基于德尔菲法的髓亏证证候诊断条目筛选

Syndrome Diagnosis Items Selection of Marrow Deficiency Based on Delphi Method

目的:探索髓亏证的证候诊断要点,以期为髓亏证的标准化研究提供依据。方法:以山东中医药大学图书馆馆藏中医典籍和中国知网数据库(CNKI)、中国生物医学文献服务系统(SinoMed)、维普医药信息资源系统(VIP)、万方数据知识服务平台为检索源,从中检索与髓亏状态相关的症状条目;在中医理论指导下筛选高频症状,建立条目池,运用德尔菲法,研讨关键性条目,就条目选择进行三轮专家咨询,至专家意见基本协调。结果:三轮咨询中,专家积极系数分别为93.75%、100.00%、100.00%,问卷的平均内容效度指数依次为0.862、0.924、0.929;第三轮咨询中,专家意见协调系数为0.380。根据专家意见的协调程度和集中程度,确定了髓亏证证候诊断的20条关键性症状,包括主症8条:健忘、智能减退、反应迟钝、腰膝酸软、齿摇或齿脱或齿槁、发焦或发落或发白、小儿发育迟缓、小儿智力低下;次症9条:神疲、注意力减退、脑鸣、头晕、头空痛、视物昏花、耳鸣、耳轮枯萎、腰背俯偻;舌、脉象3条:舌瘦、脉弱、脉虚。结论:髓的生理特性和解剖结构使得髓亏证的临床表现涉及全身多个系统,本次研究结果中的症状均具有髓亏证在相应维度诊断上的代表性和特异性,可为后续研究提供依据。

Objective:To explore the key points of syndrome diagnosis of marrow deficiency,in order to provide basis for the study of standardization of marrow deficiency syndrome.Methods:Traditional Chinese medical classics preserved in the library of Shandong University of Traditional Chinese Medicine and relevant literature in CNKI,SinoMed,VIP,and Wanfang were searched,to screen the symptom items related to marrow deficiency state.Under the guidance of traditional Chinese medicine theory,high-frequency symptoms were selected,and a item pool was established.The Delphi method was used in the study and discussion of the key items.Experts were invited to give advice on items selection.After three rounds of consultation,the opinions of the experts were basically coordinated.Results:In the three rounds of consultation,the positive coefficient of experts was 93.75%,100.00%and 100.00%respectively,and the S-CVI/Ave was 0.862,0.924 and 0.929 respectively.In the third round consultation,the final Kendall’s coefficient was 0.380.According to the degree of coordination and concentration of the experts’opinions,20 key symptoms of marrow deficiency syndrome were determined,including 8 primary symptoms:forgetfulness,decreased intelligence,slow response,weak waist and knees,loose or lost or withered teeth,poor hair quality or hair loss or grey hair,growth retardation and mental retardation in children;9 secondary symptoms:mental fatigue,decreased attention,intracranial tinnitus,dizziness,headache with an empty feeling in the head,blurred vision,tinnitus,withered auricle,humpback;3 symptoms about tongue and pulse condition:thin tongue,weak pulse and feeble pulse.Conclusions:The physiological characteristics and anatomical structure of marrow make the clinical manifestations of marrow deficiency syndrome involve multiple systems of the whole body.The symptoms in the results of this study are representative and specific in the diagnosis of marrow deficiency syndrome in corresponding dimensions,which can provide a basis for follow-up researches.