支气管哮喘证候诊断标准的初步验证  

Initial Validation of Diagnostic Criterion of Bronchial Asthma Syndrome

作　　者：李建生[1] 王至婉[1,2] 余学庆[1,2] 李海霞[1] 张钊旺[1] 

机构地区：[1]河南中医药大学/呼吸疾病诊疗与新药研发河南省协同创新中心 [2]河南中医药大学第一附属医院

出　　处：《中医杂志》2016年第20期1772-1776,共5页Journal of Traditional Chinese Medicine

基　　金：国家重点基础研究发展计划("973"计划)(2006CB504605);国家自然科学基金(81173201);国家中医药管理局国家中医临床研究基地业务建设科研专项(JDZX2012029);郑州市科技领军人才项目(131PJRC659)

摘　　要：目的初步验证本项目所建立的支气管哮喘证候诊断标准的诊断效能。方法采用前瞻性研究方法,收集4所三级医院支气管哮喘患者300例资料并建立数据库,采用＂支气管哮喘中医证候诊断调查表＂调查患者外寒内饮证、痰浊阻肺证、痰热壅肺证、风痰阻肺证、血瘀证、肺气虚证、肺脾气虚证、肺肾气虚证、肺肾阳虚证、阳气暴脱证10个证候分布情况,同时以专家经验辨证进行对照。选择敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、曲线下面积作为评价指标。结果发放表格300份,收回300份,有效300份,其中急性发作期200份,慢性持续期30份,临床缓解期70份。10个常见证候中,敏感度范围为78.26%~98.48%,其中血瘀证的敏感度最高（98.48%）,阳气暴脱的敏感度最低（78.26%）;特异度范围为90.64%~99.15%,其中血瘀证的特异度最高（99.15%）;准确度范围为90.67%~99.00%,其中血瘀证的准确度最高（99.00%）;阳性预测值范围为60.98%~97.01%;阴性预测值范围为95.38%~99.57%;阳性似然比范围为9.70~115.23;阴性似然比范围为0.02~0.23。ROC曲线下面积范围为0.803~0.954,其中血瘀证曲线下面积最大（0.954）,其次是痰热壅肺证、痰浊阻肺证,分别是0.913、0.901,肺肾气虚证、阳气暴脱证的曲线下面积较小,分别为0.803、0.809。结论支气管哮喘证候诊断标准有较好的灵敏度、特异度、准确性,其中实证的诊断效能优于虚证,实证中血瘀证的诊断效能最好,其次是痰热壅肺证、痰浊阻肺证。Objective To initially verify diagnostic efficiency of diagnostic criterion of bronchial asthma syndrome established in this project. Methods Foresight research methods was adopted to collect information of 300 cases of bronchial asthma from four grade Ⅲ,class A hospitals and to establish a database. ＂Questionnaire of Chinese Medicine Syndrome of Bronchial Asthma Diagnosis＂was used to investigate distribution of 10 syndromes in patients,including cold in the exterior and fluid retention syndrome,phlegm-turbid obstruction lung syndrome,phlegm-heat obstructing lung syndrome, wind-phlegm blocking lung syndrome, blood stasis syndrome, lung Qi deficiency syndrome,lung and spleen Qi deficiency syndrome,lung and kidney Qi deficiency syndrome,lung and kidney Yang deficiency syndrome,and sudden loss of Yang-Qi syndrome. At the same time,syndrome differentiation was conducted by experienced Chinese medical experts,and the results from both investigation and clinical experts were compared.Sensitiveness,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative predictive value,and area under the curve were selected as the evaluation indices. Results Three hundred questionnaires were distributed and they were all returned back as valid ones. Among them,there were 200 in acute attack,30 in chronic persistent stage,and 70 in clinical remission. Among 10 common syndromes with sensitiveness range of 78. 26%- 98. 48%,blood stasis syndrome was with the highest sensitiveness（ 98. 48%） and sudden loss of Yang-Qi syndrome with the lowest sensitiveness（ 78. 26%）; the specificity range was 90. 64%- 99. 15% and blood stasis syndrome was with the highest specificity among them（ 99. 15%）; the accuracy range was 90. 67%-99. 00% and blood stasis syndrome was with the highest accuracy among them（ 99. 00%）; the positive predictive value range was 60. 98%- 97. 01%; the negative predictive value range was 95. 38%- 99. 57%; the positive likelihood ratio range was 9. 70- 115.

关 键 词：支气管哮喘 证候诊断 标准验证 

分 类 号：R256.12[医药卫生—中医内科学]