肝郁证候宏观辨证标准的文献计量学研究

Bibliometrical Study on the Macroscopic Diagnostic Criteria for Hepatic Depression Syndrome

目的 初步建立异病同证中肝郁证候的宏观辨证标准。方法 采用文献研究与临床研究相结合的方法 ,通过文献研究筛选出频次高的症状体征作为参考诊断标准及症状观察量表 ,通过两个专家同时诊断作为肝郁证诊断的“金标准”与参考标准对 77例患者进行诊断 ,比较计算符合率、Kappa值及R值。结果 通过文献研究得出肝郁证参考诊断标准 :①胸胁作胀或痛 ;②精神抑郁 ;③烦躁易怒 ;④口苦 ;⑤胸闷 ;⑥善太息 ;⑦脉弦。以上 7条同时具备 4条或 4条以上即可诊断。该标准与临床专家诊断结果比较 ,Kappa值为 0 71,符合性较好。结论 经肝郁证和非肝郁证临床对照研究 ,得出以下症状、体征在肝郁证与非肝郁证比较具有显著差异 :胸胁作胀或痛、精神抑郁、烦躁易怒、口苦、胸闷、善太息、嗳气、脘腹胀痛、少腹胀闷、腹胀、症状因精神紧张而诱发、咽部异物感、舌红。结合中医理论 ,舌苔薄白、脉弦可作为进一步研究的肝郁证症状条目。

Objective To try to establish the macroscopic diagnostic criteria for hepatic depression syndrome according to the TCM theory that different diseases manifest same syndromes. Method The method of integration of literature research and clinical study was adopted in this study. The symptoms and signs of hepatic depression syndrome at high frequencies were screened out through literature research and used for establishing the reference diagnostic criteria and for designing the symptomatic observation scale. 77 Patients with hepatic depression syndrome were diagnosed according to both the 'golden criteria' set up by two clinical experts and the reference diagnostic criteria. The coincidence rate,Kappa value and R value were calculated by comparison. Results The literature research revealed that the following symptoms and signs could be included in the reference diagnostic criteria for hepatic depression syndrome: distension or pain in the chest or hypochondria,mental depression,restlessness and liable to be angry,feeling bitter in the mouth,feeling stuffed in the chest,frequent sighing,and stringy pulse. As compared with the diagnoses by the clinical experts,the Kappa value of these symptoms and signs was 0.71,showing a rather good coincidence. Conclusion Patients can be diagnosed as with hepatic depression syndrome if they are with four or with four and over of the above-mentioned symptoms and signs,namely distension or pain in the chest or hypochondria,mental depression,restlessness and liable to be angry,feeling bitter in the mouth,feeling stuffed in the chest,frequent sighing,and stringy pulse. Such signs of hepatic depression syndrome as thin white fur of tongue and stringy pulse still need to be further studied.