中医临床医生四诊信息判读及诊断一致性探讨

Study on the Diagnosis Agreement of Clinical Doctor of Traditional Chinese Medicine

目的:评价中医临床医生四诊信息判读及诊断的一致性。方法:邀请医院资深临床内科专家,对患者四诊信息进行判读,并给出辨证诊断结果;运用本课题组制作的心系问诊量表采集的心系病例资料,随机抽取25份病例,邀请两位中医学专家分别对其进行辨证诊断;随机抽取病例15份,邀请3位中医学临床医生进行证素辨证诊断,采用Kappa值统计检验,对其进行一致性评价。结果:不同医生,同一患者的现场诊断一致性评价结果:判断舌质淡红的专家有9位,一致性56%;脉象信息判读的一致性中脉沉9位,一致性56.2%;诊断虚证的一致性为89%;同一份病例量表,同一医生先后两次诊断的一致性结果:心气虚证Kap一致性系数为0.69,心阳虚证为0.80,痰浊证为0.78;不同医生诊断一致性结果:心气虚证Kap一致性系数为0.63,心阳虚证为0.72,心阴虚证为0.48。结论:中医临床医生对四诊信息判读及诊断均存在差异性,说明中医临床医生间四诊信息判读及诊断的一致性较差。

This work aimed to assess the concordance of information collected by the TCM four diagnostic methods and diagnosis. 16 TCM experts were invited from Longhua Hospital, Shuguang Hospital, and Yueyang Hospital of Shanghai University of Traditional Chinese Medicine, and randomly selected 1 patient. They recorded patient information by the TCM four diagnostic methods and diagnosis. 25 cases were randomly selected, and 2 copies were made from the numerical data collected through the Inquiry Scale for Diagnosis of Heart System Syndromes developed by our research team. The copies were disorganized and renumbered from 1 to 50. In order to evaluate the concordance of successive diagnosis by the same clinician, 2 TCM experts were invited to differentiate the syndrome and diagnose for the 50 cases by the double-blind method. 15 cases were randomly selected. Three TCM clinicians were invited to make a diagnosis based on Zangfu-organs syndrome differentiation. The Kappa test was adopted. The results of experts judgement for the same patient showed that 9 experts judged red tongue, with the concordance being 56%, 9 experts judged deep pulse, with the concordance being 56.2%, and the concordance of deficiency syndrome was 89%. The results of successive diagnosis by the same clinician showed that the Kap concordance coefficient for the syndrome of deficiency of heart qi was 0.69, that for the syndrome of deficiency of heart yang was 0.80, and that for the syndrome of turbid phlegm was 0.78. The results of diagnosis by different clinicians showed that the Kap concordance coefficient for the syndrome of deficiency of heart qi was 0.63, that for the syndrome of deficiency of heart yang was 0.72, and that for the syndrome of deficiency of heart yin was 0.48. Taken together, diagnosis by the same clinician and different clinicians varied, indicating a poor concordance of the TCM four diagnostic methods and diagnosis.