结直肠腺瘤湿证量化诊断方法的探索性研究

Exploratory Study on Quantitative Diagnostic of Dampness Syndrome of Colorectal Adenoma

目的初步建立结直肠腺瘤湿证量化诊断方法并对其进行评价,为结直肠腺瘤证候诊断提供参考。方法纳入结直肠腺瘤患者334例,按照就诊时间顺序分为训练组200例、验证组134例。将训练组患者按照中医四诊信息分为湿证亚组和非湿证亚组,剔除应答率<3%的条目后,筛选出两亚组频率差异具有统计学意义的因素为量化诊断条目,采用条件概率公式换算法对诊断条目进行赋分,以最大似然判别方法确定诊断阈值和分级标准,初步确立量化标准。分别对训练组及验证组患者进行回顾性和前瞻性检验,计算其灵敏度、特异度、准确度、阳性似然比等指标,对量化标准进行评价。结果训练组患者中湿证亚组176例,非湿证亚组24例,两个亚组患者40项诊断条目中差异具有统计学意义的诊断条目19项。对其依次进行赋分后,确定量化诊断阈值为45,结直肠腺瘤湿证量化诊断标准为:舌苔腻(7分)、舌苔厚(8分)、头重如裹(9分)、周身沉重(6分)、四肢困重(6分)、大便黏腻不爽(6分)、口中黏腻(10分)、形体肥胖(6分)、思睡(12分)、怠惰懒动(13分)、脘腹痞满(8分)、少腹胀痛(11分)、腰膝酸困(8分)、关节肌肉酸楚/酸痛(9分)、便溏(12分)、口气重(15分)、脉滑(8分)、眼分泌物多(7分)、舌体胖大(10分)。分级标准:轻度为45≤积分<61,中度为61≤积分≤104,重度为积分>104。对量化标准用200例训练组患者进行回顾性检验,灵敏度为86.36%、特异度为95.83%、准确度为87.50%,阳性似然比20.73;以验证组134例患者进行前瞻性检验,灵敏度76.64%、特异度96.30%、准确度80.60%、阳性似然比20.69。结论病证结合模式初步建立结直肠腺瘤湿证量化诊断方法具有较好的判别效果,可为相关研究提供依据。

Objective To preliminarily establish and verify the quantitative diagnosis method of dampness syn⁃drome of colorectal adenoma,so as to provide evidence for the diagnosis of colorectal adenoma syndrome.Methods This study included 334 patients with colorectal adenoma,who were grouped into 200 in the training group and 134 in the validation group by clinical visits chronologically.According to the data from the four examinations of traditional Chinese medicine,patients in training group were subgrouped into dampness syndrome subgroup and non-dampness syndrome subgroup.After eliminating items with response rate less than 3%,the factors showed statistical difference in frequency between the subgroups were screened as diagnostic items.The diagnostic items were assigned scores us⁃ing the conditional probability formula conversion method,and the diagnostic thresholds and grading criteria were de⁃termined by the maximum likelihood discriminant method,so as to establish the quantitative criteria preliminarily.Retrospective and prospective tests were conducted respectively on patients in training group and validation group,in⁃cluding the sensitivity,specificity,accuracy,positive likelihood ratio and other indexes,to evaluate the quantitative criteria.Results The training group included 176 participants as dampness syndrome subgroup and 24 participants as non-dampness syndrome subgroup,who applied 40 diagnostic items,and 19 related factors were identified as sig⁃nificant differences.After assigning the scores in turn,the quantitative diagnostic threshold was determined as 45,and the quantitative diagnostic criteria for colorectal adenoma with dampness syndrome were as follows:greasy coating(7 scores),thick coating(8 scores),heaviness of head(9 scores),heaviness of whole body(6 scores),heaviness of limbs(6 scores),sticky and greasy stool(6 scores),sticky and greasy mouth(10 scores),obesity(6 scores),sleep⁃iness(12 scores),laziness(13 scores),epigastric fullness(8 scores),abdominal distension and pain(11 scores),lumbar and knee aches and heaviness(8 scores),joint and muscle aches and pains(9 scores),loose stools(12 scores),fetid mouth odor(15 scores),slippery pulse(8 scores),overabundance of eye secretion(7 scores),and large touge(10 scores).Grading criteria:45≤points<61 as mild,61≤points≤104 as moderate,points>104 as severe.In the test retrospective of the training group involving 200 patients,the sensitivity,specificity,accuracy,and positive likelihood ratio were 86.36%,95.83%,87.50%,and 20.73 respectively;In the test prospective of the verification group involving 134 patients,the sensitivity,specificity,accuracy,and positive likelihood ratio were 76.64%%,96.30%,80.60%,and 20.69,respectively.Conclusion It is effective to diagnose and identify the dampness syndrome of colorectal adenoma by preliminarily establish a quantitative diagnostic method with a combined model of disease and evidence,and the method may provide support for future related studies.