慢性胃炎湿热证患者的口腔呼气气味图谱识别_林雪娟.pdf

中华中医药杂志(原中国医药学报)2023年2月第38卷第2期 CJTCMP,February 2023,Vol.38,No.2 866 慢性胃炎湿热证患者的口腔呼气气味 图谱识别林雪娟1,2,3，高雅1,2,3，吴青海1,2,3，田群辉4，罗志明4，黄伟荣5，李灿东1,2,3（1福建中医药大学中医证研究基地，福州 350122；2福建省中医健康状态辨识重点实验室，福州 350122；3福建省2011中医健康管理协同创新中心，福州 350122；4厦门大学，厦门 361005；5福建中医药大学附属晋江中医院，晋江 362201）摘要：目的：运用电子鼻技术结合模式识别算法探讨慢性胃炎（CG）湿热证口腔呼气的气味图谱识别。方法：选择156例CG湿热证患者为研究对象，150例CG非湿热证患者和100名健康者为对照，运用基于阵列式气体传感器技术的电子鼻采集口腔呼气的气味图谱，采用模式识别的方法进行气味图谱识别。结果：CG湿热证患者中不同湿热比重的频数分布从高到低依次为湿热并重、湿重于热、热重于湿；CG湿热证Hp阳性率为39.74%。RF模型对CG和健康人气味图谱的分类最为准确，准确率可达98%；KNN聚类对CG湿热证和非湿热证气味图谱的分类最为准确，准确率为63%。LR模型对湿热并重与非湿热并重气味图谱的分类最为准确，准确率为62%；LR模型对湿重于热与非湿重于热气味图谱的分类最为准确，准确率为71%；LR模型对热重于湿与非热重于湿气味图谱的分类最为准确，准确率达90%；SVM模型对CG湿热证Hp阳性与Hp阴性气味图谱的分类最为准确，准确率达60%。结论：运用阵列式气体传感器电子鼻检测人体口腔呼气，不仅对CG患者具有很高的识别准确率，而且也能初步判断CG湿热证及其不同湿热比重、Hp感染情况，为中医病证诊断和嗅诊客观化 提供新方法。关键词：慢性胃炎；湿热证；电子鼻；口腔呼气；气味图谱；嗅诊；模式识别算法；Hp感染基金资助：国家自然科学基金项目（No.81973752，No.81373552），福建省自然科学基金项目（No.2018J01892），载人航天领域预先研究项目（No.020104）Recognition of oral breath odor map of chronic gastritis patients with syndrome of damp-heatLIN Xue-juan1,2,3,GAO Ya1,2,3,WU Qing-hai1,2,3,TIAN Qun-hui4,LUO Zhi-ming4,HUANG Wei-rong5,LI Can-dong1,2,3(1Research Base of TCM Syndrome of Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China;2Key Laboratory of Chinese Medicine Health Status Differentiation of Fujian Province,Fuzhou 350122,China;3Fujian Province 2011 TCM Health Management Collaborative Innovation Center,Fuzhou 350122,China;4Xiamen University,Xiamen 361005,China;5Jinjiang Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine,Jinjiang 362201,China)Abstract:Objective:To explore the recognition of oral breath odor map of chronic gastritis(CG)patients with syndrome of damp-heat by electronic nose technology combined with pattern recognition algorithm.Methods:A total of 156 CG patients with of damp-heat syndrome and 150 CG patients with non-damp-heat syndrome and 100 healthy persons were observed.Odor map of oral breath were collected by the electronic nose based on a film of gas sensor array.The method of pattern recognition was used to recognize the odor map.Results:The frequency distribution of different proportion of damp and heat 研究报告通信作者：李灿东，福建省福州市闽侯上街邱阳路1号福建中医药大学中医证研究基地，邮编：350122，电话：0591-22861513E-mail：内文2.indd 8662023/2/28 10:36:45中华中医药杂志(原中国医药学报)2023年2月第38卷第2期 CJTCMP,February 2023,Vol.38,No.2 867 in CG patients with damp heat syndrome from high to low was equal damp and heat,more damp with less heat,more heat with less damp.The positive rate of Hp in CG damp-heat syndrome was 39.74%.The RF model was the most accurate for the classification of odor maps of CG and healthy persons.The accuracy rate could reach 98%.KNN clustering was the most accurate for the classification of odor maps of damp-heat syndrome and non-damp-heat syndrome in CG.The accuracy rate was 63%.LR model was the most accurate for the classification of odor maps of equal damp and heat syndrome and non-equal damp and heat syndrome.The accuracy rate was 62%.The LR model was the most accurate for the classification of odor maps of more damp with less heat syndrome and non-more damp with less heat syndrome.The accuracy rate was 71%.The LR model was the most accurate for the classification of odor maps of more heat with less damp syndrome and non-more heat with less damp syndrome.The accuracy rate was 90%.The SVM model was the most accurate for the classification of odor maps of Hp positive and Hp negative in CG damp-heat syndrome.The accuracy rate was 60%.Conclusion:The CG patient could be recognized accuracy by the electronic nose based on a film of gas sensor array.The damp-heat syndrome and its different proportion of damp and heat and Hp infection in CG also could be recognized preliminary.The electronic nose could provide a method for the diagnosis of TCM disease and syndrome and the study on the objectification of TCM smelling examination.Key words:Chronic gastritis(CG);Syndrome of damp-heat;Electronic nose;Oral breath;Odor map;Smelling examination;Pattern recognition algorithm;Hp infectionFunding:National Natural Science Foundation of China(No.81973752,No.81373552),Natural Science Foundation of Fujian Province(No.2018J01892),Pre-research Project in Manned Space Field(No.020104)慢性胃炎（chronic gastritis，CG）是消化系统的常见病，脾胃湿热证是CG常见的证型1，课题组前期研究2-3表明，湿与热是CG的两个重要病性证素，且在CG常见病性证素组合中湿热证素组合出现的频次最多。临床研究4发现，许多CG患者伴有不同程度的口腔呼气气味异常，但尚未明确CG湿热证与气味变化的关系，故本研究借助电子鼻技术，运用证素辨证的方法，探讨慢性胃炎湿热证及其不同湿热比重、Hp感染情况的口腔呼气气味图谱特征辨识，以期为CG湿热证的诊断和中医嗅诊客观化研究提供参考数据。资料与方法1.研究对象 选取2019年8月2020年10月就诊于福建中医药大学附属晋江中医院的脾胃科门诊、住院部及胃镜室的156例CG湿热证患者为观察对象，其中男性63例，女性93例，平均年龄（38.629.55）岁。150例CG非湿热证患者和100名健康志愿者为对照，其中CG非湿热证患者中男性68例，女性82例，平均年龄（41.1110.12）岁；健康对照者中男性39例，女性61例，平均年龄（39.257.91）岁，均来自福建中医药大学附属晋江中医院健康管理中心。3组性别、年龄比较，差异均无统计学意义，具有可比性。本研究经福建中医药大学附属晋江中医院伦理委员会审查并获得批准（No.闽晋中伦理审2019016）。所有研究对象均自愿参加并签署知情同意书。2.诊断标准 2.1 CG西医诊断标准 参照 中国慢性胃炎共识意见（2017年，上海）中CG诊断标准5。2.2 Hp感染诊断标准 参照第五次全国幽门螺杆菌感染处理共识报告中Hp感染诊断标准6：当13C/14C呼气试验、组织学光镜检查、快速尿素酶试验任意1项诊断阳性，即可判定 感染Hp。2.3 中医证素诊断标准 依据朱文锋教授 证素辨证学7，根据采集的四诊信息在诊断中的