摘要
目的探讨建立围绝经期失眠症(MI)肾虚肝郁证量化诊断的方法。方法纳入MI患者838例,随机分为训练样本组(肾虚肝郁证397例,非肾虚肝郁证261例)和验证样本组(肾虚肝郁证108例,非肾虚肝郁证72例)。在流行病学调查的基础上,将肾虚肝郁证辨证标准及临床常见症状作为候选相关因素,采用单因素分析和二元Logistic回归法选定相关因素。应用条件概率换算方法对相关因素进行赋分,并应用最大似然判别法确定量化诊断阈值。分别以训练样本组及验证样本组患者对建立的肾虚肝郁证量化诊断标准进行回顾性和前瞻性检验,计算其敏感度、特异度、准确度及Youden指数。结果从44项候选因素中选出17项相关因素。MI肾虚肝郁证量化诊断阈值为36分。训练样本组回顾性检验的敏感度、特异度、准确度和Youden指数分别为89.9%、90.8%、90.3%、80.7%,验证样本组前瞻性检验分别为90.7%、88.9%、90.0%、79.6%。结论以症状出现频次为基础建立MI肾虚肝郁证候量化标准,经检验其具有较好的判别效果和临床实用性。
Objective To explore the method of establishment of the quantified diagnosis of menopausal insomnia（ MI） with kidney deficiency and liver depression syndrome. Methods Eight hundred and thirty-eight MI patients were randomly divided into a training group（ 397 cases of kidney deficiency and liver depression syndrome and 261 patients without kidney deficiency and liver depression syndrome） and a validation group（ 108 cases of kidney deficiency and liver depression syndrome and 72 patients without kidney deficiency and liver depression syndrome）. On the basis of epidemiological investigation,the syndrome differentiation criteria and common clinical symptoms of kidney deficiency and liver depression were selected as candidate related factors. Single factor analysis and two element Logistic regression method were used to select related factors. The relative factors were assigned by using the conditional probability conversion method. The maximum likelihood discriminant method was used to determine the quantitative diagnostic threshold. The syndrome differentiation criteria of kidney deficiency and liver depression syndrome were retrospectively and prospectively tested by training group and validation group. The sensitivity,specificity,accuracy and Youden index were calculated. Results Seventeen related factors of 44 candidate factors were selected.The quantitative diagnostic threshold of MI with kidney deficiency and liver depression syndrome was 36. The sensitivity,specificity,accuracy and Youden index of the retrospective test in the training group were 89. 9%,90. 8%,90. 3% and 80. 7%,respectively. The prospective tests in the validation group were 90. 7%,88. 9%,90. 0% and 79. 6%,respectively. Conclusion Based on the frequency of symptoms,the syndrome differentiation criteria of MI with kidney deficiency and liver depression syndrome were established,which was proved to have good discriminating effect and clinical practicability.
出处
《中医杂志》
CSCD
北大核心
2018年第2期137-141,共5页
Journal of Traditional Chinese Medicine
基金
国家自然科学基金(81173149)
福建省省属公益类科研院所基本科研专项(2015R1035-10)
福建省卫生厅青年科研课题(2012-1-33)
关键词
失眠症
围绝经期
肾虚肝郁证
量化诊断
insomnia
menopausal
kidney deficiency and liver depression syndrome
quantified diagnosis
