中医体质量表与六维健康调查简表第一版(SF-6Dv1)的映射研究

Mapping the Constitution in Chinese Medicine Questionnaire to SF-6Dv1

目的构建中医体质量表映射到六维健康调查简表第一版(SF-6Dv1)健康效用的转换模型并进行评价,以拓宽中医体质量表的应用范围。方法纳入595例接受中医体质综合干预者为研究对象,分别于干预前及干预3、6个月进行中医体质量表和SF-6Dv1量表信息收集;构建估计数据集和验证数据集,应用普通最小二乘法(OLS)、MM稳健回归、截断最小绝对离差(CLAD)和Tobit模型四种统计算法建立备选模型;采用平均绝对误差(MAE)、均方根误差(RMSE)和组内相关系数(ICC)评估模型的预测性能。结果3个时间点中医体质量表各体质评分与SF-6Dv1健康效用值呈显著相关,其中平和质评分与SF-6Dv1健康效用值呈正相关(r为0.596、0.578、0.606,均P<0.05),8种偏颇质评分与SF-6Dv1健康效用值呈负相关(r为-0.586~-0.301,均P<0.05)。基于中医体质量表各亚量表评分构建的MM稳健回归为最佳映射模型,MAE、RMSE和ICC分别为0.0741、0.0930和0.766,进入模型的变量主要有平和质、气虚质、痰湿质、气郁质和年龄。经2次验证SF-6Dv1健康效用值的实测值与预测值呈中等正相关(r为0.673、0.617,均P<0.05),Bland-Altman图显示SF-6Dv1健康效用值的实测值与预测值一致性较好。结论中医体质量表可通过MM稳健回归转换为SF-6Dv1健康效用值,适用于卫生经济学评价。

Objective To construct and evaluate the transformation model of the Constitution in Chinese Medicine Questionnaire(CCMQ)to SF-6Dv1 health utility and broaden the applications of CCMQ.Methods The data of CCMQ and SF-6Dv1 were collected from 595 participants at baseline,3 months and 6 months after the comprehensive intervention suitable for the corresponding traditional Chinese medicine(TCM)constitution.The estimation and validation datasets were constructed,and four statistical algorithms including the ordinary least squares(OLS),MM robust regression(MM),censored least absolute deviations(CLAD)and the Tobit model were used to create alternative models.The mean absolute error(MAE),root mean square error(RMSE)and intraclass correlation coefficient(ICC)were used to evaluate the prediction performance of the model.Results The constitution scores of all TCM constitutions by CCMQ was significantly correlated with the SF-6Dv1 health utility value measured at three timepoints;the health utility value of the SF-6Dv1 was positively correlated with gentleness type(r=0.596,r=0.578,r=0.606,all P<0.05)and negatively correlated with eight unbalanced constitutions(r=-0.586~-0.301,all P<0.05).The MM established based on the subscale scores of CCMQ was the optimal mapping model,and the MAE,RMSE,and ICC values were 0.0741,0.0930 and 0.766,respectively.Gentleness type,qi-deficiency type,phlegmwetness type,qi-constraint type,and age were the primary factors included in the model.The measured and predicted value of SF-6Dv1 had a moderate positive correlation(r=0.673,r=0.617,P<0.05)and a good consistency as shown by the Bland-Altman plot.Conclusion By using MM,the CCMQ can be transformed into SF-6Dv1 health utility value for health economics analysis.