中医心系问诊量表的研制及评价

Development and evaluation of an inquiry scale for diagnosis of heart system syndromes in traditional Chinese medicine

目的:研制中医心系问诊量表,初步探讨中医问诊的规范化研究方法。方法:运用量表制作方法,以中医理论为指导,在文献梳理的基础上,研制中医心系问诊量表。借助频次、Delphi法和卡方检验等多元统计学方法筛选症状,反复修改心系问诊量表,并进行重测信度、内部一致性信度和内容效度等评价。结果:中医心系问诊量表主要包括基本信息、主诉、现病史(伴随症状)和既往史,并附望、切诊信息及中西医诊断结论。其中一般问诊包括寒热、汗、头身胸腹、饮食口味、二便、睡眠、情绪、妇女等8个维度,最终筛选出66个症状变量。经专家讨论,量表具有较好的内容效度;整个量表一致性检验的克朗巴赫系数α为0.82。同一专家前后两次诊断的一致性结果显示心气虚、心阳虚、痰浊和寒凝的辨证诊断一致性较高,同一医生前后两次测量的Kappa值均在0.74～1之间;评分者信度评价中心气虚、心阳虚、心血虚和心阴虚的诊断一致性较高,Kappa值分别为0.63、0.72、1和0.48,其余的诊断一致性较低或不能说具有一致性。结论:运用量表制作方法对中医问诊进行规范化研究具有一定的可行性,心系问诊量表的研制,还可为其他脏腑问诊量表的研制提供参考。

Objective： To develop an inquiry scale for diagnosis of heart system syndromes, and to discuss the provisional standardization of the inquiry method in traditional Chinese medicine （TCM）. Methods. Based on scale-making method, Chinese medicine theory and literature searching, an inquiry scale for diagnosis of heart system syndromes in TCM was developed. Statistics method, frequency counting and Delphi method were used for analysis. The inquiry scale was revised and tested repeatedly to check the test reliability, internal consistency reliability, and content validity, etc. Results： The inquiry scale for diagnosis of heart system syndromes mainly covered basic data, chief complaint, history of present illness （accompanying symptoms） and past history, with appendix of inspection and palpation information as well as diagnosis made according to traditional Chinese and Western medicine. Among them, general inquiries covered fever and chills, sweating, head-body and chest-belly symptoms, taste and diet, stool and urine, sleep, mood, and gynecologic symptoms, which were scaled in 8 dimensions. And 66 symptom variables were screened finally. The scale had a good content validity and its coefficient alpha was 0. 82. For the results of test-retest reliability, the Kappa values of using the scale for diagnosis of heart-qi deficiency, heart-yang deficiency, turbid phlegm, and cold coagulation twice by the same doctor ranged from 0.74 to 1, showing that the consistency of the scale was relatively high. The Kappa values of evaluation of scorer reliability in diagnosis of heart-qi deficiency, heart-yang deficiency, and heartyin deficiency were also high, which were 0.63, 0.72, 1and 0.48 respectively. Other results of diagnosis had low-consistency or even no diagnostic agreement. Conclusion. The research on the scale for inquiry in TCM indicates that it is feasible for the standardization of inquiry scale for diagnosis of heart system syndromes in TCM, offering a reference for research on the inquiry scales for other systems,