介入术后冠心病中医证候诊断标准的评价

目的评价通过专家咨询建立的介入术后冠心病主要中医证候诊断标准的真实性、可靠性和临床应用价值。方法对23家医院1 050例介入术后冠心病患者，采用诊断试验的评价方法，通过灵敏度、特异度、准确度、阳性似然比及ROC曲线下面积，评价介入术后冠心病主要中医证候诊断标准的真实性；通过观察符合率和 Kappa值，评价该标准的可靠性；通过阳性预测值和阴性预测值，评价该标准的临床应用价值。结果前期建立的介入术后冠心病主要中医证候诊断标准，其灵敏度、特异度、准确度、阳性似然比、ROC曲线下面积、观察符合率、Kappa值、阳性预测值、阴性预测值如下：血瘀证分别为95.26%、93.70%、94.86%、15.13、0.924、98.76%、0.969、97.76%、87.24%；气虚证分别为96.42%、95.34%、96.00%、20.70、0.957、99.52%、0.990、97.02%、94.42%；痰浊证分别为88.19%、96.46%、94.19%、24.89、0.923、96.67%、0.915、90.39%、95.58%；心血瘀阻证分别为91.06%、98.77%、97.05%、74.22、0.950、98.67%、0.960、95.54%、97.46%；气虚血瘀证分别为98.41%、96.73%、97.33%、30.10、0.976、98.86%、0.976、94.40%、99.09%；痰瘀互阻证分别为94.81%、94.75%、94.76%、18.07、0.948、97.71%、0.918、72.73%、99.20%。结论介入术后冠心病主要中医证候诊断标准，具有较高的真实性、可靠性和临床应用价值。

英文摘要:

Objective To evaluate the validity， reliability， and clinical applicability of Chinese medicine syndrome diagnostic standards for coronary heart disease （CHD） patients after percutaneous coronary intervention （PCI）， which was established by expert consultation. Methods A total of 1 050 CHD patients after PCI were recruited from 23 hospitals. The sensitivity， specificity， accuracy， positive likelihood ratio， and area under ROC curve were used to evaluate the validity of diagnostic standards for Chinese medical syndrome types. The observable agreement rate and Kappa value were used to evaluate the reliability. Positive predictive value and negative predictive value were used to evaluate the clinical applicability. Results The sensitivity， specificity， accuracy， positive likelihood ratio， area under ROC curve， observable agreement rate， Kappa value， positive predictive value， and negative predictive value of each Chinese medicine syndrome in CHD patients after PCI were as follows： 95.26%， 93.70%， 94.86%， 15.13， 0.924， 98.76%， 0.969， 97.76%， and 87.24% for blood stasis syndrome； 96.42%， 95.34%， 96.00%， 20.70， 0.957， 99.52%， 0.990， 97.02%， and 94.42% for qi deficiency syndrome； 88.19%， 96.46%， 94.19%， 24.89， 0.923， 96.67%， 0.915， 90.39%， and 95.58% for phlegm turbidity syndrome； 91.06%， 98.77%， 97.05%， 74.22， 0.950， 98.67%， 0.960， 95.54%， and 97.46% for cardiac blood stasis syndrome； 98.41%， 96.73%， 97.33%， 30.10， 0.976， 98.86%， 0.976， 94.40%， and 99.09% for qi deficiency blood stasis syndrome； 94.81%， 94.75%， 94.76%， 18.07， 0.948， 97.71%， 0.918， 72.73%， and 99.20% for phlegm stasis stagnation syndrome. Conclusion The validity， reliability， and clinical applicability of Chinese medicine syndrome diagnostic standards for CHD patients after PCI were rational and considerable in clinical practice.

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