引入PRO理念制作老年期痴呆临床诊断分级量表的研究

发布时间：2018-07-22 11:00

【摘要】：目的：1、初步制订用于诊断老年期痴呆的PRO评价量表,为老年期痴呆的临床诊断分级提供一种新的、实用性的手段。2、引入PRO理念为更为定量化评价中医药对于老年期痴呆的疗效提供依据。方法：结合痴呆的国际诊断标准收集符合纳入标准的60例老年患者,根据国际公认的MMSE、MoCA及CDR量表分为轻度认知障碍组21例,轻度痴呆组24例,中、重度痴呆组15例,对其进行A、B卷的测评,并统计分析A、B卷的信度、效度、区分度及应答率,验证了老年期痴呆患者临床诊断分级的PRO量表,并通过判别分析建立数学模型初步制订出评价标准。结果：本次研究共纳入病例60例,其中男性25例,女性35例,平均年龄在72.05±8.05岁,共分为三组,其中轻度认知障碍组21例,占35.0%；轻度痴呆组24例,占40.0%；中、重度痴呆组15例,占25.0%。 1、信度检验以克朗巴赫a系数为指标,A卷为0.789,B卷为0.908,具有良好的内部一致性信度。分半信度提示将A、B卷分别拆分成前后两部分后,两部分均具有很好的相关性,故可认为A、B卷具有良好的分半信度。 2、效度检验本次调研所使用的PRO评价量表(A、B卷)是经过前期文献调研、科学探讨以及专家论证等工作而形成的,从编制过程看具有内容效度。经Spearman相关系数检验,PRO量表A、B卷得分与MMSE、MoCA及CDR得分具有较高的直线相关性,可认为具有很好的标准关联效度。采用因子分析法检验A、B卷的结构效度,所提取的三个公因子可解释A卷总变异的46.373%,B卷总变异的73.565%,经方差最大法正交旋转得到旋转因子载荷矩阵,提示B卷具有较好的结构效度。考虑到A卷为患者自评的问卷,而痴呆患者对自身能力辨别存在偏差,所得公因子解释所有变量信息较低,但经因子分析后A卷与预期设计符合度尚可,待进一步扩大样本调研后再次验证。 3、区分度检验对各组病例的A、B卷总得分分别做Kruskal-Wallis检验,结果均提示p0.01,提示三组的得分情况具有显著差异,故认为A、B卷具有良好的区分度。 4、应答率检验检验患者对A、B卷各条目的阳性反应率,显示A卷条目a21应答率较低,且B卷的总体应答率高于A卷。 5、判别分析以A卷与B卷的得分作为判别指标变量,以组别为类别变量,进行多分类判别分析,建立了一组判别函数模型,正确率为82.6%,对于各组别的正确判断率分别为84.6%、78.3%和90.0%。 6、各组A、B卷总分范围观察能够进行正确有效判别的个案A、B卷得分情况,初步总结出各组别A卷及B卷的得分大致范围。结论：1、前期工作制定出的痴呆PR0量表(A、B卷)赋予分值后用于临床评价老年患者的认知程度具有较好的信度、效度及区分度。2、以A、B卷的得分为判别指标所建立的判别函数模型可以初步判别老年认知障碍患者的认知受损程度,具有较好的准确率。3、通过进一步的完善工作将使该量表作为一种实用的手段应用于痴呆患者的临床诊断分级中,并为定量化评价中医药治疗痴呆的疗效提供新的依据。
[Abstract]:Objective: 1, to establish a PRO evaluation scale for the diagnosis of senile dementia, and to provide a new and practical means of.2 for the diagnosis and classification of senile dementia, and introduce the concept of PRO to evaluate the curative effect of traditional Chinese medicine for senile dementia more quantitatively.
Methods: combined with the international diagnostic criteria for dementia, 60 elderly patients were collected in accordance with the inclusion criteria. According to the internationally recognized MMSE, MoCA and CDR scales, 21 cases were divided into mild cognitive impairment group, 24 cases of mild dementia, 15 cases of moderate and severe dementia, the evaluation of A, B volume, and statistical analysis of the reliability, validity, differentiation and response rate of A, B volume, and test. The PRO scale for clinical diagnosis of senile dementia was identified, and a mathematical model was established by discriminant analysis, and the evaluation criteria were preliminarily worked out.
Results: 60 cases were included in this study, including 25 males and 35 females, with an average age of 72.05 + 8.05 years, which were divided into three groups, of which 21 cases were mild cognitive impairment, 35%, 24 in mild dementia, 40%, 15 in severe dementia group, 25.0%..
1, reliability test
With the Krone Bach a coefficient as the index, the A volume is 0.789, the B volume is 0.908, it has good internal consistency reliability. The half reliability indicates that the A and B volume are split into two parts respectively, and the two parts have good correlation. Therefore, A, B volume has good semi reliability.
2, validity test
The PRO evaluation scale used in this survey (A, B volume) is formed by previous literature research, scientific discussion and expert demonstration. It has the content validity from the compilation process. After the Spearman correlation coefficient test, the PRO scale A, the B volume score has a high linear correlation with MMSE, MoCA and CDR scores, which can be considered as a good standard. Quasi correlation validity. The structural validity of A and B volumes was tested by factor analysis. The three common factors extracted could explain 46.373% of the total variation in A volumes, 73.565% of the total variation of B volumes, and the rotation factor load matrix was obtained by the orthogonal rotation of variance. It was suggested that the B volume had a better structural efficiency. Considering the A volume as a self-assessment questionnaire for patients, and dementia There is a deviation in the identification of its own ability, and the information of all variables is low, but the coincidence of A volume with the expected design after factor analysis is still available, and it should be further verified after the further expansion of the sample survey.
3, distinction test
The total score of A and B volume in all cases were tested by Kruskal-Wallis test respectively. The results were all P0.01, suggesting that the scores of the three groups were significantly different. Therefore, A and B volume had good division.
4, the test of response rate
The positive response rate of each item in A and B volumes was tested, showing that A21 response rate of A volume item was lower, and the total response rate of B volume was higher than that of A volume.
5, discriminant analysis
Taking the scores of A volume and B volume as discriminant index variables, taking group as category variables, multi classification discriminant analysis is carried out, and a set of discriminant function models are established, the correct rate is 82.6%, and the correct judgment rate for each group is 84.6%, 78.3% and 90.0%., respectively.
6, A, B volume range of each group
The case A and B volume score were observed and the scores of A volume and B volume of each group were preliminarily summarized. Conclusion: 1, the dementia PR0 scale established by the earlier work (A, B volume) was given a good reliability, the validity and the division degree.2 for the clinical evaluation of the elderly patients, with A and B volumes. The discriminant function model, divided into discriminant index, can preliminarily distinguish the degree of cognitive impairment in the elderly patients with cognitive impairment, and has a good accuracy rate of.3. Through further improvement, the scale will be used as a practical means in the clinical diagnosis of dementia patients, and the quantitative evaluation of Chinese medicine for the treatment of dementia. The curative effect provides a new basis.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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