中晚期原发性肺癌痰证判别要点量化的临床研究

目的 探索建立中晚期原发性肺癌痰证判别要点并对其进行量化.方法 在流行病学调查的基础上,以方永奇的广义痰证诊断标准对308例观察病例进行辨证分组,填写病例观察表,用统计比较方法筛选相关因素.根据相关因素在痰证组和非痰证组中出现症状体征的差异对其进行赋分,以此为基础建立量化判别要点,然后对量化判别要点进行检验.结果 经统计分析后,确定中晚期肺癌痰证的量化诊断阈值为37分,拟定中晚期肺癌痰证证候的判别要点如下.主症:咳嗽(17分)；咯痰(12分)；胸闷(12分).次症:痰多(10分)；苔腻(6分)；体表无痛无痒肿块(5分).证候判别要点:具备主症3项,或具备主症2项加次症2项,即可诊断.经回顾性检验,该判别要点敏感度、特异度、准确度和阳性似然比分别为90.24％、77.97％、83.00％和1.98.结论 以病证结合模式,采用统计学方法建立的中晚期原发性肺癌痰证量化判别要点符合临床实际,具有临床实用价值.

Quantization of discriminant points of phlegm syndrome of mid-stage and advanced primary lung cancer

Objective To investigate and create the discriminant points of phlegm syndrome of mid-stage and advanced primary lung cancer and quantify these points.Methods The cases(n=308) were divided into groups by using FANG Yong-qi’s generalized diagnosis criteria of phlegm syndrome on the base of epidemiological survey.The case observation table was filled and statistical comparing method was used to screen related factors,which were scored according to the difference in symtoms and signs between phlegm syndrome group and non-phlegm syndrome group.The quantified discriminant points were created and tested.Results After statistical analysis,the quantified diagnostic threshold of phlegm syndrome of mid-stage and advanced primary lung cancer was determined as 37.The discriminant points of phlegm syndrome were created as follows: main syndromes included cough(17),expectoration(12),and oppression in chest(12),and secondary syndromes included excessive phlegm(10),greasy tongue fur(6),and painless and itch-free lump on the body surface(5).The diagnosis could be made as there were 3 main syndromes or there were 2 main syndromes and 2 secondary syndromes.The sensitivity,specificity,accuracy and positive likehood ratio of these discriminant points was,respectively,90.24%,77.97%,83.00% and 1.98% after retrospective test.Conclusion In the model of disease combining syndrome,the quantified discriminant points of mid-stage and advanced primary lung cancer created by using statistical method are accorded with clinical practice and have clinical significance.