Study On The Compilation Of Diagnostic Scale For Hemorrhagic Stroke Syndrome Elements

Objective:The diagnostic scale of hemorrhagic stroke TCM syndrome was developed to provide a relatively rigorous quantitative diagnostic tool for the diagnosis of hemorrhagic stroke TCM syndrome,and to further improve the diagnostic criteria and effiicacy evaluation system for stroke TCM syndrome.Methods:1.Forming alternative TCM syndrome elements and item poolA working group was established to preliminarily determine that the hemorrhagic stroke TCM syndrome diagnosis scale involves TCM syndrome elements and a pool of four diagnosis information items based on previous studies and literature surveys.2.Expert questionnaireTwo rounds of expert questionnaires were conducted to collect items related to the diagnosis of common TCM syndromes of hemorrhagic stroke and their evaluation on the importance of TCM syndrome diagnosis.3.Clinical data collectionAll the 499 cases of hemorrhagic stroke were from three different hospitals.4.Item selectionThrough the joint selection of expert opinions and four clinical diagnosis information,the importance score,coefficient of variation,full score ratio and Spearman correlation coefficient of expert entries were calculated to comprehensively select the entries.5.Comparison of diagnostic model construction methodsTaking internal fire syndrome and qi deficiency syndrome as examples,on the basis of item selection,three diagnostic models were constructed by Logistic regression method,Fisher criterion method and principal component analysis method respectively,and the diagnostic capabilities of different diagnostic models were evaluated by ROC curve method6.Build the diagnostic model and determine the diagnostic thresholdAfter the previous comparison,the Logistic regression method was selected as the method to construct the diagnostic model,and the regression coefficient was used as the original weight.Using ROC curve analysis,the maximum point of Youden index was used as the diagnostic threshold,and the threshold value was adjusted to 20 points.The original weight was expanded and rounded in the same proportion to form the hemorrhagic stroke syndrome diagnosis scale(draft).7.Scale verificationBy back-substituting the data,the sensitivity,specificity,jorden index,positive predictive value,negative predictive value,dialectical accuracy and kappa value were calculated to verify the scale.Results:1.Hemorrhagic stroke TCM syndrome diagnosis scale involves 10 TCM syndrome elements,by the expert method,correlation coefficient method for items such as screening,screening of endogenous wind TCM syndrome after 31 items,fire 33 items,phlegm TCM syndrome in 21 entry card,wet 18,22 items of blood stasis TCM syndrome,qi deficiency and qi stagnation card 13 items,the 41 items,Yin deficiency TCM syndrome 26 items,Yang deficiency TCM syndrome 24 items,hand 14 items.2.Through ROC curve analysis of the diagnostic models of internal fire syndrome and qi deficiency syndrome,the Logistic regression model showed relatively good diagnostic ability,followed by the Fisher discriminant diagnostic model,and the pca diagnostic model had the worst diagnostic ability.3.The hemorrhagic stroke TCM syndrome factor diagnostic scale(draft)was developed,which was composed of 10 subscales.The diagnostic scale of internal wind TCM syndrome consists of 10 items,namely,jaw vibration,urgent jaw,speech slurred,irritability,dizziness,dizziness,head swelling,limb numbness,skin insensitivity and pulse.The diagnostic scale of internal fire TCM syndrome is composed of 15 items,namely,dizziness,agitation and restlessness,flushed face,mouth and lips parched crack,yellow moss,red tongue,dry tongue,coarse breath,strong heat,bitter mouth,insomnia,constipation,urine yellow,several pulse,slide pulse;The diagnostic scale of phlegm TCM syndrome consists of 11 items,which are thick moss,greasy moss,fat tongue,heavy voice,phlegm in throat,dizziness,mouth sticky,skin insensitive,nausea,moistening pulse,and slippery pulse.The diagnosis scale of wet TCM syndrome consists of 8 items,which are respectively lethargy,swelling of the face,greasy with moss,toothmark tongue,sticky mouth,unfeeling skin,bulgy and nausea.The diagnostic scale of blood stasis TCM syndrome is composed of 10 items,namely,purplish lips,purplish tongue,dark tongue,bruises and bruises on the tongue,purplish veins under the tongue,varicose veins under the tongue,pain with definite place,black stool,sinking pulse and astringent pulse.The diagnostic scale of qi stagnation TCM syndrome consists of four items,namely,depression,chest pain,abdominal pain and channeling pain.The qi-deficiency TCM syndrome diagnostic scale consists of 13 items,namely,pale complexion,pale lips,swollen hands or feet,white moss,low voice,shortness of breath,spontaneous sweating,god fatigue,slow pulse,virtual pulse,veinal pulse,micro pulse and weak pulse.The diagnostic scale of Yin deficiency TCM syndrome consists of 12 items,namely two zygomatic flushing,moss peeling,tongue light red without moss dry moss,thin tongue,cracked tongue,dry tongue,five upset heat,night sweat,tinnitus,eye acrid,dreaminess and veinlet.The diagnostic scale of yang-deficiency TCM syndrome consists of 11 items,namely pale lips,fat and large tongue,weak breath,aversion to cold,cold hands and feet,clear and long urine,nocturia,sinking pulse,slow pulse,veinlets and weak pulse.The diagnosis scale of yangkang TCM syndrome consists of five items,namely eye red,red tongue,sonorous voice,tinnitus and pulse.The assignment of items is shown in the article,and the TCM syndrome is established when it reaches 20 points.4.The verification sensitivity,specificity,youdeng index,positive predictive value,negative predictive value,dialectical accuracy,kappa value of the hemorrhagic stroke TCM syndrome diagnostic scale(draft)showed that the two subscales of internal wind TCM syndrome and phlegm TCM syndrome had good diagnostic performance.The four subscales of blood stasis,qi stagnation,qi deficiency,Yin deficiency and Yang deficiency were basically satisfactory.The diagnostic performance of the four subscales of internal wind TCM syndrome,wet TCM syndrome,gas stagnation TCM syndrome and hyperyang TCM syndrome is not good,and further adjustment is needed.Conclusion:On the whole,the hemorrhagic stroke TCM syndrome diagnostic scale developed by this research institute has good sensitivity,specificity and dialectical accuracy,and has good diagnostic performance,which provides a relatively rigorous quantitative diagnostic tool with methodology for future TCM clinical research on hemorrhagic stroke.The preparation method of the TCM syndrome diagnostic scale is in line with the clinical objective reality and provides a methodological reference for the preparation of TCM TCM syndrome diagnosis scale.ive predictive value,dialectical accuracy,kappa value,and verify the first draft of the scale.