
Palpitation -0.58075 -0.47096 -2.37533 -0.79839 -1.08843
Cold sweating in sleeping -0.84386 -0.52005 -0.51553 -0.46785 -0.48595 Fine and fast pulse in radial A. 9.30090 8.46935 9.38980 10.28144 8.99542
Heating palmar & plantar 1.00503 0.66987 2.44428 1.52349 2.79793
Afternoon tidal heat 1.10821 0.47548 0.21558 0.93598 0.03536
. 4 94.2%
.(Table 5.)
4.
각 변증지표가 해당변증에서 차지하는 중요도
를 보기 위해 회귀분석을 하였다
. (Table 6~10.)고 찰
. Doctor's diagnosis*
Pattern Identification by discriminant N(%)
Total qi
Defficiency
Dampness&
Phlegm Blood Stasis eum
Defficiency Fire & Heat
qi Defficiency 72 8 2 13 4 99
(72.73) (8.08) (2.02) (13.13) (4.04) (100.00)
Dampness& Phlegm 10 59 2 5 6 82
(12.20) (71.95) (2.44) (6.10) (7.32) (100.00)
Blood Stasis 1 2 5 0 0 8
(12.50) (25.00) (62.50) (0.00) (0.00) (100.00)
eum Defficiency 7 12 1 34 6 60
(11.67) (20.00) (1.67) (56.67) (10.00) (100.00)
Fire & Heat 6 9 0 7 50 72
(8.33) (12.50) (0.00) (9.72) (69.44) (100.00)
Total 96 90 10 59 66 321
(29.91) (28.04) (3.12) (18.38) (20.56) (100.00)
Error rate 0.2727 0.2805 0.3750 0.4333 0.3056 0.3146
*United diagnosis by specialist & resedent
Doctor's diagnosis*
Pattern Identification by discriminant N (%)
Total qi Defficiency Dampness& Phlegm eum Defficiency Fire & Heat
qi Defficiency 84 7 3 5 99
(84.85) (7.07) (3.03) (5.05) (100.00)
Dampness&
Phlegm
0 81 0 1 82
(0.00) (98.78) (0.00) (1.22) (100.00)
eum Defficiency 0 0 60 0 60
(0.00) (0.00) (100.00) (0.00) (100.00)
Fire & Heat 0 1 1 70 72
(0.00) (1.39) (1.39) (97.22) (100.00)
Total 84 89 64 76 313
(26.84) (28.43) (20.45) (24.28) (100.00)
Error rate 0.1515 0.0122 0.0000 0.0278 0.0575
*United diagnosis by specialist & resedent
4)
.
qi Defficiency (0.2312)* Estimate Odds ratio L, U(95% C.L.)
Drowsiness,like to lie 0.076 1.079 0.697, 1.669
powerless & lazy 0.617 1.853 1.305, 2.632
pale completion 1.9712 7.179 3.369, 15.300
Reluctance to speak 0.2163 1.241 0.813, 1.897
Slightly red and
White-coated tongue 0.1078 1.114 0.689, 1.801
White-coated tongue 0.2374 1.268 0.786, 2.046
Teeth printed tongue -0.1716 0.842 0.395, 1.794
spontaneous sweating -0.2818 0.754 0.509, 1.119
faint pulse 1.2616 3.531 1.956, 6.373
deadly cold hands and feet -0.1021 0.903 0.453, 1.800
* : R square
: Lower limit, Upper limit(95% Confidence Limits) : significant in statistics
Dampness& Phlegm (0.1941)* Estimate Odds ratio L, U(95% C.L.)
Yellowish complexion 1.1579 3.183 1.961, 5.167
Heavy head -0.0253 0.975 0.624, 1.524
Headache with nausea -1.3165 0.268 0.060, 1.200
Dizziness with nausea 0.3303 1.391 0.627, 3.086
Wheezing in the throat with sputum 0.5962 1.815 1.101, 2.993
White-coated tongue 0.3423 1.408 0.865, 2.291
Thickly coated tongue 0.1197 1.127 0.728, 1.744
Teeth printed tongue 0.6586 1.932 0.927, 4.027
Swollen tongue 0.4882 1.629 0.871, 3.048
Nausea 0.5138 1.672 0.686, 4.075
Borborygmus 0.2701 1.310 0.695, 2.468
Slippery pulse 1.3795 3.973 2.102, 7.508
* : R square
: Lower limit, Upper limit(95% Confidence Limits)
: significant in statistics
.
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Blood Stasis (0.0695)* Estimate Odds ratio L, U(95% C.L.)
Dark complexion -4.5343 <0.001 <0.001, >999.999
Dark inferior palpebra -10.4298 0.840 0.119, 5.924
Purpra in derma -0.1742 1.346 0.197, 9.179
Purple lip 0.2971 3.210 0.687, 14.995
Site-fixed headache 1.1663 0.458 0.113, 1.853
Pricking headache -0.7819 <0.001 <0.001, >999.999
Dry mouth -10.4514 0.499 0.115, 2.167
Purple & dark tongue -0.6948 16.567 2.120, 129.472
Purpra in tongue 2.8074 5.592 0.772 ,40.527
Pricking chest pain 1.7213 5.174 1.227, 21.813
A pulse coming and going
unsmoothly ,like scraping 1.6437 58.458 1.548, >999.999
* : R square
: Lower limit, Upper limit(95% Confidence Limits)
: significant in statistics
. 11
“ ” 2005
1 25 , 2005 7 9 2
2006 2 18, 19 3
. 2006 9 23, 24 4
2007 1
6, 7 5
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2007
eum Defficiency(0.0592)* Estimate Odds ratio L, U(95% C.L.)
Pale face and red zygomaticsite Thirsty -4.5343 1.798 0.757, 4.269
White mouth, thrush -10.4298 0.937 0.326, 2.699
Dry mouth -0.1742 1.194 0.786, 1.813
Red tongue 0.2971 1.200 0.700, 2.056
Dry tongue 1.1663 1.509 0.889, 2.562
Bare and red tongue like mirror -0.7819 3.125 1.047, 9.332
Palpitation -10.4514 1.072 0.574, 2.002
Cold sweating in sleeping -0.6948 1.150 0.709, 1.864
Fine and fast pulse in radial A. 2.8074 2.799 1.371, 5.716
Heating palmar & plantar 1.7213 1.085 0.405, 2.906
Afternoon tidal heat 1.6437 1.002 0.462, 2.172
* : R square
: Lower limit, Upper limit(95% Confidence Limits)
: significant in statistics
7 .
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68.5% .(Table 1,3,4 ) 321 8
94.2% .(Table 5. )
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Fire & Heat(0.2773)* Estimate Odds ratio L, U(95% C.L.) fidgeting due to deficiency and insomnia 0.00755 1.008 0.448, 2.265
Red face 1.1483 3.153 1.852, 5.368
Head fever -11.3525 <0.001 <0.001, >999.999
Pink eye 0.9161 2.500 1.299, 4.809
Dry eye -0.9659 0.381 0.192, 0.756
Halitosis 0.0944 1.099 0.538, 2.245
Bitter taste -0.0594 0.942 0.547, 1.622
Thirsty -0.1948 0.823 0.501, 1.353
Red tongue 0.6324 1.882 1.083, 3.271
Yello coated tongue 0.4834 1.622 0.941, 2.794
Chest distress 0.0917 1.096 0.518, 2.317
Scanty dark urine 0.327 1.387 0.874, 2.200
Constipation -0.0264 0.974 0.588, 1.614
Surging and fast Pulse in radial A. 1.6062 4.984 2.445, 10.159 Fever and aversion to heat during fever 0.5134 1.671 1.027,2.718
Heating in hand and foot 0.1852 1.203 0.490, 2.957
* : R square
: Lower limit, Upper limit(95% Confidence Limits)
: significant in statistics
, ,
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27.7%, 23.1%,
19.4%, 6.9%, 5.9%
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1,3)
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결 론
1.
321 30.84%
25.55%, 22.43%, 18.69%, 2.49%
. 2. 321
68.5%
94.2% .
3.
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27.7%, 23.1%,
19.4%, 6.9%, 5.9%
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참고문헌
