阴虚证自评量表的初步研制及考评

发布时间：2019-03-11 18:34

【摘要】：目的：研制具有中医特色的阴虚证自评量表；为临床阴虚证诊断以及辨别病位提供测量工具,为阴虚证疗效的评价提供参考依据。方法：根据量表研制的科学方法,通过文献调研得出各类疾病中阴虚证的分布情况,并对其证候进行术语规范化处理,形成备选条目池。将条目翻译成各个问题,拟定专家问卷调查进行德尔菲专家咨询初步筛选条目,形成阴虚证自评量表(初稿)。专家咨询后进行语言调试,看看患者是否能够理解各个条目,优化量表,形成阴虚证自评量表(1版)进入下一步的临床预调查。采集福建省人民医院、福建省第二人民医院、国医堂、福建省立医院、福州市第二医院、晋江市中医院等医院门诊及住院病人100例进行临床预调查,结合运用困难度分析法、反应特征分析法及相关系数法等多种统计方法处理临床数据,更进一步优化筛选条目,形成阴虚证自评量表(2版)。最终对阴虚证自评量表(2版)进行考评,采集400例患者的临床资料,以检验其信度、效度和可行性,进一步完善该量表。结果：1.经过前期的文献调研,得出232个阴虚证的症状,形成条目池。2.经三轮专家咨询,回收率均为100%。形成84条条目的阴虚证自评量表(1版),其中肾维度36条条目、肝维度29条条目、胃维度15条条目、肺维度22条条目、心维度10条条目、脾维度10条条目,协调系数为0.332(χ2值为505.903,p值为0.0000.005)。3.临床预调查,根据困难度分析法、反应特征分析法及相关系数法等客观筛选方法,对84条条目进行筛选得出56条条目,形成阴虚证自评量表(2版),其中肾维度20条条目、肝维度22条条目、胃维度13条条目、肺维度12条条目、心维度10条条目、脾维度10条条目。4.总量表分半信度为0.920,各维度分半信度均大于0.6；总量表的Cronbach's a系数为0.872,各维度的Cronbach's a系数均大于0.6,经考评具有良好的信度。经非参数检验提示量表具有良好的区分效度,因子分析提示量表具有良好的结构效度。结论：1.通过阴虚证相关文献调研,总结了阴虚证临床常见的中医疾病、西医疾病、证型及证素等情况的分布规律。2.文献调研为后续的量表研制提供了条目池,也为量表各维度的形成提供依据,还为临床调查选择病例提供可靠依据。3.证候术语规范为建立备选条目池提供了规范化方法。4.结合德尔菲专家咨询和预调查的方法对条目进行了优化筛选,形成了由56条条目组成的阴虚证自评量表(2版)。5.通过临床调查,对阴虚证自评量表(2版)进行可行性、信度和效度考评,结果表明此量表具有较好的可行性、信度以及效度,能为临床阴虚证诊断以及辨别病位提供测量工具,为阴虚证疗效的评价提供参考依据。
[Abstract]:Objective: to develop a self-rating scale for Yin deficiency syndrome with characteristics of traditional Chinese medicine, to provide a measurement tool for clinical diagnosis and identification of disease position, and to provide reference basis for evaluating the curative effect of Yin deficiency syndrome. Methods: according to the scientific method developed by the scale, the distribution of Yin deficiency syndrome in all kinds of diseases was obtained through literature investigation, and its syndrome was standardized in terms to form alternative item pool. The items were translated into various questions, and an expert questionnaire was drawn up to screen the items for Delphi expert consultation to form the self-rating scale for Yin deficiency Syndrome (preliminary draft). After expert consultation, language debugging was carried out to see if the patients could understand each item, optimize the scale, and form the self-rating scale of Yin deficiency Syndrome (version 1) to enter the next step of clinical pre-investigation. We collected 100 outpatients and inpatients from Fujian people's Hospital, Fujian second people's Hospital, National Medical Hall, Fujian Provincial Hospital, Fuzhou second Hospital, Jinjiang traditional Chinese Medicine Hospital and other hospitals for clinical pre-investigation, combined with difficulty analysis method. Many kinds of statistical methods, such as response characteristic analysis and correlation coefficient method, were used to process the clinical data, and the items were further optimized to form the self-rating scale of Yin deficiency Syndrome (version 2). Finally, the self-rating scale of Yin deficiency Syndrome (version 2) was evaluated and the clinical data of 400 patients were collected to test the reliability, validity and feasibility of the scale. Results: 1. After previous literature investigation, 232 symptoms of Yin deficiency syndrome were found, forming an entry pool. 2. After three rounds of expert consultation, the recovery rate was 100%. The self-rating scale for Yin deficiency Syndrome (version 1), which forms 84 items, includes 36 items in the kidney dimension, 29 items in the liver dimension, 15 items in the stomach dimension, 22 items in the lung dimension, 10 items in the heart dimension, and 10 items in the spleen dimension. The coordination coefficient is 0.332 (蠂 2 = 505.903, p = 0.0000.005). 3. Clinical pre-investigation, according to the objective screening methods such as difficulty analysis, response characteristic analysis and correlation coefficient method, 56 items were obtained by screening 84 items, forming self-rating scale of Yin deficiency Syndrome (version 2), of which 20 items were in kidney dimension, 20 items in kidney dimension, and 56 items were selected according to the methods of difficulty analysis, response characteristic analysis and correlation coefficient. Liver dimension 22 items, stomach dimension 13 items, lung dimension 12 items, heart dimension 10 items, spleen dimension 10 items. 4. The split-half reliability of the total scale was 0.920, and the split-half reliability of each dimension was more than 0.6. The Cronbach's a coefficient of the total scale was 0.872, and the Cronbach's-a coefficient of each dimension was more than 0.6. The results showed that the total scale had good reliability. The non-parametric test indicated that the scale had good discriminative validity and factor analysis showed that the scale had good structural validity. Conclusion: 1. Through the investigation of relevant literature of Yin deficiency syndrome, this paper summarizes the distribution regularity of common diseases of TCM, western medicine, syndrome type and syndrome element in clinical practice of Yin deficiency syndrome. 2. Literature investigation provides an entry pool for the subsequent development of the scale, also provides the basis for the formation of the dimensions of the scale, and provides a reliable basis for the clinical investigation and selection of cases. 3. The syndrome terminology specification provides a standardized method for creating pool of alternative entries. 4. Combined with Delphi expert consultation and pre-investigation, the items were optimized and screened, and the self-rating scale of Yin deficiency Syndrome (version 2) composed of 56 items was formed (version 2). Through the clinical investigation, the feasibility, reliability and validity of the self-rating scale for Yin deficiency Syndrome (version 2) were evaluated. The results showed that the scale had good feasibility, reliability and validity. It can provide a measurement tool for the diagnosis and identification of Yin deficiency syndrome, and provide reference basis for evaluating the curative effect of Yin deficiency syndrome.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R241

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