基于德尔菲法和层次分析法构建肝郁气滞证诊断量表

Construction of Diagnostic Scale of Liver Constraint and Qi Stagnation Syndrome Based on Delphi Method and Analytic Hierarchy Process

目的初步构建肝郁气滞证诊断量表。方法检索数据库中国知网、维普、万方、SinoMed从建库之日至2020年10月31日,筛选有关肝郁气滞证的病因病机、危险因素、临床症状及体征的临床观察、专家经验类文献。通过前期文献系统评价、专家会议讨论和课题组进行中医名词整理,选择频次大于15的条目进入条目池。采用德尔菲法进行3轮专家咨询确定条目指标,结合层次分析法明确指标权重;用支持度、均数、满分比、等级和、不重要百分比、变异系数进行条目筛选,层次分析法计算的比重作为条目权重,形成肝郁气滞证诊断量表。结果共纳入分析文献98篇。构建的条目池有17个条目。3轮专家德尔菲法共收回有效问卷84份,总专家积极系数99%,权威程度系数均>0.8,协调系数分别为0.648、0.512、0.384。经支持度、均数、满分比、等级和、不重要百分比、变异系数统计,筛选出脉弦、胀满(闷)或胀痛或窜痛(胸胁、少腹、乳房等)、情志抑郁、脉沉弦、舌质淡红、苔薄白、遇情志不遂时易诱发或加重、急躁易怒、太息、咽部异物感、月经不调、痛经12个条目。层次分析法得到一级指标的比重由高到低的排序为:临床症状、脉象、舌象;二级指标的比重由高到低的排序分别为:脉弦、胀满(闷)或胀痛或窜痛(胸胁、少腹、乳房等)、情志抑郁、脉沉弦、舌质淡红、苔薄白、遇情志不遂时易诱发或加重、急躁易怒、太息、咽部异物感、月经不调、痛经。结论初步构建的肝郁气滞证诊断量表主要指标包括胀满(闷)或胀痛或窜痛(胸胁、少腹、乳房等)、脉弦,次要指标包括情志抑郁、遇情志不遂时易诱发或加重、舌质淡红、苔薄白、脉沉弦、急躁易怒、太息,其他指标包括咽部异物感、月经不调、痛经。

Objective To preliminarily construct the diagnostic scale of liver constraint and qi stagnation syndrome.Methods The databases including CNKI,VIP,Wanfang and Sinomed were searched from the inception dates to October 31,2020 for clinical studies exploring the etiology and pathogenesis,risk factors,clinical symptoms and signs of liver constraint and qi stagnation syndrome.Based on the previous systematic evaluation of medical literature,experts meeting,and traditional Chinese medicine(TCM)terminology standardization,items with a frequency greater than 15 were selected to be an item pool.Delphi method was used for three rounds of consultation with experts to determine the items,and the weight of the items was determined by analytic hierarchy process(AHP).The level of support,mean value,full score ratio,grade sum,unimportant percentage and coefficient of variation were used to screen out the items,and the proportion calculated by AHP was used as the weight for each item to develop the diagnostic scale of liver constraint and qi stagnation syndrome.Results A total of 98 articles were included,and 17 items were obtained in the item.In the three rounds of Delphi survey,84 valid questionnaires were collected,with99%expert positive coefficient and the degree of authority coefficients>0.8,and the coordination coefficient was0.648,0.512,and 0.384,respectively.After analyzing the level of support,mean value,full score ratio,grade sum,unimportant percentage and coefficient of variation,12 items were selected including wiry pulse,distention(oppression)or distending pain or scurrying pain(of chest and rib-side,lesser abdomen,breast,etc.),emotional depression,deep wiry pulse,light red tongue,thin white coating,induced or aggravated in case of emotional distress,impatience and irascibility,sighing,globus pharyngeus,menstrual irregularities,and painful menstruation.The weights of the first level items obtained by AHP were ranked from high to low as follows:clinical symptoms,pulse manifestation,and tongue manifestation;the weights of second level items from high to low were:wiry pulse,distention(oppression)or distending pain or scurrying pain(of chest and rib-side,lesser abdomen,breast,etc.),emotional depression,deep wiry pulse,light red tongue,thin white coating,induced or aggravated in case of emotional distress,impatience and irascibility,sighing,globus pharyngeus,menstrual irregularities,and painful menstruation.Conclusion The preliminarily constructed diagnostic scale of liver constraint and qi stagnation syndrome is consisted of primary items including distention(oppression)or distending pain or scurrying pain(of chest and rib-side,lesser abdomen,breast,etc.)and wiry pulse,as well as secondary items including emotional depression,induced or aggravated in case of emotional distress,light red tongue,thin white coating,deep wiry pulse,impatience and irascibility,and sighing,and other items such as globus pharyngeus,menstrual irregularities,and painful menstruation.