层次分析法对2型糖尿病(气阴两虚证)中成药处方决策的优先度排序研究  

Priority ranking of Chinese patent medicine prescriptions for type 2 diabetes mellitus(syndrome of deficiency of both Qi and Yin):based on analytic hierarchy process(AHP)

作　　者：方健 谢晴宇 孟庆刚[1] 孟洪宇 栾相佳[4] FANG Jian;XIE Qing-yu;MENG Qing-gang;MENG Hong-yu;LUAN Xiang-jia(Beijing University of Chinese Medicine,Beijing 100029,China;Yinchuan Internet Hospital,Yinchuan 750027,China;Department of Renal Endocrinology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Geriatrics Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]北京中医药大学,北京100029 [2]银川医联互联网医院,宁夏银川750027 [3]北京中医药大学东直门医院肾病内分泌科,北京100700 [4]中国中医科学院广安门医院老年病科,北京100053

出　　处：《中国中药杂志》2022年第8期2237-2243,共7页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金面上项目(81973980)。

摘　　要：医生决策、患者需要和最佳证据构成了循证医学的三要素,在获得高级别、高质量证据的同时,对从定性到定量的医生处方决策进行分析,有助于提高临床疗效。对于循证证据的检索、分析、综合以及评价、推荐,目前已形成较为成熟的方法体系,然而对于医生决策的研究尚少。如何通过对加减用药优先度的排序分析医生临床决策的趋势,层次分析法(AHP)是将决策问题按总目标、各层次的子目标、评价准则的顺序分解为不同层次结构,用矩阵特征向量法求解判断的方法。该文拟基于层次分析法进行特定临床场景中医医生对气阴两虚型糖尿病处方决策的优先度分析,通过建立气阴两虚型糖尿病案例集,采用层次分析法,计算特定临床场景中,中成药最佳疗效处方决策的优先度排序,在提取的气阴两虚型糖尿病情景案例中,消渴丸是治疗2型糖尿病(气阴两虚证)的最佳处方(正常化值=0.388),其次是六味地黄丸(正常化值=0.269)、芪参胶囊(正常化值=0.230)、参麦注射液(正常化值=0.113),基于现有数据分析,对于特定诊疗场景的2型糖尿病(气阴两虚证)中医医案,消渴丸是最有效的处方。当医生的处方决策与循证证据趋势一致,对医生决策认知进行定量化表示,有助于推动基于循证证据的医学决策。但也需认识到,研究结果在一定程度上同样受到文献质量与证据分级及推荐的优先级的影响,从而具有一些局限性,建议进一步进行基于个案的小数据研究,为2型糖尿病临床决策提供循证依据。Clinical expertise,patient preference,and the best evidence are the three elements of evidence-based medicine.Based on high-level and high-quality evidence,qualitative and quantitative analysis of the prescribing decisions of physicians is beneficial to improving clinical efficacy.A mature methodological system is available for the retrieval,analysis,summary,evaluation,and recommendation of the evidence,but there are still few studies on physicians′prescribing decisions.How to analyze the trend of physicians′prescribing decisions based on the priority ranking in addition and subtraction of prescriptions?Analytic hierarchy process(AHP)is a method for decision making,which arranges the elements of the decision problem into overall goal,criteria,and operational sub-criteria,and uses the matrix eigenvector method to solve the problem.This study aims to analyze the priority of physicians′prescribing decisions for diabetes mellitus with deficiency of both Qi and Yin based on AHP.To be specific,a database of diabetes mellitus cases with deficiency of both Qi and Yin was established and AHP was used to yield the priority ranking of Chinese patent medicine prescriptions in specific clinical scenarios.In the selected cases of diabetes mellitus with deficiency of both Qi and Yin,Xiaoke Pills was the best prescription for the treatment of type 2 diabetes mellitus(deficiency of both Qi and Yin)(normalized=0.388),followed by Liuwei Dihuang Pills(normalized=0.269),Qishen Capsules(normalized=0.230),and Shengmai Injection(normalized=0.113).According to the analysis the available data,for type 2 diabetes mellitus(deficiency of both Qi and Yin),Xiaoke Pills was the most effective prescription in specific scenarios.When the physicians′prescribing decisions are consistent with the evidence,quantitative analysis of physicians′cognition will boost the evidence-based medical decision-making.However,the research results are also affected by the quality of literature,evidence level and priority,which are thus have some limitatio

关 键 词：2型糖尿病 处方决策 层次分析法 循证证据 案例推理 

分 类 号：R259[医药卫生—中西医结合]