多囊卵巢综合征脾虚痰湿证量化诊断方法研究

Study on Quantitative Diagnosis Method in Polycystic Ovary Syndrome of Spleen Deficiency and Phlegm-Dampness Syndrome

目的建立多囊卵巢综合征(PCOS)脾虚痰湿证量化诊断标准。方法纳入PCOS患者500例,随机分为训练样本组285例(脾虚痰湿证121例,非脾虚痰湿证164例)和验证样本组215例(脾虚痰湿证77例,非脾虚痰湿证138例)。参考中医四诊信息并结合文献,将脾虚痰湿证辨证标准及临床常见症状作为候选相关因素,采用单因素检验和二元Logistic回归法选定标准相关因素,应用条件概率换算方法对标准相关因素进行赋分,分析绘制ROC曲线,选择最佳诊断阈值。分别对训练样本组及验证样本组患者建立的脾虚痰湿证量化诊断标准进行回顾性和前瞻性检验,计算其灵敏度、特异度、准确度及Youden指数。结果从39项候选因素中选出15项相关因素,并建立PCOS脾虚痰湿证量化诊断赋分表,确定量化诊断阈值为80。训练样本组回顾性检验的灵敏度、特异度、准确度及Youden指数分别为90.1%、82.3%、85.6%、72.4%,验证样本组前瞻性检验分别为84.4%、89.9%、87.9%、74.2%。结论PCOS脾虚痰湿证量化诊断标准相关因素赋分合理,量化诊断阈值为80,具有较好的判别效果。

Objective To establish quantitative diagnostic criteria for polycystic ovary syndrome(PCOS)of spleen deficiency and phlegm-dampness syndrome.Methods A total of 500 PCOS patients were included and randomly divided into a training sample group of 285 cases including 121 cases of spleen deficiency and phlegm-dampness syndrome and 164 cases of non-spleen deficiency and phlegm-dampness syndrome and a verification sample group of 215 cases including 77 cases of spleen deficiency and phlegm-dampness syndrome and 138 cases of non-spleen deficiency and phlegm-dampness syndrome.With reference to information of four diagnostic methods in traditional Chinese medicine(TCM)and literature,syndrome differentiation criteria of spleen deficiency and phlegm-dampness syndrome and common clinical symptoms were used as candidate related factors.One-way analysis of variance and binary logistic regression were used to select criteria-related factors.The conditional probability conversion method was used for scoring the criteria-related factors.ROC curve was drawn and analyzed,and the optimal diagnostic threshold was selected.Retrospective and prospective tests were performed on the quantitative diagnostic criteria of spleen deficiency and phlegm-dampness syndrome established for the training sample group and the verification sample group,and their sensitivity,specificity,accuracy and Youden index were calculated.Results A total of 15 related factors were selected from the 39 candidate factors to establish a scoring table on quantitative diagnosis for PCOS spleen deficiency and phlegm-dampness syndrome,and the quantitative diagnostic threshold was determined to be 80.The sensitivity,specificity,accuracy and Youden index of the retrospective test in the training sample group were 90.1%,82.3%,85.6%and 72.4%,respectively;and those of the prospective test in the verification sample group were 84.4%,89.9%,87.9%and 74.2%,respectively.Conclusion The quantitative diagnostic criteria-related factors in PCOS spleen deficiency and phlegm-dampness syndrome are reasonably scored,and the quantitative diagnostic threshold is 80,which has a good differentiation effect.