基于数据挖掘技术建立的儿童肺炎中医辨证规范量表的信度和效度研究

Reliability and validity study on the scale of differentiation of symptoms and specification of traditional Chinese medicine in children pneumonia by data excavation technique

目的辨证论治是中医防治疾病最主要的方法和手段,完善现有优势病种的诊疗规范,使证候的诊断客观化、标准化和规范化,有利于中医学的推广与发展。本研究提出一种基于数据挖掘技术生成中医辨证动态量表的方法,将其应用于儿童肺炎的中医辨证规范。方法选择6家中医和1家西医院作为儿童肺炎中医辨证规范研究的参研单位,将同时符合中医儿童肺炎喘嗽常证、西医儿童肺炎轻症诊断标准的患儿纳入研究组;辽宁中医药大学附属医院诊断的儿童非肺炎病例作为验证组。对所采集的儿童肺炎临床证候信息进行聚类挖掘和关联分析,生成儿童肺炎所属各证的基本构成和构成比、儿童肺炎各证所属症状的构成比,在证中证候组成模型和证间证候贡献模型的基础上构造儿童肺炎辨证量表。对量表的信度和效度进行评价。结果研究组纳入1063例,验证组纳入2000例。通过对既往儿童肺炎中医研究文献的复习,汇总216项对儿童肺炎病证诊断有临床意义的证候变量,覆盖与儿童肺炎有关的30个方面。经过聚类处理后,有临床意义与统计学意义的指标有109项。痰热闭肺、风热闭肺、气阴两虚、阴虚肺热、痰浊未尽、痰热未清、风寒闭肺和毒热闭肺证量表的信度分别为0.742、0.583、0.666、0.258、0.370、0.559、0.797和0.861。内容效度系数较高的症状为:痰热闭肺证为小便(0.611)、咽喉症状(0.585)、口渴(0.575)、脉象/数(0.548)、厚苔(0.442)、痰/性质(0.42)、发热/性质(0.418)和咳嗽/程度(0.412);风热闭肺证为咽部症状(0.658)、咳嗽/程度(0.572)、汗/程度(0.535)和脉象/数(0.52);气阴两虚证为脉象/无力(0.876)、脉象/细(0.847)、咳嗽/声音(0.742)、腻苔(0.695)和痰/性质(0.551);阴虚肺热证为脉象/数(0.551)、痰-性质(0.535)、脉象/细(0.488)、剥脱苔(0.409);痰浊未尽证为脉象/数(0.534)、脉象/滑(0.533)、痰/量(0.41)和厚苔(0.407);痰热未清证为脉象/滑(0.611)、咳嗽/程度(0.598)、痰/性质(0.548)、痰/量(0.428)、痰/颜色(0.427)、脉象/数(0.425)和厚苔(0.406);风寒闭肺证为小便(0.927)、咽部症状(0.9)、精神神志/程度(0.879)、痰/性质(0.732)、腻苔(0.63)、哮鸣音(0.55)和脉象/紧(0.409);毒热闭肺证为咳嗽/程度(0.891)、口渴(0.824)、大便(0.813)、指纹性质(0.8)、发热/性质(0.771)、指纹程度(0.748)、腻苔(0.642)、咳嗽/声音(0.58)和发热/温度(0.481)。结论数据挖掘技术支持儿童肺炎的病证结合辨证规范和辨证标准的建立,是可行的技术方法。研究所形成的儿童肺炎辨证量表是有效的辨证标准化的评估方法。

Objective The improvement of the present standardized diagnosis and treatment norms along with the unified symptom-pattern identification will objectify and standardize the diagnosis of symptoms, thus to promote and develop traditional Chinese medicine（TCM）. This study presented a method that generated TCM dynamic scales based on the data excavation to be applied to the establishment of symptom differentiation standards on child pneumonia. Methods Seven hospitals were chosen as multicentre participating study unities, whose cases were all consistent with pneumonia diagnosis standard in western medicine and TCM. The non-pneumonia children from Affiliated Hospital of Liaoning University of TCM were taken as verification group. The collected information of clinical symptoms in children pneumonia was manipulated by clustering excavation and association analysis. The analysis of the clustering excavation results was performed to form the basic composition and constituent ratio of each symptom belonged to children pneumonia, symptomatic composition belonged to children pneumonia and differentiation of symptoms and specification scale of TCM in children pneumonia. Child pneumonia differentiation of symptoms and signs scales were produced based on the models composed by penthemeron in symptoms and contribution models composed by penthemeron between symptoms. And the reliability and validity of scales were evaluated. Results The study group and verification group contained 1 063 cases and 2 000 cases, respectively. Through literature review on children pneumonia of TCM, 216 symptoms and penthemeron variances were summarized, which were significant to the diagnosis of children pneumonia and covered 30 aspects related to the children pneumonia. 109 indexes with statistical and clinical significance were obtained after clustering management. The reliabilities of phlegm-heat stagnating in lung, wind-heat stagnating in lung, Qi and Yin deficiency, lung-heat due to Yin deficiency, stagnation of phlegm in the interior, accumulation of phlegm and heat, pathogenic wind-cold factors tightening the lung and pathogenic heat stagnating in lung scales were 0. 742,0. 583,0. 666,0. 258,0. 370,0. 559,0. 797 and 0. 861, repectively. The symptoms in high validity coefficient ： phlegm-heat stagnating the lung symptoms were urination （ 0.611 ）, throat symptoms （ 0. 585 ） , thirsty （ 0. 575 ） , pulse-frequent （ 0. 548 ）, thick tongue fur （ 0. 442 ）, sputum-quality （ 0. 42 ）, fever-quality （0.418 ）, cough-degree （ 0.412 ） ; wind-heat stagnating the lung symptoms were pharyngeal portion symptoms（ 0. 658 ） , sweat-degree（0. 535 ） , cough-degree （0. 572 ）and pulse-frequent （0. 52） ; Qi and Yin deficiency the symptoms were pulse-weakness （0. 876 ） , pulse-parvus （0. 847 ） , cough-voice （0. 742 ） , slimy tongue fur （ 0. 695 ） , sputum-quality （ 0. 551 ） ; lung-heat due to Yin deficiency symptoms were pulse-frequent （ 0. 551 ） , sputum-quality（0. 535 ）, pulse-parvus （0. 488 ）, exfoliative fur（0. 409 ）; stagnation of phlegm in the interior the symptoms were pulse-frequent（0. 534）, pulse-slippery （ 0. 533 ）, sputum-quantity （ 0. 41 ）, thick tongue fur （ 0. 407 ） ; accumulation of phlegm and heat the symptoms were pulse-slippery（ 0. 611 ） , cough-degree （ 0. 598 ） , sputum-quality （ 0. 548 ） , sputum-quantity （ 0. 428 ） , sputum-color （ 0. 427 ）, pulse-frequent （ 0. 425 ）, thick tongue fur （ 0. 406 ） ; pathogenic wind-cold factors tightening the lung symptoms were urination（0. 927 ） , throat symptoms （ 0. 900 ） , mind-degree （0. 879 ） , sputum-quality （ 0. 732 ） , slimy tongue fur （0. 63 ）, wheezing （0. 55 ）, pulse-tight （0. 409 ） ; pathogenic heat stagnating the lung symptoms were cough-degree （0. 891 ）, thirsty （0. 824 ）, sedes （ 0. 813 ）, fingerprint quality （ 0. 8 ）, fever-quality （ 0. 771 ）, fingerprint degree （ 0. 748 ）, slimy tongue fur （0. 642） , cough-voice（0. 58） ,fever-temperature （0. 481 ）. Conclusions The chiasm subjects, data excavation technique were used in the paper to offer a beneficial exploration of the differentiation of symptoms and specification of TCM. Studies showed that data excavation technique was an effective technical method to be used to support the establishment of the symptom differentiation norms and the standards for differentiation of symptoms and signs. The differentiation of symptoms scale assessment of children pneumonia was an effective standardized evaluation method.