缺血性中风脾肾两虚证诊断标准  

Diagnostic Criteria of Spleen and Kidney Deficiency Syndrome in Ischemic Stroke Patients

作　　者：董稳悦 刘向哲[1] 王新志[1] 路永坤[1] 杨海燕[1] DONG Wenyue;LIU Xiangzhe;WANG Xinzhi;LU Yongkun;YANG Haiyan(Encephalopathy Center of the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,China)

机构地区：[1]河南中医药大学第一附属医院脑病中心,郑州450000 [2]河南中医药大学第一临床医学院,郑州450046

出　　处：《中国实验方剂学杂志》2025年第9期134-141,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2022YFC3501103);河南省“双一流”创建中医学科研专项(HSRP-DFCTCM-2023-2-18);中华中医药学会团体标准项目(20231204-BZ-CACM);河南省科技攻关计划(242102311277);河南省中医药学科领军人才项目(豫卫中医函[2021]8号)。

摘　　要：目的:初步建立缺血性中风脾肾两虚证诊断标准,为缺血性中风的规范化诊疗提供依据。方法:对缺血性中风脾肾两虚证诊断标准相关文献进行检索,并挖掘和提取数据,形成条目池;在条目池形成的基础上,采用德尔菲法,向遴选出的专家发起2轮问卷调查,完成条目初筛及症状重要程度的判别;采用前瞻性临床调查方法,收集患者临床信息,综合运用统计分析方法及数据挖掘技术,确定其主证、次证。基于以上研究已明确的主证、次证,结合专家小组讨论初步建立缺血性中风脾肾两虚证诊断标准。结果:共纳入相关辨证标准25部,对条目进行拆分、规范及筛选后,建立了包含48个条目的条目池。第一轮调查问卷共咨询专家30名,专家积极系数及问卷有效率均为100%,肯德尔协调系数为0.359。根据条目筛选标准,本轮问卷保留26个条目。通过临床信息调查共收集176份病例,其中脾肾两虚证94例,非脾肾两虚证82例,统计结果为①描述性统计,频率≥30%的主证:神疲乏力、腰膝酸软等;10%≤频率≤30%的次证:神疲懒言、气短等。②二元Logistic回归分析,比值比(OR)值≥3的主证:神疲乏力、腰膝酸软等;1≤OR≤3的次证:神疲懒言、气短等。③人工神经网络,0.5≤权重值(W_(ij))<1的主证:神疲乏力、神疲懒言等;0.3≤W_(ij)<0.5的次证:气短、肢体痿软等。第二轮调查问卷共咨询专家37名,专家积极系数及问卷有效率均为100%,肯德尔协调系数为0.237。根据德尔菲法主证、次证判定标准,本轮问卷纳入主证包括神疲乏力、神疲懒言等;次证包括:气短、头晕等。结论:缺血性中风脾肾两虚证主证为神疲乏力,腰膝酸软,便溏,舌质淡胖或伴齿痕,脉沉细或脉弱无力;次证为气短,头晕,耳鸣耳聋,食欲减退或食后腹胀,面色晄白,夜尿多,舌质暗淡,舌苔白滑。初步建立的缺血性中风脾肾两虚证诊断标准,能够提供规范化及�Objective:To establish preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients and provide a basis for standardized diagnosis and treatment of ischemic stroke.Methods:Relevant literature on the diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients was retrieved,and data were mined and extracted to form an item pool.Based on the formation of the item pool,this study used the Delphi method to initiate two rounds of questionnaire surveys with selected experts to complete the initial screening of items and the discrimination of symptom importance.A prospective clinical investigation method was adopted to collect clinical information from patients,and statistical analysis methods and data mining techniques were comprehensively used to determine their primary and secondary symptoms.Based on the clear main and secondary symptoms identified,combined with expert group discussions,the study established preliminary diagnostic criteria for spleen and kidney deficiency syndrome in ischemic stroke patients.Results:A total of 25 relevant syndrome differentiation standards were included.After splitting,standardizing,and screening the items,the study established a pool of 48 items.The first round of questionnaire survey consulted 30 experts,with both the positive coefficient of experts and the effectiveness rate of the questionnaire reaching 100%.The Kendall's coefficient of concordance was 0.359.According to the item screening criteria,26 items were retained in this round of questionnaire survey.A total of 176 cases were collected through clinical information investigation,including 94 cases with spleen and kidney deficiency syndrome and 82 cases without spleen and kidney deficiency syndrome.The statistical results were as follows:①Descriptive statistics:The main symptoms with a frequency of≥30%included mental fatigue and lack of strength,weakness of the lower back and knees,etc.The secondary symptoms with a frequency of≥10%and≤30%were lass

关 键 词：缺血性中风 脾肾两虚证 德尔菲法 专家调查问卷 临床调查 诊断标准 

分 类 号：R22[医药卫生—中医基础理论] R287[医药卫生—中医学] R255.2