慢性阻塞性肺疾病急性加重期证候疗效评价要素研究——基于文献研究结合专家咨询

Syndrome Elements for Effectiveness Evaluation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease:based on Literature Research and Expert Consultation

目的筛选慢性阻塞性肺疾病急性加重期(AECOPD)证候疗效评价要素,为证候疗效评价量表的建立提供依据。方法检索中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库及中国生物医学文献数据库中自建库至2019年10月17日AECOPD中医证候研究相关文献,建立并规范数据库,统计基础证型及症状的频次频率;对频率≥3%的症状进行聚类分析,推断出常见基础证型并提取相应症状;基于文献研究结果进行专家咨询,分析重要性评分的均值及变异系数等指标,筛选重要性评分较高的基础证型及具有疗效评价属性的相应症状;综合文献研究及专家问卷的结果,最终筛选出AECOPD证候疗效评价要素。结果纳入文献211篇,共979条记录(每个证候作为1条记录),涉及基础证型30个,症状174个;对频率≥3%的症状进行系统聚类分析,依据中医专业知识推断出7个常见基础证型,包括风寒证、寒饮证、痰热证、痰湿证、血瘀证、脾气虚证、肾气虚证,提取因子载荷系数≥0.3的相应症状。专家问卷中选择频率≥50%、重要性评分均值≥3.0且变异系数≤0.3的基础证型有风寒证、寒饮证、痰热证、痰湿证、血瘀证;同时选取重要性评分均值≥7.0且变异系数≤0.3的相应症状。结论本研究最终筛选出AECOPD 5个常见基础证型,分别是风寒证、寒饮证、痰热证、痰湿证及血瘀证,同时确定了各常见基础证型中具有疗效评价属性的相应症状,为证候疗效评价量表理论框架及条目池的建立提供了依据。

Objective To determine the syndrome elements for effectiveness evaluation of acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide the basis for the establishment of the theoretical framework and item pool of syndrome effectiveness evaluation scale.Methods We searched CNKI,Wanfang,VIP and Sinomed from their inception dates to October 17 th,2019 for literature related to AECOPD syndromes,and the database was established based on the included literature.Data were standardized,and the frequency of basic syndromes and symptoms were calculated.Cluster analysis was performed on the symptoms with frequency≥3%,to infer the common basic syndromes and extract the corresponding symptoms.Based on the results of literature research,expert consultation was conducted to analyze the mean value and coefficient of variation of importance score,and to select the basic syndromes with high importance score and corresponding symptoms with attribute of effectiveness evaluation.Based on the results of literature research and expert questionnaire,the syndrome elements for effectiveness evaluation of AECOPD were determined finally.Results A total of 211 papers with 979 items(syndromes and symptoms)were included,involving 30 basic syndromes and 174 symptoms.Systematic cluster analysis was performed on symptoms with frequency≥3%,and seven common basic syndromes were inferred based on professional knowledge of traditional Chinese medicine,including wind cold syndrome,cold fluid syndrome,phlegm heat syndrome,phlegm dampness syndrome,blood stasis syndrome,spleen qi deficiency syndrome,and kidney qi deficiency syndrome;the corresponding symptoms with factor loading coefficient≥0.3 were extracted.According to the expert questionnaire,the basic syndromes with frequency≥50%,mean importance score≥3.0,and coefficient of variation≤0.3 were wind cold syndrome,cold fluid syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome;the corresponding symptoms with mean importance score≥7.0 and coefficient of variation≤0.3 were extracted.Conclusion Five common basic syndromes of AECOPD are finally determined,including wind cold syndrome,cold fluid syndrome,phlegm heat syndrome,phlegm dampness syndrome and blood stasis syndrome,and simultaneously the corresponding symptoms with attribute of effectiveness evaluation in each common basic syndrome are also defined,thereby providing a basis for the establishment of theoretical framework and item pool of syndrome effectiveness evaluation scale of AECOPD.