一种单脏腑辨证方法的统计学验证(英文)

Statistical validation of strategies for Zang-Fu single pattern differentiation

目的:提出一种能帮助中医临床医师进行单脏腑辨证的方法,并对其进行验证。方法:收集患者的四诊资料,然后在中医诊断知识数据库中进行检索,获取不同的备选辨证结果(证型),根据其能够解释四诊所得临床表现的多少进行排序,形成假设诊断列表,从中确定最终诊断结果。利用从中医诊断知识数据库中获取的96600种模拟证候群对该诊断方法进行验证。利用基于混淆矩阵的统计学方法评估望、闻、问、切等单个诊断手段、二诊(望诊和闻诊)或三诊(望诊、闻诊和问诊)结合及四诊合参的准确性。结果:问诊的准确度(89.7%)最高,其次为望诊(70.7%)、闻诊(59.9%)和切诊(56.1%)。敏感度和阴性预测值的排序相同。各单个诊断方法的特异度和阳性预测值均相近且较高(>99%)。四诊合参的准确度(93.2%)、敏感度(86.5%)和阴性预测值(88.1%)最高,同样,四诊合参亦具有较高的特异度(99.9%)和阳性预测值(99.8%)。与望、闻、问、切等单个诊断手段以及二诊或三诊结合诊断方法相比,四诊合参的诊断性能更高。结论:该证候诊断方法获得了统计学证据支持,可用于帮助中医临床医师依据脏腑理论进行单脏腑辨证诊断。

Objective： To propose and validate a method to aid traditional Chinese medicine （TCM） physicians in differentiation of Zang-Fu single patterns. Methods： The procedure started with data collection and search on a knowledge database. Candidate patterns were selected and ranked according to the relative amount of explained exam＇s manifestations. Diagnosis identification was performed on a list of diagnostic hypotheses. Validation was conducted with 96 600 simulations of manifestation profiles obtained from database. Statistical performance based on confusion matrices was assessed for individual methods including inspection, auscultation and olfaction, inquiry, and palpation. Combined methods （inspection＋auscultation and olfaction, inspection＋auscultation and olfaction＋inquiry） and four methods （inspection＋auscultation and olfaction＋inquiry＋palpation） were also tested. Results. The highest accuracy was obtained with the inquiry method （89.7%）, followed by inspection （70.7%）, auscultation and olfaction （59.9%）, and palpation （56.1%）. The same sequence was found for both sensitivity and negative predictive values. Specificity and positive predictive values were almost equal and high （〉99%） among individual exam methods. The combination of all methods provided the highest accuracy （93.2%）, sensitivity （86. 5%）, and negative predictive value （88. 1%）, while sustained high specificity （99. 9%） and positive predictive value （99. 8%）. The four methods presented the higher performance compared to combination of two or three exam methods as well as all single exam methods. Conclusion： The proposed strategies present statistical evidence of its diagnostic performance and can be used to aid TCM physicians in making single pattern diagnosis according to Zang-Fu theory.