Discussion On Syndrome Regularity Of Adenomyosis Based On Structured Medical Records

Part ⅠConstruction of the Structurized Traditional Chinese Medicine Out-patient Record for AdenomyosisObjectiveOn the background of real world research,combining with traditional Chinese medicine diagnosis and treatment law and adenomyosis clinical characteristics,we built up the structurized TCM out-patient record of adenomyosis,to meet the demand of real and comprehensive collection of clinical data and synchronous accumulation of scientific research data,and realize the integration of clinical research,to add bricks and tiles of building a evidence-based traditional Chinese clinical research system of adenomyosis.MethodsFollowing the clinical research datamation principle of Clinical Medical Research Information Sharing System,the research adopts China Academy of Chinese Medical Sciences’the acquisition platform of electronic medical records and clinical research data of TCM’ as the tool.According to content and requirement of Chinese medical records writing of the national ’basic norms of electronic medical records(Trial)’,’the diagnostics of TCM’,we design adenomyosis electronic medical record plates;According to ’terminology specification for clinical common symptoms of TCM ’,’the diagnosis and treatment guidelines of endometriosis’ relevant information,we conduct structural decomposition on each plate.ResultsRefer to Health industry specification and adenomyosis related guidelines,we transfer the complex intervention and various expression Chinese medicine clinical information of adenomyosis patients into standardized,structurized,digitalized data,to construct the structurized traditional Chinese medicine out-patient record for adenomyosis,and complete medical records data entry and monitoring.ConclusionConstruction of the structurized traditional Chinese medicine out-patient record for adenomyosis plays an important role in collection of vast amounts of clinical data and scientific research information in accordance with TCM thinking model,and probe into the complete and effective syndrome differentiation mode of TCM in the treatment of adenomyosis,to lay the foundation for further clinical research of adenomyosis on real world research on TCM.Part ⅡStudy on the syndrome discipline of adenomyosis based on association rulesObjectiveBy mining the clinical data of patients of adenomyosis,we discussed the distribution characteristics of TCM Syndromes of adenomyosis,and each syndrome’s symptoms’characteristics and correlation between symptoms.Under the guidance of TCM theory,combining with Professor Zhao Ruihua’s clinical idea,we intend to reveal the etiology and pathogenesis characteristics of adenomyosis and the internal relationship between symptoms.MethodsClinical data were collected by the established structurized TCM outpatient record for adenomyosis.The input data of 230 cases of adenomyosis patients from January 2014 to December 2017 in the gynecology department of Guang’anmen Hospital of Chinese Academy of Chinese Medical Sciences were extracted and pretreated.The statistical analysis software SPSS20.0 was used to make a descriptive statistics on the clinical data of the patients included in the study,and the rapid clustering method was used for the syndrome classification.The clinical symptoms and symptoms of each syndrome of the patients of adenomyosis were extracted and association analyzed by Data Mining platform developed by Guang’anmen Hospital of Chinese Academy of Chinese Medical Sciences.Results1.The patients of adenomyosis included in the study,whose ages range from 21 to 52,concentrates in 31-40 years old,about 51.7%,followed by 41-50,accounting for 33.5%.There are 196 people aged 31-50 years old,accounting for 85.2%of the total number of patients.2.In the main symptoms of 230 patients of adenomyosis,there are 163 cases of dysmenorrhea,about 70.9%;99 cases of menorrhagia,about 43.0%;79 cases of infertility,about for 34.3%;35cases of hypomenorrhea,about 15.2%;34 cases of menostaxis,about 14.8%;10 cases of delayed menstruation,about 4.3%.3.The core symptoms of 230 patients of adenomyosis include intolerance to cold and cold limbs,fatigue,dysmenorrhea,soreness of waist,irritability,heavy head body,poor appetite,dry mouth,menorrhagia,followed by loss of sexual desire,depression,infertility、superficial sleep and early awakening,stool viscosity,difficulty falling asleep,sallow complexion,five upset hot,chest tightness,dizziness.4.There is a strong association between intolerance to cold and cold limbs,soreness of waist and fatigue in the symptoms of 230 cases of adenomyosis.Intolerance to cold and cold limbs,soreness of waist often accompanied by fatigue,with lift respectively 1.09 and 1.09;Intolerance to cold and cold limbs are strongly associated with soreness of waist,cases with intolerance to cold and cold limbs accounting for 80%of cases with soreness of waist,whose lift is 1.13;when two factors of the three factors mentioned above appear at the same time,will enhance the role of the third one,and lift is greater than the single factor.Irritability is associated with fatigue with lift 1.12.5.The TCM syndrome of adenomyosis is mainly composed of ’cold coagulation and blood stasis’ syndrome,about 40.9%,followed by ’qi deficiency and blood stasis ’syndrome(25.2%),’ qi stagnation and blood stasis’ syndrome(23.0%),’ kidney deficiency and blood stasis’ syndrome(10.9%).6.The core symptoms of ’cold coagulation and blood stasis ’syndrome include intolerance to cold and cold limbs,fatigue,dysmenorrhea,pain relieved by heat,loss of sexual desire,infertility,loose stool.There are strong associations between intolerance to cold and cold limbs,dysmenorrhea,pain relieved by heat,infertility.Cases with dysmenorrhea,infertility accompanied by intolerance to cold and cold limbs,account for respectively 92%,95%.In the patients with dysmenorrhea,83%of the patients’ pain will relieve when receive heat.When patients with intolerance to cold and cold limbs,the possibility of dysmenorrhea,infertility is improved.7.The core symptoms of’qi deficiency and blood stasis’ syndrome include fatigue,menorrhagia,dysmenorrhea,poor appetite,sallow complexion,stool viscosity.Fatigue has a strong correlation with dysmenorrhea.poor appetite,menorrhagia.sallow complexion.and enhance the possibility of the latters.When patients of ’qi deficiency and blood stasis’syndrome have hypermenorrhea or menostaxis,the chance probability of fatigue is 94%and 100%respectively.Some patients were accompanied by intolerance to cold and cold limbs,irritability.8.The core symptoms of ’qi stagnation and blood stasis’ syndrome include irritability,depression,dysmenorrhea,five upset hot,chest tightness,fatigue,poor appetite,superficial sleep and early awakening.In the ’qi stagnation and blood stasis’syndrome irritability,depression is highly correlated with menorrhagia,accounting for 94%and 72%of the patients of menorrhagia,with lift 1.08 and 1.09 respectively.When irritability and depression appear at the same time,the upgrade degree raised to 1.15.Irritability and depression can lead to fatigue and poor appetite.78%of the irritable patients are fatigued and 59%show poor appetite.9.The core symptoms of ’kidney deficiency and blood stasis ’include soreness of waist,dysmenorrhea,infertility,tinnitus,loss of sexual desire,intolerance to cold and cold limbs.Soreness of waist in ’kidney deficiency and blood stasis ’syndrome is strongly associated with dysmenorrhea,infertility,intolerance to cold and cold limbs.The amount of soreness of waist in patients with dysmenorrhea,infertility account for 100%and 95%respectively.Soreness of waist is positively correlated with intolerance to cold and cold limbs,with lift 1.04.Soreness of waist can directly improve the occurrence of dysmenorrhea and infertility,also through intolerance to cold and cold limbs lifting.Conclusion1.The study shows that the main symptoms of adenomyosis are dysmenorrhea,menorrhagia,infertility.The core symptoms include intolerance to cold and cold limbs,fatigue,dysmenorrhea,soreness of waist,irritability,heavy head body,poor appetite,dry mouth,loss of sexual desire,depression.There is a strong association between intolerance to cold and cold limbs,soreness of waist and fatigue.Irritability can lead to fatigue.2.The common syndrome types of adenomyosis include cold coagulation and blood stasis syndrome,qi deficiency and blood stasis syndrome,qi stagnation and blood stasis syndrome and kidney deficiency and blood stasis syndrome.The syndrome of cold coagulation and blood stasis is the most common syndrome type.3.There are complex association rules in the clinical symptoms of adenomyosis.Different syndromes’ symptoms have particular characteristics and associate with each other.The different factors of the same syndrome type,various factors of different syndrome types are closely linked,mutual transformation and pinch.The clinical need to discern the principal contradictions and the secondary contradictions and transformations between them.4.The database of adenomyosis was constructed and analyzed by the structurized traditional Chinese medicine outpatient record for adenomyosis.The conclusion accords with the basic theory of TCM,which is of guiding significance to the clinic.This method is an effective means to explore the law of TCM in the treatment of adenomyosis.