Depression In Tcm Syndrome Classification Diagnosis Scale And Syndrome Characteristics Research

BackgroundDepression is a clinical common and frequently-occurring disease, Related study shows that Chinese medicine (CM) has some strengths in the treatment of depression. However, the treatment of depression stays on syndrome differentiation of expertise, no unified standard of diagnosis and treatment of depression was applied. Although there is a scale of typing syndrome diagnosis, it has many entries, which lead it to operate complicatedly, and the most important is that there is lack of evaluation of diagnostic scale, therefore establishing a standardized, rigorous and easy to operate and good performance of syndrome typing diagnostic scale is necessary.ObjectiveTo establish a CM syndrome diagnostic scale of depression by mathematical model, evaluate the diagnostic performance of the scale, analysis the Clinical distribution characteristics of CM syndromes of depression, Summarize the core pathogenesis of depression, so this study can provide a premise and basis for using standardized CM to diagnose and treat depression standardization of diagnosis.Method11306cases were screened and569cases were included. Four diagnostic information of CM were collected. In order to obtain syndrome elements, some mathematical statistical methods were used to reduce the number of items of CM information, that’s Frequency, Principal Component Analysis, System clustering, Two Logistic Regression, and so on. The correlations between syndromes and symptoms were established. In order to get the weights of items of every syndrome, Two Logistic Regression was used. At last, diagnostic threshold was established by received operating characteristic curve(ROC). In order to test the diagnostic performance of the scale, forward-looking experiment was applied.2In order to learn the distribution of the syndromes in patients, the cases were divided into different groups according to the gender, age, the incidence of depression in different seasons, different occupations, different times of onset, duration of disease, first or second onset of depression, onset varying degrees of depression, and the depression with anxiety or without anxiety. Some statistical methods were used, the main methods are Frequency and Chi-square test.3To investigate the core pathogenesis of depression, Synonyms conversion was applied, diagnostic criteria of depression of the10th International Code of Diseases (ICD-10) were translated into CM symptoms, and the translated CM symptoms were used to extracted the CM core pathogenesis of depression. The pictures of the tongue-pulse of CM, syndrome elements, syndromes were also used to prove this point of view.Results1There were150items of CM information,27items were included in scales,6syndromes were gotten, that’s, liver depression and spleen deficiency, the deficiency of heart-spleen, yin deficiency of liver-kidney, phlegm-turbidity, Qi and blood stasis, excessive fire of heart-liver. And6CM typing syndrome diagnostic scales of depression were established. The total score of every scale are50scores, diagnostic threshold score arel8scores.Diagnostic performance of the scale is that the sensitivity of the scale is between81.3%and94.7%, the specificity of the scale is between57.5%and99.8%, Youden index between45.6%and81.1%. Clinical validation by the small sample was applied, the result showed that the sensitivity of the scale was between88.46%-93.3%, the specificity of the scale was between66.9%-98.4%, Youden index between56.9%-87.7%, accuracy rate was between63.3%-98%.2The difference between male group and female group in the distribution of the syndromes was clear (PearsonX2=10.781, P=0.001). There were no statistically significant difference between different groups of different seasons (PearsonX2=17.8905, P=0.233) and no difference between different groups of different occupations (PearsonX2=37.797, P=0.155). The distribution of the syndromes between different age groups is significant (PearsonX2=23.22, P=0.010), compared with the old-aged group, the syndrome of liver depression and spleen deficiency and the deficiency of heart-spleen are more common between the adolescent and youth group, but phlegm-turbidity is more common in the old-aged group (PearsonX2=13.656, P=0.000). There are no statistically significant difference between middle-aged group and old-aged group and middle-aged group and the youth group. There are some difference between different courses of diseas e (PearsonX2=43.627, P=0.000), the syndrome of liver depression (PearsonX2=11.411, P=0.001) and spleen deficiency and the deficiency of heart-spleen (PearsonX2=9.136, P=0.003) are more common in less than12months group of course of disease, but the course of disease between13and36months group shows the main syndromes are deficiency of liver-kidney and phlegm-turbidity (PearsonX2=13.060, P=0.000), there are no statistically significant difference between other groups. The study shows that the main syndromes of on set-depression group is liver depression and spleen deficiency (PearsonX2=9.038, P=0.003), but the syndrome of deficiency of liver-kidney (PearsonX2=9.038, P=0.003) and phlegm-turbidity (PearsonX2=9.028,P=0.003) are common in recurrence-depression group. Mild-depression group illustrates that the syndrome of deficiency of heart-spleen (PearsonX2=8.288, P=0.004) is more common than moderate depression group, phlegm-turbidity (PearsonX2=14.710, P=0.000) is common in moderate group. There are two common syndrome in pure-depression group, that’s,liver depression and spleen deficiency and the deficiency of heart-spleen (PearsonX2=39.655, P=0.000), but the syndrome of liver depression and spleen deficiency (PearsonX2=39.655, P=0.000), deficiency of liver-kidney (PearsonX2=21.355, P=0.000) and phlegm-turbidity (PearsonX2=26.420, P=0.000) are more common in compounded group.3The study got43CM symptoms from the diagnostic criteria of depression of the10th International Code of Diseases (ICD-10), in those symptoms,22symptoms were selected to extract the core pathogenesis of depression, at last, liver depression and spleen deficiency were established for the core pathogenesis of depression. Other factors were used to prove this point of view.Conclusion1CM syndrome Diagnostic Scale of depression has a good diagnostic performance. So they are can be used to screen and include cases.2There are some differences in the distribution of the syndromes in patients between genders, ages, the course of the disease, severity of disease, and the treatment of the degree of the disease. But there is no difference in seasons and occupations. The character of the distribution in syndromes can provide a clue of different treatments of different syndromes.3The CM core pathogenesis of depression is liver depression and spleen deficiency.