目的 基于冠心病"瘀毒"病因病机的理论认识,建立急性冠脉综合征瘀毒互结证诊断标准.方法 采用文献系统分析与横断面临床研究构建条目池,采用德尔菲法专家咨询对条目进行筛选,采用层次分析法确定各条目权重.在此基础上,结合条目权重及临床实用性原则建立诊断标准.结果 文献系统分析筛选条目43个,横断面临床研究纳入患者400例,筛选条目39个,归纳分类后形成包含67个条目的条目池;经过两轮德尔菲专家咨询,筛选保留条目28个;通过层次分析法,确定高权重类条目(0.0430～0.1976)9个、中权重类条目(0.0153～0.0289)9个与低权重类条目(0.0060～0.0147)10个.结合临床实用性原则,优化形成包括必要指标(心绞痛程度进行性加重、近1个月反复发作性心绞痛等)、理化指标(心脏肌钙蛋白或肌酸激酶同工酶升高等)及舌象脉象(舌青紫或紫暗等、脉弦细或脉涩)3个维度的急性冠脉综合征瘀毒互结证诊断标准.两轮专家问卷咨询肯德尔和谐系数分别为0.368、0.395,格朗巴赫系数为分别为0.967、0.893,提示专家意见一致性好,结果可信度高.结论 该诊断标准涵盖了反映瘀毒互结致病特点的宏观表征和理化指标,可指导急性冠脉综合征瘀毒互结证的诊断.
Objective To establish diagnostic criteria for acute coronary syndrome(ACS)with blood stasis and toxin,based on the theoretical understanding of the etiology and pathogenesis of"blood stasis and toxin"in coronary heart disease.Methods An item pool was generated using systematic literature analysis and a clinical cross-sectional survey.The Delphi expert consultation process was used to filter entries,and weights were assigned to each item using the analytic hierarchy process.Diagnostic criteria were then established based on item weights and clinical practicability.Results A total of 43 items were selected through systematic literature analysis,and 39 items were selected from a cross-sectional survey of 400 patients,forming a pool of 67 items.After 2 rounds of Delphi expert consultation,28 items were retained.Following the analytic hierarchy process,9 high-weight(0.0430～0.1976),9 medium-weight(0.0153～0.0289),and 10 low-weight(0.0060～0.0147)items were confirmed.The final diagnostic criteria for ACS with a pattern of blood stasis and toxin were formed in three dimensions:necessary indicators(i.e.,progressively worsening chest pain,recurrent bouts of chest pain within the past month),physicochemical parameters(e.g.,elevated cardiac troponin or creatine kinase isoenzymes),and tongue/pulse characteristics(e.g.,bluish or purplish tongue;thin and stringlike pulse or astringent pulse).Kendall's concordance coefficients for the two rounds of expert questionnaires were 0.368 and 0.395 respectively,and Cronbach's α coe什icients were 0.967 and 0.893,respectively,indicating consistent expert opinion and reliable results.Conclusion The diagnostic criteria encompass macroscopic characteristics and physicochemical indicators that reflect the pathogenic features of stasis-toxin interaction,guiding the diagnosis of acute coronary syndrome with blood stasis and toxin.
田文得;鞠建庆;高洁;付长庚;高铸烨;薛梅;徐浩;史大卓;陈可冀
中国中医科学院西苑医院心血管病中心,国家中医心血管病临床医学研究中心(北京 100091)
急性冠脉综合征;瘀毒互结证;德尔菲法;层次分析法;诊断标准
acute coronary syndrome;binding of blood stasis and toxin pattern;Delphi method;analytical hierarchy process;diagnostic criteria
《中国中西医结合杂志》 2024 (005)
543-547 / 5
国家中医药传承创新团队项目(No.ZYYCXTD-C-202007);中国中医科学院科技创新工程创新团队项目(No.CI2021B004)
10.7661/j.cjim.20240308.105
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