应用德尔菲法确立甲状腺癌中医证候的调查研究

TCM patterns types and indicators of thyroid cancer by Delphi method:an investigation

目的运用德尔菲法对甲状腺癌的证候及各证候指标进行专家调研,初步确立甲状腺癌证候和证候指标,为临床辨治提供参考与依据。方法在文献调研的基础上,编制两轮《甲状腺癌中医辨证专家问卷调查表》,对全国30多位专家进行两轮问卷调查并进行统计分析。问卷调查表主要包括甲状腺癌证候及证候指标的重要性和熟悉性判定、术前术后证候分类、证候判定标准等内容。筛选、整理问卷条目,初步建立甲状腺癌中医辨证专家共识。结果两轮调查问卷分别回收有效问卷33份和36份,专家积极系数分别为100%与92.31%。第一轮专家调函克郎巴赫(Cronbaeh’sα)系数为0.297,经调整与修订,第二轮专家调函Cronbaeh’sα系数为0.696,调函内部一致性较高,可以接受。第一轮调查肯德尔和谐系数(W系数)为0.214,第二轮调查W系数为0.382,提示专家对甲状腺癌证候的评价意见协调性较为一致。最终将本病的中医证候确定为痰瘀互结证、肝郁气滞证、瘀热伤阴证、气血两虚证、气阴两虚证、脾肾阳虚证。痰瘀互结证术前为多,气阴两虚证术后多见。结论基本建立了甲状腺癌中医辨证专家共识,对促进甲状腺癌辨证规范,提高临床诊疗水平具有积极意义。

Objective To use Delphi method to decide the TCM pattern types and indicators of thyroid cancer,so as to provide reference and basis for TCM clinical practice. Methods Based on the literature retrieving and TCM theory,two-round Questionnaire of TCM Patterns of Thyroid Cancer were drafted,and more than 30 experts answered the questionnaires in two rounds. The questionnaires were consisted of criterion of importance and familiarity of TCM Syndromes and tables of thyroid cancer,TCM pattern classification of pre-operation and post-operation,standard of TCM pattern decision. Then the two-round questionnaires were screened and analyzed,and the experts consensus of TCM patterns of thyroid cancer was initially established. Results In the first round,33 questionnaire were returned with the positive coefficient of 100%,and 36 were returned in the second round,with the positive coefficient of 92. 31%.Cronbaeh＇s α coefficient of the first-round was only 0. 297. After modification and revision,Cronbaeh＇sα coefficient of the first-round increased to 0. 696,a higher questionnaire reliability than the first round.Kendall＇s coefficient of concordance（ W） of the first-round was 0. 214 as well as that of the second-round0. 382,which showed the experts converged towards the results. The process was stopped. TCM patterns of thyroid cancer were decided as stagnation due to phlegm and blood,stagnation of liver qi,deficiency of yin due to stagnantion of heat,deficiency of both vital qi and yin,deficiency of both vital qi and blood,the type of yang deficiency of the spleen and kidney. Stagnation due to phlegm and blood can mostly be observed in preoperative patients,while deficiency of both vital qi and yin can mostly be observed in postoperative patients. Conclusion The establishment of experts consensus of TCM patterns of thyroid cancer has a positive significance of promoting the standardization of pattern differentiation and clinical diagnosis and treatment.