大肠癌脾气虚证辨证量化标准的研究

Quantified diagnositic standard for large intestinal cancer of spleen qi deficiency syndrome

目的:建立大肠癌脾气虚证辨证量化标准。方法:在对311例大肠癌患者进行临床流行病学调查的基础上,组织专家组对其进行辨证,根据各相关中医症状在脾气虚证组和非脾气虚证组中出现状况的差异对这些症状进行赋分;根据专家辨证的结果,应用接受者操作特征曲线(receiver operating characteristic curve,ROC)的方法选择最佳诊断阈值从而建立量化辨证标准;以专家组统一辩证作为金标准对建立的量化标准进行回顾性检验。结果:结合专家意见,分析了所有可能与脾虚证相关的中医症状,确定乏力等28个中医症状为大肠癌脾气虚证的候选相关因素;经列联表分析,乏力等11项中医症状在脾气虚证和非脾气虚证中出现频次的差异有统计学意义(P<0.05),将这11项中医症状作为logistic回归分析的变量进行筛选,最后确定乏力、神疲、便溏、纳呆为大肠癌脾气虚证的相关中医症状;应用条件概率方法换算,这4个症状的赋分分别为16、11、4、8;经ROC方法分析,确定量化辨证标准为≥13分;回顾性检验的敏感度、特异度、准确度均在80%以上,阳性似然比为9.89。结论:建立的量化标准较符合大肠癌的临床特点和中医辨证的临床实际。

Objective： To set a quantified diagnostic standard for large intestinal cancer of spleen qi deficiency syndrome. Methods： The spleen qi deficiency syndrome was identified by experts on the basis of clinical epidemiological investigation of 311 patients suffering from large intestinal cancer. Corresponding points were assigned to the correlative factors （traditional Chinese medicine symptoms） on the basis of symptom differences between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome. The best threshold was determined by receiver operating characteristic curve （ROC） according to syndrome differentiation from expert team, and the quantified diagnostic standard was established. The syndrome identification from the expert team which was regarded as golden standard was tested retrospectively. Results： All the traditional Chinese medicine symptoms possibly related to spleen qi deficiency syndrome were analyzed based on the opinions of experts, and 28 symptoms were confirmed as candidate correlative factors. The occurrence of 11 symptoms between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome showed statistical differences by means of crosstabs analysis （P〈0.05）. The 11 symptoms were filtered by logistic regression analysis, and tiredness, fatigue, loose stool, and poor appetite were finally determined as the symptoms relative to large intestinal cancer. These four symptoms were analyzed with conditional probability conversion and endowed with 16, 11, 4 and 8 points respectively. The diagnostic standard of spleen qi deficiency syndrome of large intestinal cancer was over 13 points. The sensitivity, specificity and accuracy of retrospective examination were all above 80%, and its positive likelihood ratio was 9.89. Conclusion： The quantified diagnostic standard for spleen qi deficiency syndrome of large intestinal cancer is in accordance with clinical characteristics of large intestine cancer and the characteristics of TCM syndrome diagnosis.