基于病证结合及证候要素构建中医辨证诊断量表的研究思路与方法

Constructing TCM Syndrome Differentiation Diagnostic Scale Based on Combination of Disease and Syndrome and Syndrome Elements Research Ideas and Methods

[目的]探究中医辨证诊断量表的构建思路与方法。[方法]基于病证结合的角度,以不寐病-心证证素维度为例,选择相应的统计学方法,通过文献回顾性分析,对心证证素条目进行数据挖掘;采用专家咨询法对心证证素条目进行主观筛选;运用横断面流行病学方法收集中医四诊资料,对心证证素条目进行客观筛选;并对不寐病-心证证素维度中医诊断量表进行信度、效度考评及诊断性试验。[结果]经归并、拆分、修改等规范化处理,拟定不寐病-心证症状条目池,确立专家意见咨询调查表;通过主、客观相结合,多维度综合筛选,得出重要性高、特异度强、内部一致性好的心证证素条目;采用Logistic回归分析确定各证素条目的贡献值,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)确定心证维度的最佳诊断阈值;构建灵敏度、特异度及诊断效能俱佳的不寐病-心证证素维度中医诊断量表。[结论]基于病证结合,通过文献数据挖掘分析,主、客观综合筛选条目,是构建中医辨证诊断量表的可行思路,该思路能为中医辨证诊断的客观化、规范化及可量化提供一定指导。

[Objective]To explore the construction ideas and methods of traditional Chinese medicine(TCM)syndrome differentiation and diagnosis scale.[Methods]Based on the combination of disease and syndrome,the dimension of insomnia disease-heart syndrome elements was taken as an example,and the corresponding statistical methods were selected to carry out data mining on the entries of heart syndrome elements through retrospective literature analysis.It subjectively screened the entries of heart syndrome elements by expert consultation method;cross-sectional epidemiological method was used to collect the data of the four diagnoses of TCM,and objective screening was conducted for the entries of heart syndromes.The reliability,validity and diagnostic test of insomnia disease-heart syndrome element dimension TCM diagnostic scale were carried out.[Results]By merging,splitting,modifying and other standardized treatments,it developed insomnia disease-heart syndrome symptom item pool,established expert advice questionnaire;through the combination of subjective and objective,multi-dimensional comprehensive screening,the items of high importance,strong specificity and good internal consistency were obtained.Logistic regression analysis was used to determine the contribution value of each syndrome element,and the receiver operating characteristic curve(ROC)was used to determine the best diagnostic threshold of the heart syndrome dimension.It constructed TCM diagnostic scale of insomnia disease-heart syndrome element dimension with good sensitivity,specificity and diagnostic efficacy.[Conclusion]Based on the combination of disease and syndrome,through literature data mining,the method of subjective and objective comprehensive screening of syndrome elements is a feasible idea to construct the scale of TCM syndrome differentiation and diagnosis.This idea can provide some guiding significance for the objectification,standardization and quantification of TCM syndrome differentiation and diagnosis.