基于德尔菲法的强直性脊柱炎脾虚湿阻证诊断指标的研究  

Research on diagnostic indicators for ankylosing spondylitis syndrome of spleen deficiency and dampness obstruction with Delphi method

作　　者：杨辉[1] 黄琳[1] 李海昌[1] 曹炜[2] 范永升[1] 谢志军[1] 王忆勤 周岳君[1] 温成平[1] YANG Hui;HUANG Lin;LI Hai-chang;CAO Wei;FAN Yong-sheng;XIE Zhi-jun;WANG Yi-qin;ZHOU Yue-jun;WEN Cheng-ping(School of Basic Medical Sciences,Zhejiang Chinese Medical University,Hangzhou 310053,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Department of Traditional Chinese Medicine Diagnosis,Basic Medical College of Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]浙江中医药大学基础医学院,杭州310053 [2]中国中医科学院广安门医院,北京100053 [3]上海中医药大学基础医学院中医诊断教研室,上海201203

出　　处：《中华中医药杂志》2022年第9期5304-5307,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：浙江中医药大学远志人才项目(No.2019ZR07)。

摘　　要：目的:采用专家调查的方式筛选强直性脊柱炎脾虚湿阻证的诊断指标,评价其重要性,以形成强直性脊柱炎脾虚湿瘀证的证候诊断标准。方法:制定强直性脊柱炎脾虚湿阻证诊断标准体系专家咨询问卷,遴选全国风湿免疫领域从事中医、中西医结合临床工作的专家20位,进行3轮问卷调查;统计专家积极系数,采用五尺度评分法,采用直接打分法、直接估计法、百分比法、秩和比法对专家指标重要性进行评估;并采用算数均数、等级和、满分比分析专家评价意见集中程度;采用变异系数(CV)、协调系数分析专家评价意见协调程度;并针对条目的赋分进行临床验证。结果:对专家指标重要性评估结果中,主要症状:(1)中轴关节酸痛;(2)脊背活动受限、凌晨痛甚伴活动后缓解,伴腰骶沉重、僵硬(必备);(3)纳少甚或纳呆;(4)肢体酸楚困重,神疲乏力;(5)舌苔腻。秩和比法值依次为0.15、0.14、0.13、0.12、0.10。专家评价意见集中程度分析结果中,主要症状的专家评分算数均数为4.95分,满分比为98%,CV为0.04。第1轮问卷CV波动在0.24~0.44,第2轮专家问卷CV波动在0~0.44,第3轮专家问卷CV波动在0~0.27。结论:经过3轮调查研究,专家积极程度和专业程度较高,意见可信度较高,且协调程度较高,基本形成强直性脊柱炎脾虚湿阻证的诊断标准。Objective: To screen the diagnostic indicators of spleen deficiency and dampness syndrom of ankylosing spondylitis by means of expert investigation and evaluate its importance, so as to form the diagnostic criteria of spleen deficiency and dampness syndrom of ankylosing spondylitis. Methods: This study developed a standard questionnaire for the diagnosis of spleen deficiency and dampness syndrome in ankylosing spondylitis, and selected 20 clinical experts, through three rounds of questionnaire surveys, statistical experts’ positive coefficients, evaluation indicators degree of concentration of expert evaluation opinions, coordination of expert opinions analysis by five-scale scoring method. Results: The main symptoms:(1)Centraxonial joint sale,(2)limited back movement, and the pain intensified in wee hours,(3)poor appetite and digestion,(4)Body sale and ache,(5)whitish glossy coating of the tongue, the rank sum ratio method value were 0.15, 0.14, 0.13, 0.12, 0.10. The average expert score of the main symptoms was 4.95, the full score ratio was 98%, and the CV(CV) was 0.04. The CV of the first round of questionnaires fluctuated between 0.24-0.44. The CV of the second round of expert questionnaire fluctuates between 0-0.44, and the CV of the third round of expert questionnaire fluctuates between 0-0.27. Conclusion: The experts in this survey have high enthusiasm and professionalism, high credibility of opinions and high degree of coordination. After three rounds of investigation,the diagnostic criteria of spleen deficiency and dampness syndrom of ankylosing spondylitis are formed.

关 键 词：强直性脊柱炎 脾虚湿阻证 诊断标准 德尔菲法 诊断指标 

分 类 号：R259[医药卫生—中西医结合]