Hou Feng-gang, Cen Yi, Guan Jian, Zhu Ling-yun, Yin Xiao-ling
Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai 200071, China.
Zhong Xi Yi Jie He Xue Bao. 2009 Sep;7(9):814-8. doi: 10.3736/jcim20090903.
To set a quantified diagnostic standard for large intestinal cancer of spleen qi deficiency syndrome.
The spleen qi deficiency syndrome was identified by experts on the basis of clinical epidemiological investigation of 311 patients suffering from large intestinal cancer. Corresponding points were assigned to the correlative factors (traditional Chinese medicine symptoms) on the basis of symptom differences between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome. The best threshold was determined by receiver operating characteristic curve (ROC) according to syndrome differentiation from expert team, and the quantified diagnostic standard was established. The syndrome identification from the expert team which was regarded as golden standard was tested retrospectively.
All the traditional Chinese medicine symptoms possibly related to spleen qi deficiency syndrome were analyzed based on the opinions of experts, and 28 symptoms were confirmed as candidate correlative factors. The occurrence of 11 symptoms between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome showed statistical differences by means of crosstabs analysis (P<0.05). The 11 symptoms were filtered by logistic regression analysis, and tiredness, fatigue, loose stool, and poor appetite were finally determined as the symptoms relative to large intestinal cancer. These four symptoms were analyzed with conditional probability conversion and endowed with 16, 11, 4 and 8 points respectively. The diagnostic standard of spleen qi deficiency syndrome of large intestinal cancer was over 13 points. The sensitivity, specificity and accuracy of retrospective examination were all above 80%, and its positive likelihood ratio was 9.89.
The quantified diagnostic standard for spleen qi deficiency syndrome of large intestinal cancer is in accordance with clinical characteristics of large intestine cancer and the characteristics of TCM syndrome diagnosis.
制定大肠癌脾气虚证的量化诊断标准。
通过对311例大肠癌患者进行临床流行病学调查，由专家对脾气虚证进行辨证。根据脾气虚证与非脾气虚证的症状差异，对相关因素（中医症状）赋予相应分值。依据专家团队辨证结果，采用受试者工作特征曲线（ROC）确定最佳阈值，建立量化诊断标准。并对被视为金标准的专家团队辨证结果进行回顾性检验。
根据专家意见，对所有可能与脾气虚证相关的中医症状进行分析，确定28个症状为候选相关因素。通过交叉表分析，其中11个症状在脾气虚证与非脾气虚证之间的出现情况有统计学差异（P<0.05）。经逻辑回归分析筛选这11个症状，最终确定疲倦、乏力、便溏、食欲不振为与大肠癌相关的症状。对这4个症状进行条件概率转换分析并分别赋予16、11、4和8分。大肠癌脾气虚证的诊断标准为积分超过13分。回顾性检验的灵敏度、特异度和准确度均在80%以上，其阳性似然比为9.89。
大肠癌脾气虚证量化诊断标准符合大肠癌临床特点及中医证候诊断特点。
