小儿反复呼吸道感染中医证候量表的建立与评价  

Construction and Evaluation of Pediactric RRTI TCM Syndrome Macro-differentiation Quantification Form

作　　者：王力宁[1] 黄志碧[2] 刘含[1] 蔡晓静[3] 初晓[1] 张晓春[1] 蒙美禄[1] 张磊[1] 

机构地区：[1]广西中医学院第一附属医院,广西南宁530023 [2]广西医科大学公共卫生学院,广西南宁530021 [3]北海市中医院,广西北海536000

出　　处：《中华中医药学刊》2009年第7期1392-1396,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：广西科技开发与研究立项课题(桂科攻0472002-34)

摘　　要：目的:探讨小儿反复呼吸道感染中医辨证分型规律及其量化诊断方法,科学评价小儿反复呼吸道感染《中医证候宏观辨证量表》的实用价值。方法:在文献研究的基础上,设计《小儿反复呼吸道感染证候学及其影响因素问卷调查表》,通过多中心临床问卷调查,收集438例2～7岁的反复呼吸道感染患儿的辨病资料、《中医证候宏观辨证量表》、《主要症状体征分度表》数据及发病与证候形成因素信息等资料,与同期的116例儿童作对照。《中医证候宏观辨证量表》分为营卫失调证、肺脾气虚证、肺脾阴虚证、脾虚肝旺证、脾气肾阳虚证等若干证型,以各证候表现的无、轻、中、重及权重系数计算积分总和的比例优势作为证候分型的依据;通过填写《主要症状体征分度表》判断各证型主症的性质与程度,并对《中医证候宏观辨证量表》填写的符合一致性信度检验。采用logistic回归模型,对RRTI主要证型的主要和次要症状进行分析;运用Bayes判别分析方法,对营卫失调、肺脾气虚、脾肺阴虚、脾虚肝旺、脾肾两虚等分型的主要证候进行分析。结果:438例复感儿患儿经量表判断为营卫失调证型88例(20.10%),肺脾气虚证型186例(42.47%),肺脾阴虚证型45例(10.27%),脾虚肝旺证型66例(15.07%),脾肾两虚证型10例(2.28%),其他证型43例(9.82%);各个证型预测营卫失调型符合率为88.3%,肺脾气虚型符合率为66.4%,肺脾阴虚型符合率为91.5%,脾虚肝旺型符合率为88.3%,脾肾两虚符合率为98.4%;面色萎黄、大便溏烂、食少纳呆、多汗易汗、舌淡苔白、大便干结、苔花剥、脉细数、心烦易怒、舌淡红、四肢不温、发育落后、脉弱、恶风恶寒、脉无力等15个症状是RRTI主要证型分型的依据,得出RRTI主要证型的判别函数式,营卫失调证、肺脾气虚证、脾肺阴虚证、脾肺阴虚证、脾肾两虚证的预测符合率分别为71.6%、7Objective：To do research on TCM syndrome differentiation and quantificational diagnosis of pediatric recurrent respiratory tract infections（RRTI） and evaluate the practicality of TCM Syndrome Macro -differentiation Quantification Form. Method： Based on the literature studay, a Questionary of TCM Syndrome Differentiation and its Impact Factors of Pediatric RRTI was designed. With the method of clinical multicenter survey, the information of 438 RRTI cases who are 2-7 year-old were collected and analyzed comparing with 116 nomal cases in the same term. These information which including data from TCM Syndrome Macro- differentiation Quantification Form, Main synptom ＆ Physical Sign Scaling Table, syndrome - forming factors and other information in syndrome differentiation. In TCM Syndrome Macro-differentiation Quantification Form, RRTI syndromes were divides into several types which including Ying- wei -disturbance, Lung-spleen-qideficiency, Lung-spleen-yin-deficiency, Spleen-deficiency-and-hyperactive-liver-fire, Spleen-qi-and-kidney-yang deficieney. The differentiation metioned above were based on the proportional odds of calculation result of severe extent and weight coefficient. The property and severe extent of main symptoms in each type were measured by Main synptom ＆ Physical Sign Scaling Table. The consistency test of content of Syndrome Macro-differentiation Quantification Form were conducted also. Main and secondary symptoms of RRTI cases were analyzed with logistic regression model. 5 common types of syndromes, which includs Ying-wei-disturbance, Lung-spleen-qi-deficiency, Lung-spleen-yin-deficiency, Spleen-deficiency-and-hyperacfive-liver-fire, Spleen-qi-and-kidney-yang deficiency,were analyzed with Bayes discriminant analysis. Result ：438 RRTI cases were differenciated as followed： 88 cases（20. 10% ）with Ying-wei -disturbance, 186 eases （42. 47% ）with Lung-spleen-qideficiency, 45 cases （10. 27% ） with Lung-spleen-yin-deficiency, 66 cases（ 15. 07% ）with Spleen-deficiency-an

关 键 词：小儿反复呼吸道感染 中医辨证 证候量表 

分 类 号：R56[医药卫生—呼吸系统]