基于改良德尔菲法的支气管哮喘急性发作风险预警因素调查表及条目筛选研究

Risk Prediction Questionnaire and Item Screening for Acute Exacerbation of Asthma Based on the Modified Delphi Technique

背景我国哮喘患者人群庞大,发病率逐年上升,整体控制较差,急性发作率高,然而导致哮喘急性发作的风险因素较多,缺乏系统的筛选。目的基于改良德尔菲法筛选哮喘急性发作风险预警因素,形成临床调查表,为多维度构建风险预测模型提供参考。方法基于文献报道和临床预调查,制定哮喘急性发作风险预警因素专家咨询问卷,遴选行业专家30名,采用改良德尔菲法于2021年4—10月通过电子邮件的方式进行两轮问卷咨询,使用SPSS 25.0软件对风险预警因素进行赋权和分析,并根据专家组讨论制定的筛选标准,最终确定哮喘急性发作风险预警因素。结果两轮专家咨询的积极系数均为100%,专家熟悉程度分别为0.894、0.920,判断依据为0.963、0.976,权威系数为0.929、0.948,肯德尔和谐系数为0.331、0.437(P<0.001)。筛选出的哮喘急性发作风险预警因素包括临床症状/体征、疾病情况、生存质量、生物学信息、中医证候、患者基本情况6个一级指标,疾病严重程度、哮喘控制测试、喘息、胸闷、过敏史、激素类药物使用情况、工作/生活环境、嗜酸粒细胞、过去一年急性发作次数、患者依从性、气候/季节变化等29个二级指标。结论基于改良德尔菲法筛选出的哮喘急性发作风险预警因素包括临床症状/体征、疾病情况、生存质量、生物学信息、中医证候、患者基本情况6个一级指标及29个二级指标,较为精炼,可为后续研究提供参考。

Background China owns a huge number of asthma patients and an increasing incidence of asthma,but low rate of overall control and high rate of acute asthma exacerbation.Moreover,there is a lack of methods for systematically screening the risks of acute exacerbation of asthma.Objective To develop a risk prediction questionnaire for acute exacerbation of asthma after screening the associated risk factors using the modified Delphi technique,providing a reference for building a multidimensional risk prediction model of asthma acute exacerbation.Methods Based on literature reports and our clinical pre-investigation results,an expert consultation questionnaire on risk predictors of acute exacerbation of asthma was developed,and was distributed through E-mail to 30 experts for review through two rounds of online consultation survey using the modified Delphi technique conducted from April to October 2021.SPSS 25.0 was used to assign weight and analyze the risk predictors.Then according to the screening criteria developed by the experts,the risk predictors were finally determined.Results Both two rounds of consultation achieved a 100%response rate.The familiarity,judgment,and authority coefficients as well as Kendall’s W were 0.894,0.963,0.929,and 0.331,respectively,for the first round of expert consultation(P<0.001),and were 0.920,0.976,0.948,and 0.437,respectively,for the second round of expert consultation(P<0.001).The determined risk predictors of acute exacerbation of asthma include six domains(clinical symptoms and signs,conditions,quality of life,biological information,traditional Chinese medicine syndromes and basic demographics),and 29 indices including severity of asthma,Asthma Control Test,wheezing,chest tightness,allergy history,hormone therapy,work and living environment,eosinophils,number of exacerbations in the past year,treatment compliance,climate and seasonal changes,and so on.Conclusion The based on the modified Delphi method,the risk predictors of acute exacerbation of asthma determined using expert consultation with the modified Delphi technique include the aforementioned six domains and 29 indices,which is relatively concise,and can provide a reference for follow-up studies.