Sung J J Y, Leung W K, Ching J Y L, Lao L, Zhang G, Wu J C Y, Liang S M, Xie H, Ho Y P, Chan L S, Berman B, Chan F K L
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Aliment Pharmacol Ther. 2004 Nov 15;20(10):1205-10. doi: 10.1111/j.1365-2036.2004.02242.x.
Traditional Chinese Medicine was frequently used by patients with irritable bowel syndrome.
To evaluate the agreement on diagnoses and prescription of irritable bowel syndrome among Traditional Chinese Medicine practitioners.
Consecutive irritable bowel syndrome patients were interviewed independently by four Traditional Chinese Medicine practitioners. The study was divided into three phases: (i) blinded individual assessment, (ii) discussion to achieve consensus on diagnosis and treatment, (iii) individual assessment based on consensual diagnostic criteria. Patients with other causes of diarrhoea were recruited as controls in phase (iii). Percentage agreement and kappa-value in diagnosis, treatment principle and regime were determined.
Thirty-nine irritable bowel syndrome patients were assessed in phase (i) whereas 65 irritable bowel syndrome patients and 17 non-irritable bowel syndrome controls were studied in phase (iii). The mean agreement rates in diagnosis, treatment principle and regimen were: 57, 58 and 52% for phase (i) and 80, 81 and 80% for phase (iii) (P = 0.002). Accordingly, there was significant improvement in the mean kappa-values in diagnosis (0.11-0.34, P = 0.015) and treatment principle (0.16-0.37, P = 0.002) but not in treatment regime.
Variations in diagnosis and treatment principles do exist among Traditional Chinese Medicine practitioners. Concordant diagnosis can be reached by mutual understanding and converging opinion among Traditional Chinese Medicine practitioners.
肠易激综合征患者经常使用传统中医治疗。
评估中医从业者对肠易激综合征诊断和处方的一致性。
连续的肠易激综合征患者由四位中医从业者独立进行访谈。该研究分为三个阶段：（i）盲法个体评估，（ii）就诊断和治疗达成共识的讨论，（iii）基于共识诊断标准的个体评估。在第三阶段招募其他腹泻原因的患者作为对照。确定诊断、治疗原则和方案中的一致性百分比和kappa值。
在第一阶段评估了39例肠易激综合征患者，而在第三阶段研究了65例肠易激综合征患者和17例非肠易激综合征对照。诊断、治疗原则和方案的平均一致率在第一阶段分别为57%、58%和52%，在第三阶段分别为80%、81%和80%（P = 0.002）。相应地，诊断（0.11 - 0.34，P = 0.015）和治疗原则（0.16 - 0.37，P = 0.002）的平均kappa值有显著改善，但治疗方案没有。
中医从业者在诊断和治疗原则上确实存在差异。通过中医从业者之间的相互理解和意见趋同可以达成一致的诊断。
