IgA肾病气阴两虚证量化诊断方法学研究

作者	单位
魏日胞	中国人民解放军总医院肾科
王天芳	北京中医药大学基础医学院中医诊断系
李艳丽	中国人民大学统计学院
李建军	北京中医药大学基础医学院中医诊断系中国人民解放军总医院肾科
陈香美	中国人民解放军总医院肾科

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中文摘要:

目的探讨建立IgA肾病气阴两虚证量化诊断的方法。方法选择原发性IgA肾病患者1 016例,经SPSS软件简单随机分为训练样本组(气阴两虚证组344例,非气阴两虚证组456例)和验证样本组(气阴两虚证组77例,非气阴两虚证组139例)。在流行病学调查的基础上,将气阴两虚证辨证标准及临床常见症状作为候选相关因素,采用二元Logistic逐步回归法选定相关因素;应用条件概率换算方法对相关因素进行赋分;应用最大似然判别法确定量化诊断阈值;绘制受试者工作特征曲线(ROC),计算曲线下面积、敏感度、特异度、准确度,对建立的气阴两虚证量化诊断标准进行回顾性和前瞻性检验。结果 IgA肾病气阴两虚证量化诊断阈值为12分;量化诊断标准回顾性和前瞻性检验的敏感度、特异度、准确度分别为均75.3%、68.0%、71.1%和84.4%、60.4%、69.0%,ROC曲线下面积分别为0.80及0.78。结论以症状出现频次为基础建立IgA肾病证候量化标准是一种可行的方法,但该方法未能涵盖症状的强度信息。

英文摘要:

Objective To study the method for establishing a quantization diagnostic standard for immunoglobulin A(IgA) nephropathy of qi-yin deficiency syndrome(QYDS).Methods 1 016 patients with primary IgA nephropathy were recruited in this study.They were randomly assigned to the training sample group(344 cases of QYDS and 456 cases of non-QYDS) and the testing sample group(77 cases of QYDS and 139 cases of non-QYDS) using SPSS software.On the basis of epidemiological survey,the typing standards for QYDS and common clinical symptoms were taken as candidate correlated factors.The correlated factors were selected using binary Logistic stepwise regression.The correlated factors were scored using conditional probability conversion method.The threshold value of the quantization diagnostics was determined using maximum likelihood method.The receiver operating characteristic(ROC) curve was drawn to calculate the area under curve(AUC),sensitivity,specificity,and accuracy rating.The retrospective and prospective tests were performed on the established quantization diagnostic standard for QYDS.Results The quantization diagnosis threshold value of IgA nephropathy of QYDS was 12 points.The sensitivity,specificity,and accuracy rating of the quantization diagnostic standard were 75.3%,68.0%,and 71.1% in the retrospective test,as well as 60.4%,84.4%,and 69.0% in the prospective tests.The AUC was 0.80 and 0.78 respectively.Conclusions It was a feasible method to set up a quantization diagnostic standard for IgA nephropathy of QYDS by taking the occurrence frequency of symptoms.But this method failed to cover the strength information of symptoms.

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