肠癌湿热内蕴证量化辨证标准的研究

摘要

目的:建立肠癌湿热内蕴证辨证量化标准.方法:在对311例肠癌患者进行临床流行病学调查的基础上,组织专家组对其进行辨证,根据各相关中医症状在湿热内蕴证组和非湿热内蕴证组中出现状况的差异对这些症状进行赋分;根据专家辩证的结果,应用ROC(receiver operating characteristic ourve)曲线的方法选择最佳诊断阅值从而建立量化辨证标准;以专家组统一辨证作为"金标准"对建立的量化标准进行回顾性检验;结果:我们结合专家意见,分析了所有可能与湿热内蕴证相关的中医症状,确定身重等20个中医症状为肠癌湿热内蕴证的候选相关因素;经列联表分析,尿黄、黄疸等5项中医症状在湿热内蕴证和非湿热内蕴证中出现的差异有统计学意义(P<0.05),将这5项中医症状作为logistic回归分析的变量进行筛选,最后确定尿黄、黄疸、苔黄、厚、腻为肠癌湿热内蕴证的相关中医症状;应用条件概率方法换算,这五个症状的赋分为9、9、8、8、9 ;经ROC方法分析,确定量化辨证标准为≥9分;回顾性检验的敏感度、特异度、准确度均在75%以上,阳性似然比4.32;结论:建立的量化标准的特点是:①较符合肠癌的临床特点;②符合中医辨证的临床实际;③数理统计方法的运用比较合理.%Objective: To establish the quantitative criteria of internal stasis of dampness and heat according to diagnosis in colon cancer. Methods: Based on the clinic epidemiologic investigations of 311 cases of colon cancer patients, a board of specialists made differential diagnosis for these patients. Scores were given to damp-heat affecting the endo-retention pattern and non-damp-heat af- fecting the endo-retention pattern of colon cancer, according to the difference of symptoms between these two patterns. Grounded on the specialists' differential diagnosis, applying ROC curve(Receiver Operating Characteristic Curve) methods to select the best diagnostic thresholds and to establish standardized differential diagnostic criteria, then using the concerted differential diagnosis of the specialists board as "Golden Criteria"to retrospectively test the standardized measurements. Result: Combining with the opinions of the specialists, we analyzed all the possible symptoms concerning the Endo-rentention of Damp Heat Type, we identified 20 symptoms, including body weight,were the candidate factors of Endo-retention of Damp Heat Type. Using the Contingency Table Analysis, 5 symptoms, including xanthourine and jaundice were of statics significance between damp-heat affecting the endo-retention pattern and non-damp-heat affect- ing the endo-retention pattern of colon cancer (P＜0.05), using Logistic Regression Analysis to analyze these 5 symptoms, we finally established that xanthourine, jaundice, and yellow, thick, greasy tongue fur were the related symptoms to damp-heat affecting the endo-retention pattern. Using Conditional Probability Method calculation, the scores for these 5 symptoms were 9, 9, 8, 8 and 9 respective- ly.After ROC curve analysis, the established standard score is ≥ 9. The sensitivity, specificity and accuracy of the Retrospective Test were ≥ 75％, Positive Likelihood Ratio was 4.32. Conclusions: The characteristics of the standardized measurements are: ①it concords with the clinic features of the colon cancer, ②it fits with the clinic practice of traditional Chinese medicine differential diagnosis, ③ the application of statics methods were justified.