骨质疏松症常见中医证候诊断规范研究

A study of diagnostic criteria for traditional Chinese medicine syndromes in osteoporosis

目的:建立骨质疏松症常见中医证候诊断规范。方法:应用文献整理、临床调查、专家研讨等方法,建立骨质疏松症常见中医证候诊断规范草案,将诊断规范的辨证结果与专家经验辨证进行对照验证,根据临床验证结果对诊断规范进行反复修订,逐步完善。结果:初步建立了骨质疏松症常见中医证候诊断规范,包括定性与定位证候诊断两个部分。定性诊断包括精亏、气虚、阴虚、阳虚、血瘀,共5种定性证候;定位证候诊断其病在骨,其脏在肾,涉及肝、肺、脾(胃)、心。确立了各证候诊断的特异性症状与非特异性症状,并设定了满足诊断的条件。临床验证结果显示:用该诊断规范辨证的结果与专家辨证结果对照,定性诊断符合率为80.56%,定位诊断符合率为85.56%。结论:骨质疏松症中医常见证候诊断规范基本符合中医临床实际,值得在临床上进一步推广应用。

Objective： To establish diagnostic criteria for common traditional Chinese medicine （TCM） syndromes in osteoporosis.Methods： Based on the collection and analysis of related medical literature, clinical investigation, and expert discussion, a draft of preliminary diagnostic criteria for the basic syndromes of TCM in patients with osteoporosis was formulated. Then it was used in clinic for verification and revised repeatedly until a formal version of diagnostic criteria was satisfactorily achieved. Results： The basic syndromes listed in the diagnostic criteria for patients with osteoporosis consisted of two parts： qualitative diagnosis and localization diagnosis. Results of qualitative diagnosis showed that the qualitative syndromes included damage of essence, deficiency of vital energy, deficiency of yin, deficiency of yang and blood stasis. The localization diagnosis showed that location of osteoporosis is bone and corresponds to the kidney, and also involves liver, lung, spleen （stomach） and heart. The diagnostic content has established the specific symptoms and the non-specific symptoms during various stages. Each of the above syndromes could be diagnosed according to a specific combination of its corresponding symptoms or signs. The clinical verification results showed that the total matching ratio of qualitative diagnosis was 80.56% between the diagnoses made according to the criteria and the diagnoses acquired from the experts＇ experience, and the total matching ratio of localization diagnosis was 85.56%. Conclusion： The TCM syndrome diagnostic criteria for osteoporosis is generally consistent with TCM clinical practice, worthy of further popularization and application in clinical practice.