亚急性甲状腺炎肝经郁热证量化诊断标准的初探

Study on the Quantitative Diagnosis Method of Subacute Thyroiditis in the Liver Meridian Syndrome

目的建立亚急性甲状腺炎(SAT)肝经郁热证量化诊断标准。方法基于医院信息系统(HIS)选取2017年1月至2019年12月就诊于湖北中医药大学附属医院甲状腺专科的SAT患者,随机分为训练样本组和验证样本组。以训练样本组数据建立量化诊断模型,采用频数法及二元logistics逐步回归分析进行相关因素筛选,运用条件概率换算公式建立相关因素赋分表,通过绘制ROC曲线选择最佳诊断阈值,根据诊断性试验评价原则,分别计算训练样本组和验证样本组数据的灵敏度、特异度、准确度、阳性似然比,对量化诊断模型进行回顾性检验和前瞻性检验。结果共采集临床研究病例768例,其中训练样本组614例(肝经郁热证343例,非肝经郁热证271例)和验证样本组154例(肝经郁热证84例,非肝经郁热证70例),结合病例特征,共提取143项临床表征,经频数法和逐步回归分析后最终得到12项相关因素(正相关因素8项,负相关因素4项);经量化赋分、ROC曲线及诊断性试验评价原则,确定仅建立正相关因素赋分表,确定诊断阈值为22。回顾性检验和前瞻性检验灵敏度、特异度、准确度、阳性似然比分别为91.55%、95.56%、93.31%、20.60和89.39%、95.65%、92.16%、20.54。模型具有良好的科学性和实用性。结论SAT肝经郁热证量化诊断标准相关因素赋分合理,量化诊断阈值为22,具有较好的判别效果,可为临床提供参考。

Objective:To establish quantitative diagnostic criteria for subacute thyroiditis(SAT)syndrome of liver meridian. Methods:Based on the Hospital Information System(HIS),SAT patients who were treated in the Thyroid Specialty Department of Hubei Provincial Hospital of TCM from January 2017 to December 2019 were selected and randomly divided into the training sample group and verification sample group. A quantitative diagnosis model was established based on the training sample group data,the frequency method was used to conduct a preliminary screening of candidate factors,binary logistics stepwise regression analysis was used to screen related factors,conditional probability conversion formulas were used to establish a score table for related factors,ROC curves was drawn to select the best diagnostic threshold,the sensitivity,specificity,accuracy,and positive likelihood ratio were calculated respectively according to the diagnostic test evaluation principles,the quantitative diagnostic model was analyzed and evaluated,and finally the validation sample group data was used to complete the scientific attribute evaluation of the model. Results:A total of 768 clinical research cases were collected in this study,including 614 in the training sample group(343 cases of liver meridian syndrome,271 cases of non-liver meridian syndrome)and 154 cases in the verification sample group(84 cases of liver meridian syndrome,non-liver 70 cases of meridian syndrome);combined with the characteristics of the cases,a total of 143 clinical features were extracted. After frequency method and stepwise regression analysis,12 relevant factors were finally obtained(8 positively correlated factors,4 negatively correlated factors);after quantitative scoring,ROC curve and diagnostic test evaluation principles,it was determined that only positively correlated factors table were assigned and confirmed that the diagnostic threshold was 22. The sensitivity,specificity,accuracy,and positive likelihood ratio of retrospective test and prospective test were 91.55%,95.56%,93.31%,20.60 and 89.39%,95.65%,92.16%,20.54,respectively. The model had good scientificity and practicality. Conclusion:The SAT quantitative diagnostic criteria for liver meridian syndrome has a reasonable score for relevant factors,and the quantitative diagnostic threshold is 22. It has a good discriminating effect and can provide a clinical reference.