中医药疗效评价指标体系构建方法中存在的问题及思考  

Problems and Thinking on the Methods for Establishing the Effectiveness Evaluation Index System of Traditional Chinese Medicine

作　　者：张彭 张艺尹 许家昕 谢洋[1,3,4] ZHANG Peng;ZHANG Yiyin;XU Jiaxin;XIE Yang(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,450000;The First Clinical Medical College,Henan University of Chinese Medicine;Henan International Joint Laboratory of Evidence-based Evaluation for Respiratory Diseases,the First Affiliated Hospital of Henan University of Chinese Medicine;Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R.China,Henan University of Chinese Medicine/Henan Key Laboratory of Chinese Medicine for Respiratory Disease,Henan University of Chinese Medicine)

机构地区：[1]河南中医药大学第一附属医院,河南省郑州市450000 [2]河南中医药大学第一临床医学院,河南省郑州市450000 [3]河南省呼吸疾病循证评价国际联合实验室 [4]河南中医药大学呼吸疾病中医药防治省部共建协同创新中心/河南省中医药防治呼吸病重点实验室

出　　处：《中医杂志》2024年第18期1875-1881,共7页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划“中医药现代化”重点专项(2023YFC3502600,2023YFC3502601);河南省中医药科学研究专项课题(2024ZYZD04);河南省第二批中医药拔尖人才项目(豫卫中医函[2021]15号)。

摘　　要：指标的收集、筛选、赋权、综合评价是中医疗效评价指标体系建立的关键环节,通过系统梳理不同环节中的研究方法,分析其中存在的问题并提出思考与建议。指标收集方面,多采用文献研究和专家访谈法,患者的参与度不足;指标筛选方面,德尔菲法应用广泛,但尚缺乏指标筛选的标准和证据支持,少数研究应用了临床调查法;指标赋权方面,包括主观赋权法和客观赋权法,但多为单一种类赋权方法,指标权重缺乏可靠性;在综合评价方面,层次分析法、逼近理想点法、模糊综合评价法、秩和比法、模糊层次理想点法、灰色关联分析法、数据包络分析法等逐渐被应用于中医疗效评价研究,但多反映中医药的短期效应,无法凸显其远期疗效优势。基于此,提出在指标收集中应加强患者访谈,考虑患者观点;指标筛选过程中应为专家提供重要性判断的证据支持;指标赋权中,应融合主客观数据信息,积极开展优化组合赋权方法研究;最后搭建疾病信息化管理平台,构建动态综合评价模型,为中医药疗效评价提供思路与方法。The collection,screening,weighting,and comprehensive evaluation of indicators are key steps in establishing the effectiveness evaluation index system of traditional Chinese medicine(TCM).This article systematically reviewed the research methods in different stages,explored their existing problems,and provide reflections and recommendations.For indicator collection,literature research and expert interviews are generally used,but patient participation is not sufficient;for indicator screening,the Delphi method is the most widely used method,but there is still a lack of criteria and evidence to support indicator screening,and a few studies have applied clinical investigation methods;for indicator weighting,including subjective weighting and objective weighting,but they are mostly the application of a single type of method,and the indicator weights lack reliability;for comprehensive evaluation,analytic hierarchy process,TOPSIS,fuzzy comprehensive evaluation,rank sum ratio,the fuzzy-hierarchy technique for order preference by similarity to an ideal solution,grey relational analysis,and data envelopment analysis have gradually been applied to the study of TCM effectiveness evaluation,however,they often reflect the short-term effectiveness of TCM and can not highlight their long-term effectiveness advantages.Therefore,it is necessary to strengthen the participation of patients and consider their perspectives;in the process of selecting indicators,evidence support for importance judgments should be provided to experts;in indicator weighting,we should integrate subjective and objective data information and actively carry out research on optimizing combination weighting methods;finally,a disease information management platform could be established and a dynamic comprehensive evaluation model could be constructed to provide new ideas and methods for evaluating the effectiveness of TCM.

关 键 词：中医药疗效评价 疗效评价指标 指标权重 综合评价模型 

分 类 号：R2-03[医药卫生—中医学]