中醫(yī)四診信息采集者間一致性評價的統(tǒng)計方法研究
發(fā)布時間：2018-10-20 11:09
【摘要】：目的：辨證論治是中醫(yī)學(xué)的精髓,而中醫(yī)辨證建立客觀的量化標(biāo)準(zhǔn)是十分重要的。中醫(yī)四診信息的采集是量化的基礎(chǔ),顯得尤為重要。以慢性支氣管炎為例,本研究采用不同的統(tǒng)計分法考核不同研究者和不同研究單位對中醫(yī)四診信息采集的一致性研究,以提高中醫(yī)臨床辨證的精確性和可重復(fù)性,使臨床試驗中療效評價相對科學(xué)、客觀。方法：收集兩個不同醫(yī)師分別進(jìn)行采集的321例慢性支氣管炎數(shù)據(jù),用Epidata進(jìn)行雙人雙機(jī)錄入并校對,以保證數(shù)據(jù)的準(zhǔn)確性。對慢性支氣管炎的四診信息采用常用的一致性評價方法進(jìn)行評價,根據(jù)Fleiss對kappa系數(shù)的分級篩選出一致性程度一般的四診信息,再對篩選出的四診信息進(jìn)行一致性模型的構(gòu)建,首先應(yīng)用對數(shù)線性模型,根據(jù)BIC指標(biāo)選擇出擬合程度最好的模型,對其參數(shù)進(jìn)行估計與解釋；最后應(yīng)用潛在類別模型,得到四診信息的各等級在潛在類別下的條件概率。研究用SAS9.3軟件和Mplus軟件相結(jié)合,SAS9.3進(jìn)行一致性描述、一致性的對數(shù)線性模型,而Mplus進(jìn)行潛在類別分析。結(jié)果：主要研究結(jié)果如下：1、一致性描述：一致性程度一般的有14個,占四診信息總個數(shù)的36.8%,一致性程度較好的有24個,占四診信息總個數(shù)的63.2%。一致性程度一般的四診信息分別為咳嗽、咳痰、氣喘、神疲乏力、少氣懶言、自汗、納呆、精神萎靡、耳鳴、氣短、胸悶、胸痛、苔膩、弦脈。一致性程度一般的四診信息相對于一致性程度較好的四診信息,屬于更為主觀的判斷指標(biāo),沒有客觀的指標(biāo)或體征說明。對于kappa系數(shù)在0.75以下的變量分別采用對數(shù)線性模型及潛在類別模型進(jìn)一步考慮一致性的評價。2、對數(shù)線性模型：考慮等權(quán)重與相關(guān)性對一致性的影響時,等權(quán)重和線性間交互對于所有的四診信息的數(shù)據(jù)解釋均有意義。考慮等權(quán)重、相關(guān)性、協(xié)變量對一致性造成的影響,各四診信息等級之間重要程度對的一致性數(shù)據(jù)解釋均具有統(tǒng)計學(xué)意義,說明等權(quán)重有利于解釋一致性數(shù)據(jù)。除胸悶、神疲乏力外,其余四診信息在不同醫(yī)院之間的一致性的差異沒有統(tǒng)計學(xué)意義,即協(xié)變量醫(yī)院對一致性是沒有影響的。3、潛在類別分析：咳嗽在主治醫(yī)師與主任(副)醫(yī)師之間的評價標(biāo)準(zhǔn)是存在部分的不一致的。在無的級別上,基本上兩類醫(yī)師的一致性都較好,對于中度或輕度,醫(yī)師在某些項目(如精神萎靡、自汗等)中的評價存在一定的差異,而對于重度的級別其出現(xiàn)的頻率較少,其一致性并不理想。結(jié)論：中醫(yī)四診信息屬于更為主觀、不能觸摸到或觀察到具體特征的指標(biāo),只能是醫(yī)師依靠自身的技能主觀判斷和醫(yī)師依據(jù)病人對病情的描述。四診信息的等級間的相關(guān)和各等級的重要程度對于一致性都是有影響的。四診信息各等級的條件概率還可為四診信息的等級劃分提供依據(jù)。一致性的分析為提高研究的精確性和臨床的研究質(zhì)量起到重要作用。
[Abstract]:Objective: syndrome differentiation is the essence of traditional Chinese medicine, and it is very important to establish objective quantification standard. The information collection of four diagnoses of TCM is the basis of quantification, and it is especially important. Taking chronic bronchitis as an example, different statistical methods were used to examine the consistency of information collection of four diagnoses of TCM by different researchers and different research units, in order to improve the accuracy and repeatability of TCM clinical syndrome differentiation. The evaluation of curative effect in clinical trial is relatively scientific and objective. Methods: the data of 321 cases of chronic bronchitis collected by two different doctors were collected, and the data were recorded and proofread by double machines with Epidata to ensure the accuracy of the data. The four diagnosis information of chronic bronchitis was evaluated by the commonly used consistency evaluation method. According to the classification of kappa coefficient by Fleiss, the four diagnostics information of general consistency degree was screened out, and the consistency model of the four diagnosis information was constructed. First, the logarithmic linear model is used to select the best fit model according to the BIC index, and its parameters are estimated and explained. Finally, the conditional probability of each level of four diagnostics information under the potential category is obtained by using the potential category model. Using SAS9.3 software and Mplus software, SAS9.3 is used to describe consistency, logarithmic linear model of consistency is used, and Mplus is used for latent category analysis. Results: the main results were as follows: 1. Consistency description: there were 14 cases of general consistency, accounting for 36.8% of the total number of information of four diagnoses, and 24 cases of good consistency, accounting for 63.2% of the total number of information of four diagnoses. The general information of the four diagnoses were cough, expectoration, asthma, fatigue, indolence, sweating, depression, tinnitus, shortness of breath, chest tightness, chest pain, greasy moss and string pulse. The information of four diagnostics with general consistency degree is more subjective than that with good consistency, and there is no objective index or sign explanation. For the variables with kappa coefficient below 0. 75, the logarithmic linear model and the potential category model are used to further consider the evaluation of consistency. 2, logarithmic linear model: considering the influence of equal weight and correlation on consistency, The equal-weight and linear interactions are significant for the interpretation of all four diagnostics. Considering the influence of equal weight, correlation and covariable on consistency, and the importance of each level of information, there is statistical significance in the interpretation of consistency data, which is beneficial to the interpretation of consistency data. In addition to chest tightness and fatigue, there was no significant difference in the consistency of the other four diagnostics among different hospitals. That is, covariant hospitals have no effect on consistency. 3. Potential Category Analysis: there is partial inconsistency in the evaluation criteria of cough between the attending physician and the chief (deputy) physician. Basically, there was a good consistency between the two categories of physicians at the no level. For moderate or mild, there was some difference in the evaluation of certain items (such as mental retardation, self-sweating, etc.), but for the severe grade, the frequency of occurrence was lower. Its consistency is not ideal. Conclusion: the information of the four diagnoses of TCM is more subjective and can not touch or observe the specific characteristics. It can only depend on the subjective judgment of the doctor's own skills and the description of the patient's condition according to the doctor's own skills. The correlation between the four levels of diagnostic information and the importance of each level have an impact on consistency. The conditional probability of each grade of four diagnosis information can also provide the basis for the classification of four diagnosis information. Consistency analysis plays an important role in improving the accuracy of research and the quality of clinical research.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R241
本文編號：2282976
[Abstract]:Objective: syndrome differentiation is the essence of traditional Chinese medicine, and it is very important to establish objective quantification standard. The information collection of four diagnoses of TCM is the basis of quantification, and it is especially important. Taking chronic bronchitis as an example, different statistical methods were used to examine the consistency of information collection of four diagnoses of TCM by different researchers and different research units, in order to improve the accuracy and repeatability of TCM clinical syndrome differentiation. The evaluation of curative effect in clinical trial is relatively scientific and objective. Methods: the data of 321 cases of chronic bronchitis collected by two different doctors were collected, and the data were recorded and proofread by double machines with Epidata to ensure the accuracy of the data. The four diagnosis information of chronic bronchitis was evaluated by the commonly used consistency evaluation method. According to the classification of kappa coefficient by Fleiss, the four diagnostics information of general consistency degree was screened out, and the consistency model of the four diagnosis information was constructed. First, the logarithmic linear model is used to select the best fit model according to the BIC index, and its parameters are estimated and explained. Finally, the conditional probability of each level of four diagnostics information under the potential category is obtained by using the potential category model. Using SAS9.3 software and Mplus software, SAS9.3 is used to describe consistency, logarithmic linear model of consistency is used, and Mplus is used for latent category analysis. Results: the main results were as follows: 1. Consistency description: there were 14 cases of general consistency, accounting for 36.8% of the total number of information of four diagnoses, and 24 cases of good consistency, accounting for 63.2% of the total number of information of four diagnoses. The general information of the four diagnoses were cough, expectoration, asthma, fatigue, indolence, sweating, depression, tinnitus, shortness of breath, chest tightness, chest pain, greasy moss and string pulse. The information of four diagnostics with general consistency degree is more subjective than that with good consistency, and there is no objective index or sign explanation. For the variables with kappa coefficient below 0. 75, the logarithmic linear model and the potential category model are used to further consider the evaluation of consistency. 2, logarithmic linear model: considering the influence of equal weight and correlation on consistency, The equal-weight and linear interactions are significant for the interpretation of all four diagnostics. Considering the influence of equal weight, correlation and covariable on consistency, and the importance of each level of information, there is statistical significance in the interpretation of consistency data, which is beneficial to the interpretation of consistency data. In addition to chest tightness and fatigue, there was no significant difference in the consistency of the other four diagnostics among different hospitals. That is, covariant hospitals have no effect on consistency. 3. Potential Category Analysis: there is partial inconsistency in the evaluation criteria of cough between the attending physician and the chief (deputy) physician. Basically, there was a good consistency between the two categories of physicians at the no level. For moderate or mild, there was some difference in the evaluation of certain items (such as mental retardation, self-sweating, etc.), but for the severe grade, the frequency of occurrence was lower. Its consistency is not ideal. Conclusion: the information of the four diagnoses of TCM is more subjective and can not touch or observe the specific characteristics. It can only depend on the subjective judgment of the doctor's own skills and the description of the patient's condition according to the doctor's own skills. The correlation between the four levels of diagnostic information and the importance of each level have an impact on consistency. The conditional probability of each grade of four diagnosis information can also provide the basis for the classification of four diagnosis information. Consistency analysis plays an important role in improving the accuracy of research and the quality of clinical research.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R241
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