中医对慢性迁延性病毒性肝炎辨证论治临床一致性的评价

本文报道用测量临床不一致性的方法,探讨并评价中医对80例慢性迁延性病毒性肝炎辨证论治的不一致性,结果表明一致率相当高,说明在肝炎的中医辨证论治中,只要按照中医的基础理论,细致地进行望、闻、问、切,同时应用寒热、虚实、阴阳进行分类,是可以得出相当可靠的一致结果的。

Clinical Disagreement of TCM Doctors in Treating Patients According to Syndrome Differentiation for Chronic Persistent Hepatitis

80 cases of patients with chronic persistent hepatitis were examined and diagnosed by two TCM doctors blindly and separately for measuring the clinical disagreement between observers.Same patients were examined and diagnosed twice by each of the two doctors blindly for measuring intraobserver agreement i.e.agreement between two exams by the same physician on different occasions.Clinical data including tongue and pulse conditions,and other symptoms were assessed by scoring.Zheng(syndrome)were categorized into Yin and Yang.Therapeutic principles were divided into reinforcement and elimination methods.The amount of agreement was expressed by the value of kappa(K),the relation between P_o and P_c or P_o-P_c/1-P_c, where P_o was the observed proportion of agreement,and P_c was the chance-expected proportion of agreement calculated with a 2×2 contingency table.The results were as follows:K for intraobserver agreement on symptoms,tongue and pulse pictures,diagnosis and therapeutic principles were 0.80,1.00,0.89,1.00,1.00 respectively, indicating that the intraobserver agreement was moderately or perfectly reliable(K>0.60).K for interobserver agmeement of pulse examination is 0.65. K for other symptoms,diagnosis and thera- peutic principles were all less than 0.60.However,byusing U-test(significance test for K),it showed that the agreement was also moderately reliable,but not as that for intraobserver agmeement. Therefore the conclusion is:it is advisable to make diagnosis and treatment by two or more than two TCM doctors.