| Objective:The clinical characteristics of cardiac neurosis(CN)were the co-occurrence of cardiovascular and neurological symptoms,but no evidence of organic heart disease or other physical diseases affecting the heart with causal relationship was found.Influenced by social environmental factors,the incidence of CN is increasing day by day,but the diagnosis of cardiac neurosis often needs to be made after excluding serious organic lesions and evaluating the psychological and mental state of patients.The lack of quantitative diagnostic criteria leads to low recognition rate,which is easy to be misdiagnosed and missed diagnosed.In modern medicine,Oryzanol,β-blockers,anti-anxiety and depression drugs are often used for treatment,but there is no effective and lasting treatment plan,and resulting in more adverse reactions.Traditional Chinese medicine therapy in the treatment of cardiac neurosis has a significant advantage,is widely used in clinical treatment by modern doctors.Therefore,it is very important to form a systematic program of TCM treatment based on the theory of"prevention before disease".Constitution theory,as an important part of the theory of traditional Chinese medicine,occupies an important position in the theory of "prevention before disease".It is widely used in the research of psychosomatic diseases and can be used to guide clinical diagnosis and prevention.Therefore,in this study,constitution type was included into the influencing factors of CN.By analyzing the relevant clinical data of patients,the risk factors affecting the occurrence of CN were analyzed,and the clinical diagnosis and prediction model of CN was constructed,with a view to guiding the risk prediction and intervention of early onset of the disease,and providing evidence support for the prevention and treatment of CN by integrating traditional Chinese and western medicine.Methods:In this study,275 patients were included and divided into cardiac neurosis group(CN group)and non-cardiac neurosis group(NCN group)according to diagnostic criteria,including 150 patients in cardiac neurosis group and 125 patients in non-cardiac neurosis group.Structured questionnaire was used to collect patient information,personal history,past history,clinical symptoms,Chinese perceived stress scale(CPSS),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),Social readjustment rating scale(SRRS),Pittsburgh sleep quality index(PSQI),Traditional Chinese Medicine Constitution Classification and Distinguishing Scale and other data;the influencing factors and main constitution types of cardiac neurosis were selected.Then,all the above samples were randomly divided into two groups according to 8:2,which were set as training set and test set.Single and multiple logistic regression were used to screen the predictors,and logistic regression model and random forest model were established.The stability of the model was verified by ten-fold cross validation,and the model was verified by using test set data from three aspects:differentiation,consistency and decision curve analysis.Results:1 The influencing factors of CN were obtained based on univariate analysisThis study found that age,female menopause,body mass index(BMI),marital status,education level,concomitant disease,concomitant symptoms,frequency of medical visits,HAMA score,HAMD score,PSQI score,SRRS score of the two groups of patients,constitution type had statistical differences(p>0.05),the specific results are as follows:1.1 Basic informationThe age of CN group was 20-64 years old,with an average age of 40.17 years old and BMI of 23.44(20.79,26.79).The NCN age ranged from 18 to 64 years old,with an average age of 30.02 years old and BMI of 21.68(19.72,23.59).All the differences were statistically significant(p<0.01).The male to female ratio in CN group was 1:2,and that in NCN group was 1:2.21,with no statistical differences(p>0.05).Compared with NCN group,the proportion of menopausal patients in female patients in CN group(21.00%)was higher than that in NCN group(3.49%),and the difference was statistically significant(p<0.01).Compared with NCN group,the proportion of married patients(78.00%)and patients with bachelor degree or less(23.30%)in CN group was higher than that in NCN group(33.60%and 4.00%),and the difference was statistically significant(p<0.01).There was no statistical differences in the proportion of brain workers and work pressure between the two groups(p>0.05).1.2 Personal historyThere was no statistical differences in smoking history,drinking history and allergy history between the two groups(p>0.05).1.3 Associated diseases and associated symptomsCompared with NCN group,the proportion of patients with accompanying diseases in CN group(34.67%),and the proportion of patients with insomnia,fatigue,irritability and shortness of breath(70.67%,73.33%,75.33%,71.33%)were higher than those in NCN group(7.20%,54.40%,45.60%,56.80%,26.40%).The difference was statistically significant(p<0.01).1.4 Psychological factorsCPSS score,HAMA score,HAMD score,PSQI score and SRRS score of CN group were higher than those of NCN group,and there was no statistical difference in CPSS score between the two groups(p>0.05).There were statistical differences in HAMA score,HAMD score,PSQI score and SRRS score between the two groups(p<0.05).Compared with NCN group,the proportion of patients in CN group who saw a doctor≥3 months/time(63.30%)was higher than that in NCN group(8.00%),and the difference was statistical(p<0.05).There was no statistical difference in the stress level between the two groups(compared with those around them)(p>0.05).1.5 Constitution TypePatients in CN group mainly had qi depression constitution(28.00%),yang deficiency constitution(20.67%)and qi deficiency constitution(19.33%),while patients in NCN group mostly had mild constitution(48.80%),yang deficiency constitution(12.00%)and qi depression constitution(10.40%).No special constitution was found in the CN group,while there were 6 special constitution in the NCN group.There was significant difference in body type between the two groups(p<0.01).2 Establish and verify the clinical prediction model of cardiac neurosisCombined with the results of univariate analysis,the predictive factors were screened,and the following variables were selected to be included in the prediction model by univariate and multivariate logistic regression analysis:age,BMI,frequency of medical treatment,HAMA score,HAMD score,PSQI score,mild constitution.Both the logistic regression model and the random forest model had good prediction effect,and the area under ROC curve of the logistic prediction model in the training set was 0.952(95%CI 0.922-0.981).The areas under ROC curves of random forest model were 0.956(95%CI 0.927-0.984).The area under ROC curve of the logistic prediction model in the test set was 0.978(95%CI 0.949-1.000),and that of the random forest model was 0.964(95%CI 0.924-1.000).The correction curve indicates that the prediction effect of these models are better.The clinical decision curve showed that the prediction models curve of cardiac neurosis was far away from the extreme curve on the whole,indicating that the prediction model had a larger threshold,higher clinical net benefit,and had clinical reference value.Conclusions:This study found that,age,proportion menopause,BMI,marital status,education level,accompanying diseases,accompanying symptoms,frequency of medical treatment,HAMA score,HAMD score,PSQI score,SRRS score and constitution type are all influencing factors of cardiac neurosis.According to the test results of the model,it can be considered that this study has established diagnosis and prediction models of cardiac neurosis with good differentiation,consistency and clinical net benefit. |
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