胃癌前病变脾虚血瘀证诊断量表的研制及验证

Development and Verification of Diagnostic Scale for Spleen Deficiency and Blood Stasis Syndrome in Gastric Precancerous Lesions

目的:编制胃癌前病变脾虚血瘀证诊断量表并进行效能验证。方法:通过文献及专家访谈,形成胃癌前病变脾虚血瘀证诊断量表条目池;采用综合区分度法、相关系数法和克朗巴赫系数法对条目进行筛选;以Logistic回归法确定条目的权重分值,ROC曲线确定诊断界值,形成脾虚血瘀证诊断量表。结果:胃癌前病变脾虚血瘀证诊断量表中包括7个条目,分别为胃脘刺痛、食欲不振、乏力、胃脘痞满、大便溏稀、舌暗红、舌有瘀点。当得分≥20分时,脾虚血瘀证诊断成立。经小样本验证该量表敏感度为85.71%,特异度为90.63%,准确度为88.33%。结论:胃癌前病变脾虚血瘀证诊断量表敏感度、特异度表现良好,可满足临床及科研使用,其编制思路及方法可为病证结合的复合证候量表的研制提供借鉴。

Objective:To develop the diagnostic scale of Spleen deficiency and blood stasis syndrome in gastric precancerous lesions and verify its efficacy.Methods:Through literature and expert interviews,the item pool of the diagnostic scale of Spleen deficiency and blood stasis syndrome in gastric precancerous lesions was formed.The comprehensive discrimination method,correlation coefficient method and Kronbach coefficient method are used to screen the items;Logistic regression method was used to determine the weight scores of items,and ROC curve was used to determine the diagnostic threshold,thus forming the diagnostic scale of Spleen deficiency and blood stasis syndrome.Results:The diagnostic scale of Spleen deficiency and blood stasis syndrome in precancerous lesions of stomach included seven items,namely,stabbing pain in the stomach,loss of appetite,fatigue,fullness in the stomach,loose stool,dark red tongue and petechiae on the tongue.When the score is≥20,the diagnosis of Spleen deficiency and blood stasis syndrome is established.The sensitivity,specificity and accuracy of the scale were 85.71%,90.63%and 88.33%respectively.Conclusion:The sensitivity and specificity of the diagnostic scale of Spleen deficiency and blood stasis syndrome in gastric precancerous lesions are good,which can meet the needs of clinical and scientific research.The ideas and methods of its compilation can provide reference for the development of the composite syndrome scale combining syndrome with disease.