The Establishment And Preliminarily Validation Of Diagnostic Criterion Of Pneumoconiosis Syndrome Based On Statistical Approach And Data Mining Analysis

Objective : Based on literature research,clinical investigation and the expert questionnaire,the diagnostic criterion of pneumoconiosis syndrome is established,and preliminarily verified the diagnostic efficacy of the established diagnostic criteria of pneumoconiosis syndrome.Methods:1.The formulation of clinical questionnaire based on literature research combined with the first round of expert questionnaires.Base on the results of literature research,the Delphi method is used to further screen out the syndromes and four diagnosis information item pool.The results of literature research and the first round of expert questionnaires are combined to formulate a clinical questionnaire of pneumoconiosis syndromes.2.The determination of syndrome diagnosis elements based on clinical investigation and the second round of expert questionnaire.Collect data on outpatient and inpatient pneumoconiosis patients in 8 hospitals and establish a TCM certificate for pneumoconiosis Syndrome clinical investigation and research database.Frequency and other statistical descriptions,cluster analysis,factor analysis,binary logistic regression and other multivariate statistical methods and artificial neural network data mining technology were used to explore the classification of common syndromes and the characteristics of primary and secondary symptoms of pneumoconiosis;The Delphi method was used for the second round of expert consultation,combined with the results of clinical investigation and research,to clarify the diagnosis elements of pneumoconiosis syndromes.3.The establishment of diagnostic criterion of pneumoconiosis syndrome based on data mining analysisCombining association rules and Bayesian network methods,analyze the relationship between the above symptoms and clarify the contribution of symptoms(groups)to syndromes,and the diagnosis conditions for pneumoconiosis syndromes are established.The combination method of diagnosis conditions is combined with the evaluation of the expert group to establish the diagnostic criterion of pneumoconiosis syndrome.4.Preliminarily verification of diagnostic criteria for syndromeUsing prospective research methods,we collected the data of 195 patients with pneumoconiosis in 4 hospitals across the country and established the database.Expert syndrome differentiation as the control.Select sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,and area under the curve as evaluation indicators to evaluate the diagnostic efficacy of the established diagnostic criteria of pneumoconiosis syndromes.Results:1.The formulation of clinical questionnaire based on literature research combined with the first round of expert questionnaires.1.1 Finally,48 qualified documents were included,with a total of 163 records.After standardization,34 syndromes were obtained.The syndromes with higher frequency are syndrome of lung qi deficiency,syndrome of lung yin deficiency,syndrome of pathogenic dryness invading the lung,syndrome of phlegm and dampness obstructing the lung,syndrome of lung and spleen qi deficiency.The results show that the main disease nature of syndrome elements of pneumoconiosis are mainly qi deficiency(51,21.89%),yin deficiency(43,18.45%),phlegm(37,15.88%),and the main disease location of syndrome elements are lung(131,66.50%),kidney(36,18.27%),spleen(21,10.66%);the combination of syndrome elements is more common in the combination of two syndromes and three syndromes.1.2 In the results of the first round of expert questionnaires,the average and full scores of syndrome of lung qi deficiency,syndrome of phlegm and stasis obstructing the lung,syndrome of dual deficiency of qi and yin in lung and kidney are relatively high,and the coefficient of variation is small.And analyzed the diagnostic indicators of each syndrome.1.3 Based on literature research and the first round of expert questionnaires,the main syndromes of pneumoconiosis and the main four diagnosis information were screened,the reference items for the diagnosis of each syndrome were formed,and the clinical questionnaire of syndromes of pneumoconiosis was developed.2.The determination of syndrome diagnosis elements based on clinical investigation and the second round of expert questionnaire.2.1 A total of 1080 clinical questionnaires and 1032 valid clinical questionnaires were collected.Combining the frequency of syndromes and the results of cluster analysis,it is preliminarily concluded that the common syndromes of pneumoconiosis are the syndrome of pathogenic dryness invading the lung,the syndrome of phlegm and dampness obstructing the lung,the syndrome of lung qi deficiency,the syndrome of lung and spleen qi deficiency,the syndrome of qi deficiency of kidney and lung,syndrome of blood stasis;and use frequency combined with binary logistic regression and artificial neural network to determine the primary and secondary symptoms of 6 common syndromes.2.2 A total of 21 qualified expert questionnaires were collected.Combined with expert opinions,the average score of 6 syndromes,syndrome of pathogenic dryness invading the lung,syndrome of phlegm and dampness obstructing the lung,syndrome of lung qi deficiency,syndrome of lung and spleen qi deficiency,syndrome of qi deficiency of kidney and lung,syndrome of blood stasis are relatively high,and the coefficient of variation is relatively small further clarify the primary and secondary symptoms of each syndrome.2.3 Comprehensive clinical investigation and research and the second round of expert questionnaire results,it is concluded that the common symptoms of pneumoconiosis are syndrome of pathogenic dryness invading the lung,the syndrome of phlegm and dampness obstructing the lung,the syndrome of lung qi deficiency,the syndrome of lung and spleen qi deficiency,the syndrome of qi deficiency of kidney and lung,syndrome of blood stasis 6 common syndromes.The primary and secondary symptoms of common syndromes were identified.3.The establishment of diagnostic criterion of pneumoconiosis syndrome based on data mining analysisBased on the clinical features of the common syndromes of pneumoconiosis and the relationship between the symptoms,using the combination of diagnostic conditions,the diagnostic criteria of pneumoconiosis syndromes was established.3.1 Syndrome of pathogenic dryness invading the lungDiagnosis conditions:(1)dry cough,or less phlegm or sticky sputum;(2)dyspnea,or shortness of breath;(3)oppression in chest or even chest pain;(4)dry mouth or throat,or thirst;(5)night sweating;(6)constipation;(7)red tongue,or eroded fur or without fur,dry,thread and rapid pulse.Diagnosis basis: The diagnosis should meet two of(1),(2),(3)and three of(4),(5),(6),(7).3.2 Syndrome of phlegm and dampness obstructing the lungDiagnosis conditions:(1)cough,or expectoration,or excessive phlegm,white stickiness;(2)shortness of breath,or oppression in chest;(3)anorexia or reduced appetite;(4)epigastric oppression;(5)sleepy of limbs,(6)white and greasy fur,slippery puls.Diagnosis basis: The diagnosis should meet(1)and(2),and two of(3),(4),(5),(6).3.3 Syndrome of lung qi deficiencyDiagnosis conditions:(1)cough,or dyspnea;(2)shortness of breath,or oppression in chest,aggravated by movement;(3)aversion to wind,or susceptibility to colds;(4)spiritlessness or weakness,aggravated by movement;(5)spontaneous sweating,aggravated by movement;(6)pale tongue,thin and white fur,or deep and thready pulse.Diagnosis basis: The diagnosis should meet one of(1),(2)and two of(3),(4),(5),(6).3.4 Syndrome of lung and spleen qi deficiencyDiagnosis conditions:(1)dyspnea,or cough,or expectoration;(2)shortness of breath,weakness,aggravated by movement;(3)spontaneous sweating,or susceptibility to colds;(4)epigastric oppression or abdominal distension,or loose stools;(5)anorexia or reduced appetite;(6)plump tongue or teeth-printed tongue,pale tongue,or deep and thready pulse.Diagnosis basis: The diagnosis should meet two of(1),(2),(3)and two of(4),(5),(6).3.5 Syndrome of qi deficiency of kidney and lungDiagnosis conditions:(1)dyspnea,or cough,or shortness of breath,aggravated by movement;(2)spiritlessness and weakness,spontaneous sweating,aggravated by movement;(3)susceptibility to colds,or fear of wind and cold;(4)soreness and weakness of waist and knees,or tinnitus;(5)facial and eyes edema;(6)frequent micturition,frequent urination at night,or enuresis when coughing;(7)pale tongue,or deep and thready pulse or weak pulse.Diagnosis basis: The diagnosis should meet two of(1),(2),(3)and two of(4),(5),(6),(7).3.6 Syndrome of blood stasisDiagnosis conditions:(1)oppression and pain in chest,or stabbing pain of chest;(2)dim complexion;(3)cyanotic lips and onychia;(4)dark red or dark purple tongue or ecchymosis on tongue;(5)tortuous or thicker sublingual vein Diagnosis basis: The diagnosis should meet one of(1),(2),(3),(4),(5).4.Preliminarily verification of diagnostic criteria for syndromeAmong the established diagnostic criteria for syndromes,the sensitivity of the 6 common syndromes ranges from 76.60% to 87.50%,the specificity ranges from 92.09% to 97.42%,the accuracy ranges from 90.26% to 95.38%,and the positive predictive value ranges from 90.26% to 95.38%.The negative predictive value ranges from 80.77% to89.74%,the negative predictive value ranges from 92.76% to 96.79%,the positive likelihood ratio is from 10.83 to 33.91,the negative likelihood ratio is from 0.13 to 0.25,and the area under the ROC curve is 0.872 ~ 0.933.Conclusion: Based on literature research,clinical investigation and the expert questionnaire,the diagnostic criterion of pneumoconiosis syndrome is established.There are three types and six syndromes in the diagnostic criterion of pneumoconiosis syndrome,including excess syndromes(syndrome of pathogenic dryness invading the lung,the syndrome of phlegm and dampness obstructing the lung),deficiency syndromes(the syndrome of lung qi deficiency,the syndrome of lung and spleen qi deficiency,the syndrome of qi deficiency of kidney and lung),and concurrent syndrome(syndrome of blood stasis).The established diagnostic criteria of pneumoconiosis syndromes have high authenticity,reliability and clinical practical significance.