| Objective:Phlegm syndrome is a main TCM Syndromes of coronary heart disease. Based on Delphi method and analytic hierarchy process from qualitative& quantitative aspects and by using expert consultation, the study is to form expert consensus for differentiation basis of phlegm syndrome in coronary heart disease, so as to provide the service for the clinical diagnosis and treatment.Method:1. Medicine literature system evaluation method was used:determining the search strategy, making literature inclusion criteria and exclusion criteria, collecting literature with phlegm syndrome comprehensively and evaluating accordingly to draw up phlegm syndrome diagnostic information questionnaire for screening and counseling.2. On the basis of the literature evaluation system, expert consultation questionnaire for phlegm syndrome differentiation of coronary heart disease was formulated. Preliminary find the differentiation basis of phlegm syndrome in coronary heart disease, by using expert consultation based on Delphi method.3. On the basis of Delphi expert consultation, the analytic hierarchy process was using to determine the weight of differentiation basis of phlegm syndrome in coronary heart disease. Expert consensus was formed from a quantitative aspect.Result:1. phlegm syndrome literature system evaluation5803 related literatures with phlegm syndrome were retrieved and 118 qualified literatures were filtered through the inclusion criteria and exclusion criteria. Through frequency analysis, a total of 83 symptoms of phlegm syndrome were obtained. They are, from high frequency to low:greasy coating, slippery pulse, chest tightness/pain, nausea and vomiting, loss of appetite, dizziness, excessive phlegm, abdominal distention and fullness, sensation of head, obesity, stringy pulse, moisten pulse, fatigue, etc. Expert consultation questionnaire item pool was formed for screening and expert consulting.2. Delphi method for phlegm syndrome of coronary heart disease.Based on the results of systematic literature reviews and several small group discussion,16 items was retained, formed Delphi expert consultation questionnaire for differentiation basis of phlegm syndrome in coronary heart disease. Two rounds of Delphi expert consultation has launched nationwide. A total of 93 experts are participated. All the experts are came from "World Federation of Chinese Medicine Societies cardiovascular disease Specialized Committee" and "Academic Committee on cardiovascular diseases combined with traditional Chinese and Western Medicine". They are experts with long engagement in domestic long-term coronary heart disease daily diagnosis and treatments, represented the high level of industry.The recovery rate and each question response rate were 100%in two expert consultation questionnaires.22 experts were consulted in the first round, which reliability and validity of the questionnaire were 0.905 and 73.456%. 71 experts were consulted in second round, which reliability and validity of the questionnaire were 0.876 and 65.529%. Two rounds of consultation total the reliability and validity were 0.885 and 63.213%, which suggesting that stability and validity of the questionnaire are acceptable. The consistency of two rounds of expert consultation questionnaire indicated that there were no significant difference (P>0.05), the consistency of judgment made by the experts in the two rounds of consultation is acceptable. The overall coordinate coefficient of expert advice is 0.264, x2=649.106, P<0.01, which suggested that there is a high degree of coordination.Mean size, mark frequency, sum of ranks and coefficient of variation for each entry were analyzed statistically. An entry was deleted if it has three or more indexes in the end 30%of the rank. Four entries were deleted which are vomiting, lethargy, pale tongue, pulse moisten.12 entries of differentiation basis of phlegm syndrome in coronary heart disease were retained. They are chest tightness/pain, excessive phlegm, abdominal distention and fullness, obesity, loss of appetite, sensation of head, dizziness, sensation of body, fatigue, greasy coating, slippery pulse, and stringy pulse.3. Analytic hierarchy process for phlegm syndrome of coronary heart disease.Based on the previous literature research and Delphi expert consultation, two rounds of analytic hierarchy process expert consultation has launched in the nationwide. A total of 81 experts participated. The way of consultation is face to face interview, comparison of any two entries conducted.81 questionnaires were recovered in two rounds of consultation, the recovery rate of 100%, which showed that the experts are positive.40 experts were consulted in the first round and 41 experts were consulted in second round. The consistency check for two rounds of expert consultation questionnaire indicated that there were no significant difference (P>0.05), the consistency of judgment made by the experts in the two rounds of consultation is acceptable.Two rounds of analytic hierarchy process expert consultation, based on expert group decision method, were conducted to determine the weight coefficient and weight rank of differentiation basis of phlegm syndrome in coronary heart disease. The calculation of the value has good consistency (CI＜O.10).(1) Rank of contribution weight of primary indicators for diagnosis in phlegm syndrome of coronary heart disease from high to low as follows: tongue:0.3807; clinical symptoms:0.3726; pulse:0.2467.(2) Contribution weight of secondary indicators for diagnosis in phlegm syndrome of coronary heart disease from high to low as follows:Greasy coating:0.2426; pale tongue:0.138; Slippery pulse:0.1074; Moisten pulse: 0.0708; String pulse:0.0685;Chest tightness/chest pain:0.0559; Excessive phlegm:0.0430;Sensation of body:0.0348; Distention and fullness:0.0341; Obesity:0.0328; Sensation of head:0.0312; Dizziness:0.0307; Nausea and vomiting:0.0278; Loss of appetite:0.0277; Fatigue:0.0277; Sleepiness: 0.0270;4. Weight of score conversion for differentiation basis of phlegm syndrome in Coronary Heart Disease.To facilitate the clinical diagnosis and treatment operation, weight percent of score conversion for differentiation basis of phlegm syndrome in Coronary Heart Disease was conducted. The results are as follows:chest tightness/chest pain (2 points), excessive phlegm (2 points), sensation of body(1 points), distention and fullness(1 points), obesity(1 points), sensation of head (1 points), dizziness(1 points), greasy coating(9 points), pale tongue(5 points), slippery pulse(3 points), moisten pulse(2 points), string pulse(2 points). The total scores are 30 points.Conclusion:1. The qualitative of expert consensus for diagnosis of phlegm syndrome in coronary heart disease.(1)The main symptoms, tongue and pulse:chest tightness/chest pain, excessive phlegm, greasy coating, slippery pulse;(2) Secondary symptoms, tongue and pulse:sensation of body, distention and fullness, obesity, sensation of head, dizziness, pale tongue, moisten pulse, string pulse;2. Initial establishment of phlegm syndrome in coronary heart disease diagnosis questionnaire.(1) The reliability and validity of the phlegm syndrome questionnaire in coronary heart disease were 0.876 and 65.529%.(2) 12 entries and score:Chest tightness/chest pain:0.0559; Excessive phlegm:0.0430; Sensation of body:0.0348; Distention and fullness:0.0341; Obesity:0.0328; Sensation of head:0.0312; Dizziness:0.0307; Nausea and vomiting:0.0278; Loss of appetite:0.0277; Fatigue:0.0277; Sleepiness: 0.0270;The total scores are 30 points. It can be diagnosed as coronary heart disease phlegm when the total scores are more than 20 points.3. Explore the research model of the differentiation basis of syndrome: the process includes systematic literature reviews, Delphi method expert consultation determine differentiation basis of syndrome and analytic hierarchy process expert consultation determine the weight differentiation basis of syndrome for expert consensus. But it needs further clinical practice from sensitivity and specificity aspect to evaluation. |
PDF Full Text Request