肝火上炎证证候量表的初步编制

Primary compilation of a scale for Liver-Fire Ascending Syndrome

目的:初步编制中医肝火上炎证证候量表,并对自评量表所收集的数据进行统计分析。方法:①病种经流行病学调查,选取2005-07/2006-07湘雅医院、湘雅三医院的门诊和住院患者110例,其中肝火上炎证80例,肝阳上亢证30例。诊断标准:中医辨证按全国标准进行,西医诊断参考最新版眼科学和内科学。两类证候患者在性别、年龄、文化程度上经统计学检验差异无显著性意义(P>0.05),对本实验知情同意。②根据全国标准的中医病证治法术语,参照第五版中医诊断学,并在本研究所编制的中医肝脏证候临床辨证标准及症状程度分级量化的基础上确立条目的编制与评分。初步编出胸胁灼痛、急躁易怒、目赤、面红、头晕胀痛、耳鸣、耳内肿痛或流脓、突发耳聋、口苦、口干欲饮、衄血、失眠、多梦、大便秘结、尿黄、尿少这16项可操作性条目,各条目均分为无、轻度、中等、偏重、严重5级,依次计0～4分。并将量表分为肝火上攻维度和肝火内扰维度,各维度分数按累积得分法计算。③16项条目通过标准差法、逐步回归法、Cronbach’sα系数法和相关系数法进行筛选分析,符合以下2项或2项以上标准的条目予以删除:标准差<0.6;标准回归系数<0.95;Cronbach’sα系数>0.8;相关系数<0.3。量表编制完毕后进行信度和效度检验。结果:实验选取肝火上炎证患者80例及肝阳上亢证患者30例,均进入结果分析。①条目筛选结果:耳内肿痛或流脓、尿少这两项条目被删除,16项条目的量表削减为14项。②量表信度检验结果:两个维度重测信度的相关系数,肝火上炎证患者为0.706～0.897,肝阳上亢证患者为0.807～0.834,表明量表跨时间的一致性。条目和各维度分的分半信度系数为0.892～0.908,表明量表内部结构的一致性。两个维度的Cronbach’sα系数为0.897～0.933,证明量表跨指标的一致性。③量表效度检验结果:主成分因子分析结果表明,肝火上攻因子、肝火内扰因子、肝火上攻+内扰因子共解释总方差的71.713%,代表量表的总体结构。与肝火上炎证比较,肝阳上亢证在肝火上攻维度、肝火内扰维度方面差异均有显著性意义(t=13.456～19.360,P均<0.01)。结论:肝火上炎证证候量表具有良好的信度和效度,为肝火上炎证的研究提供了一个标准化的工具和方法。

AIM： To basically develop a scale for Live-Fire Ascending Syndrome, and to analyze the data statistically. METHODS：①According to the epidemiological investigation, a total of 110 cases were selected from Xiangya Hospital and the thint of Xiangya Hospital from July 2005 to July 2006. Eighty of them were Live-Fire Ascending Syndrome patients and 30 were Live-Yang Hyperactivity Syndrome patients. Diagnostic criteria： The differentiation of symptoms and signs of traditional Chinese medicine was according to the reference in China, and the diagnosis of western medicine was got from the latest book of ophthalmology and internal medicine. The patients in the two kinds of syndromes had not got significant differences in sexes, ages and culture degree according to the statistical test （P 〉 0.05）. All of them knew the fact and agreed with the experiment. ② The developing and scores of the item were established according to the standard technical terms in disease and syndromes of Traditional Chinese Medicine in China, and the fifth edition of diagnostics of Traditional Chinese Medicine, and it was established in the basic of standard clinical differentiation of symptoms and signs of the Liver syndrome and the classified and quantised symptom degree in this research. Totally 16 symptoms were organized, such as the burning pain of chest and hypechondrium, restless and tantrum, conjunctival congestion, flushing, dizzy＇and gas pains, tinnitus, swelling or pus in ear, flup deafness, bitter taste of mouth, dry mouth and desiring to drink, non-traumatic hemorrhage, anypnia, many dream, constipation, yellow urine, little urine, as the handling item, each of which was 5 grades none, mild, moderate, slightly severe, severe, from 0 to 4 points. The scale was divided into 2 dimensions as Live-Fire Ascending Syndrome and Livefire stirring up inside Syndrome, and accumulated the grades each other. ③The methods of standard deviation, stepwise regression, Cronbach＇s alpha and correlation coefficient were used to choose and analyze 16 items. The patients who got 2 or above following items were excluded： standard deviation〈 0.6, standard regression coefficient〈 0.95, Cronbach＇s alpha coefficient 〉 0.8 and correlation coefficient 〈 0.3. The reliability and validity should be analyzed after developing the scale. RESULTS： The 80 patients with Live-Fire Ascending Syndrome and 30 with Live-Yang Hyperactivity Syndrome were involved in the result analysis. ①Result of bolting items： 2 of the items （swelling or pus in ear, little urine） were cut out, and there were 14 items left. ②Result of reliability of the scale： The test-retest reliability ranged from 0.706-0.897 in patients with Live-Fire Ascending Syndrome and 0.$07-0.834 in patients with Live-Yang Hyperactivity Syndrome. It showed the consistency of cross time of scale. The split-half reliability of items and each dimension ranged from 0.982-0.908, which showed the consistency of internal structure of the scale. The Chronbach＇s α coefficient ranged from 0.897-0.933, which verified the consistency of cross index of scale. ③ Result of validity of the scale： The result of analyzing principal constituent fact showed that the fact of Liver-Fire Ascending, the fact of Live-fire stirring up inside, the facts of Liver-Fire Ascending and Live- fire stirring up inside explained the 71.713% of the total variation. It represented the scale＇s overall structure. Compared to the Live-Fire Ascending Syndrome, Live-Yang Hyperactivity Syndrome had significant significances in both of dimensions of Liver-Fire Ascending Syndrome and Live-fire stirring up inside Syndrome （t=13.456-19.360,P 〈 0.01 ） CONCLUSION： The scale for Live-Fire Ascending Syndrome attains satisfactory reliability and validity, and can supply a standard mean in researching Live-Fire Ascending Syndrome.