脾气虚、脾湿热、脾虚湿热证自评诊断量表的初步研制  

Preliminary development of a self⁃evaluation diagnostic scale for spleen qi deficiency,spleen damp⁃heat,and spleen deficiency with damp⁃heat syndromes

作　　者：姚思梦 朱晓霞 张佳河 刘凤斌[4,5] YAO Simeng;ZHU Xiaoxia;ZHANG Jiahe;LIU Fengbin(The Eighth Clinical College,Guangzhou University of Chinese Medicine,Foshan,Guangdong 528051,China;The Second Clinical College,Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China;Nongyuan Community Health Service Clinic of Shenzhen Hospital,Guangzhou University of Chinese Medicine,Shenzhen,Guangdong 518000,China;Department of Spleen and Stomach,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China;Lingnan Institute of Spleen and Stomach of the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528051 [2]广州中医药大学第二临床医学院,广东广州510405 [3]广州中医药大学深圳医院农园社区健康服务站,广东深圳518000 [4]广州中医药大学第一附属医院脾胃科,广东广州510405 [5]广州中医药大学岭南脾胃研究所,广东广州510405

出　　处：《上海中医药杂志》2024年第11期7-12,共6页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81774264)。

摘　　要：目的研制脾气虚、脾湿热、脾虚湿热证客观量化中医辨证工具,为中医证候标准化及量化研究提供方法学参考和示例。方法以文献法、仓储法和精选法构建3个证型症状条目库,通过3轮德尔菲专家调查,对条目进行优化筛选,采用主客观联合赋权法对条目进行赋权,最后以医生辨证结果为金标准构建受试者工作特征曲线,根据约登指数确定各证型诊断阈值。结果根据文献研究共收集到337条脾气虚、脾湿热、脾虚湿热证中医证候相关症状条目,经过筛选优化后,脾气虚证包含纳差、倦怠乏力、完谷不化等10个核心因子;脾湿热证包含四肢沉重、烧心、口中黏腻等11个核心因子;脾虚湿热证包含倦怠乏力、四肢沉重、口中黏腻等9个核心因子。3个证型诊断阈值分别为10分、16.5分、12.5分。结论研制的脾气虚、脾湿热、脾虚湿热证自评诊断量表可辅助中医师临床辨证,同时为非中医学专业的人员提供可量化的中医辨证工具。Objective To develop an objective and quantifiable traditional Chinese medicine(TCM)diagnostic tool for spleen qi deficiency,spleen damp-heat,and spleen deficiency with damp-heat syndromes,providing a methodological reference and example for the standardization and quantification of TCM syndromes.Methods The study constructed symptom item pools for the three syndromes using literature review,warehouse method,and selection method.The items were then optimized and screened through three rounds of Delphi expert surveys.A combined subjectiveobjective weighting method was used to assign weights to the items.Finally,the receiver operating characteristic curve(ROC)was constructed using physician diagnostic results as the gold standard,and the Youden index was used to determine the diagnostic thresholds for each syndrome.Results A total of 337 symptom items related to spleen qi deficiency,spleen damp-heat,and spleen deficiency with damp-heat syndromes were collected through literature research.After screening and optimization,spleen qi deficiency syndrome included 10 core factors such as poor appetite,lassitude,fatigue,and undigested food in stools;spleen damp-heat syndrome included 11 core factors such as heaviness in the limbs,heartburn,and sticky mouth;and spleen deficiency with damp-heat syndrome included 9 core factors such as lassitude,fatigue,heaviness in the limbs,and sticky mouth.The diagnostic thresholds for the three syndromes were 10 points,16.5 points,and 12.5 points,respectively.Conclusion The self-evaluation diagnostic scale for spleen qi deficiency,spleen damp-heat,and spleen deficiency with damp-heat syndromes can assist TCM physicians in clinical syndrome differentiation,and provides a quantifiable TCM diagnostic tool for non-TCM professionals.

关 键 词：中医证候 标准化 脾气虚 脾湿热 脾虚湿热 辨证论治 

分 类 号：R241[医药卫生—中医诊断学]