溃疡性结肠炎常见证候要素对应症在其诊断中贡献度的专家问卷调查研究

目的：探讨溃疡性结肠炎常见证候要素对应症在其诊断中的贡献度。方法：基于前期研究确定了量表中调查的病位类证候要素为8个,病性类证候要素为11个。对全国7个省市的15家三级甲等医院从事消化系统疾病临床工作且具有副主任医师及以上职称的专家进行问卷调查,根据问卷调查结果分析与该病常见证候要素对应的症状或体征在其诊断中权重的均数与变异系数,初步获取症状或体征在证候要素诊断中的贡献度。结果：通过专家问卷调查,确定了各证候要素的对应症和诊断贡献度。病位类证候要素中,与肝对应的症状或体征有精神抑郁等9个,贡献度值范围为7．49～4．18;心的症状或体征有心悸等6个症状或体征（6．90～5．51）;脾的症状或体征有便溏等14个（7．96～5．55）;肺的症状或体征有易感冒等5个（6．30～5．27）;肾的症状或体征有五更泄等9个（7．82～5．71）;胃的症状或体征有胃脘胀满等8个（7．53～6．15）;大肠的症状或体征有脓血便等12个（8．40～6．70）;肠络的症状或体征有脓血便等2个（8．49～6．41）。11个病性类证候要素的对应症及其诊断贡献度范围分别为：气虚的症状或体征有少气懒言等13个（7．44～5．60）;血虚的症状或体征有唇／甲／眼睑色淡等8个（7．90～5．59）;阴虚的症状或体征有五心烦热等17个（6．88～4．91）;阳虚的症状或体征有四肢不温等18个（7．54～5．57）;湿的症状或体征有黏液便等17个（7．91～4．96）;实热（火）的症状或体征有肛门灼热等18个（7．13～5．69）;实寒的症状或体征有腹冷痛等6个（7．51～6．14）;气滞的症状或体征有腹胀痛等11个（7．38～5．88）;气陷的症状或体征有肛门下坠等2个（7．65～7．43）;血瘀的症状或体征有舌有瘀斑瘀点等10个（7．60～5．79）;饮的症状或体征有肠鸣漉漉等11个（7．08～4．46）。结论：在文献回顾及临床调查的基础上,通过专家问卷调查能较好地获取专家的共识性意见,初步确定溃疡性结肠炎常见证候要素对应症在其诊断中的贡献度,为进一步建立基于证候要素的证候诊断标准提供依据。

Weighting coefficients of symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis based on expert questionnaire investigation

OBJECTIVE： To define the weighting coefficients of the symptoms and signs in the diagnosis of corresponding traditional Chinese medicine （TCM） syndrome elements of ulcerative colitis based on expert questionnaire investigation. METHODS： The questionnaire inc）uded eight syndrome elements of location and ]1 syndrome elements relating to disease characteristics. Experts who answered the questionnaire were titled as associate chief physician or above, and had been practicing as professionals in general practice of medicine of digestive system for a long time. They came from 15 third-grade class-A hospitals （6 provinces and Beijing） in China. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis were identified preliminarily based on consent degree of the experts （mean value and variation coefficient）. RESULTS： There were 9, 6, 14, 5, 9, 8, 12 and 2 symptoms and signs corresponding to 8 TCM syndrome elements related to disease location and the ranges of weighting coefficients were listed as follows： liver, from 7.49 to 4.18; heart, from 6.90 to 5.51; spleen, from 7.96 to 5.55; lung, from 6.30 to 5.27; kidney, from 7.82 to 5.71; stomach, from 7.53 to 6.15; large intestine, from 8.40 to 6.70; bowel collaterals, from 8.49 to 6. 41. Numbers of symptoms and signs corresponding to 11 TCM syndrome elements related to disease nature were 13, 8, 17, 18, 17, 18, 6, 11, 2, 10 and 11 and the ranges of weighting coefficients were listed as follows： qi deficiency, from 7.44 to 5.60; blood deficiency, from 7.90 to 5.59; yin deficiency, from 6.88 to 4.91; yang deficiency, from 7.54 to 5.57; dampness, from 7.91 to 4.96; excess heat （fire）, from 7.13 to 5.69; excess cold, from 7.51 to 6.14; qi stagnation, from 7.38 to 5.88; qi sinking, from 7.65 to 7.43; blood stasis, from 7.60 to 5.79; fluid retention, from 7.08 to 4.46. CONCLUSION： On the basis of previous document research and clinical research in ulcerative colitis, the expert questionnaire can collect consensus opinions of experts. The weighting coefficients of the symptoms and signs in the diagnosis of corresponding TCM syndrome elements of ulcerative colitis are defined preliminarily. Thereby it will lay the foundation for establishing differentiation criteria of ulcerative colitis based on TCM syndrome elements.