心房颤动常见病理因素中西医结合诊断量表研制
Development of a Diagnostic Scale for Atrial Fibrillation Based on Common Pathological Factors in Integrated Traditional and Western Medicine
王啸轶1，方格2，刘建和3，胡志希1△
Wang Xiaoyi1, Fang Ge2, Liu Jianhe3, Hu Zhixi1△
（1．湖南中医药大学，长沙 410208；2．湖南中医药高等专科学校，株洲 412012；3．湖南中医药大学第一附属医院，长沙 410007）
(1.Hunan University of Traditional Chinese Medicine,Changsha 410208;2.Hunan Higher Vocational College of Traditional Chinese Medicine, Zhuzhou 412012;3.First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007)
摘要：目的 研制心房颤动常见病理因素中西医结合诊断量表。方法 检索并筛选近30年知网、维普、万方、中国生物医学文献数据库收录的心房颤动辨证相关文献，提取相关病理因素及对应症状、体征、理化指标等诊断条目，并对条目进行规范化处理，确定条目池；使用德尔菲法筛选诊断条目，筛选指标为均数、满分比、变异系数；基于综合权重，结合条目均数、满分比、变异系数对筛选后条目赋权并确定诊断阈值，形成心房颤动常见病理因素中西医结合诊断量表。结果 共检索文献6526篇，最终纳入115篇，提取血瘀、气虚、阴虚、痰浊、阳虚、气滞共6个常见病理因素，诊断条目共169个。基于德尔菲法专家问卷咨询，删除气滞病理因素，共筛选血瘀、气虚、阴虚、痰浊、阳虚5个心房颤动常见病理因素的中西医结合诊断条目各18、12、11、12、19个，拟定心房颤动常见病理因素中西医结合诊断量表。结论 本研究筛选心房颤动常见病理因素，明确各病理因素诊断条目及其对应的权重与诊断阈值，研制了心房颤动常见病理因素中西医结合诊断量表，为心房颤动中西医结合临床诊断提供指导。
Abstract：ObjectiveTo develop a diagnostic scale for common pathological factors of atrial fibrillation based on a combination of traditional Chinese and Western medicine.MethodsLiterature from the past30years was searched andscreened from databases including CNKI, VIP, Wanfang, and Chinese Biomedical Literature Database, focusing on atrial fibrillation syndrome differentiation related literature, extracting relevant pathological factors and corresponding symptoms, signs, and physical and chemical indicators for diagnostic items, and standardizing these items, to determine the item pool; the Delphi method was used to screen diagnostic items, with screening criteria including mean, full score ratio, and coefficient of variation; based on comprehensive weight, the selected items were assigned weights and diagnostic thresholds were determined by combining item means, full score ratios, and coefficients of variation to form a diagnostic scale for common pathological factors of atrial fibrillation based on a combination of traditional Chinese and Western medicine.ResultsA total of6526 articles were retrieved, and finally115 articles were included, extracting a total of6 common pathological factors: blood stasis, qi deficiency, yin deficiency, phlegm turbidity, yang deficiency, and qi stagnation, with a total of169 diagnostic items.Based on the Delphi method expert questionnaireconsultation, the pathological factors of Qi stagnation were removed, and a total of bloodstasis, Qi deficiency, Yin deficiency, phlegm turbidity, and Yang deficiency5 common pathological factors of atrial fibrillation were screened, with combined Chinese and Western medicine diagnostic items of18,12,11,12,19 items,and a combined Chinese and Western medicine diagnostic scale for common pathological factors of atrial fibrillation was proposed.Conclusion This study screened common pathological factors of atrial fibrillation, clarified the diagnostic items of each pathological factor and their correspondingweights and diagnostic thresholds, and developed a combined Chinese and Western medicine diagnostic scale for common pathological factors of atrial fibrillation, providing guidance for the clinical diagnosis of atrial fibrillation using both Chinese and Western medicine.It seems there is no source text provided for translation. Please provide the text you would like to have translated
关键词：心房颤动；病理因素；中医药标准化；德尔菲法；诊断量表
Keywords:Atrial fibrillation; pathological factors;Traditional Chinese medicinestandardization;Delphi method;diagnosticscale
心房颤动（atrial fibrillation，AF）简称房颤，是心律失常中最常见的一种类型，房颤本身不是一种致死性心律失常，但其可导致脑卒中、心肌梗死、心力衰竭、痴呆等严重并发症，对全人类的生命健康构成了巨大威胁，极大地加重了社会的医疗负担[1-2]。长久以来，房颤的中西医结合诊断存在缺乏统一标准、主观性强、定量不足、与现代医学指标结合不足的弊端。本研究以病理因素为切入点，经文献研究构建诊断条目池，再开展两轮德尔菲法专家问卷调查，筛选心房颤动不同病理因素诊断条目，再通过数理统计，最终形成心房颤动常见病理因素中西医结合诊断量表，为心房颤动中西医结合诊断提供指导，并探索中西医结合诊断研究的思路与方法。
Atrial fibrillation (atrialfibrillation,AF) is commonly referred to as AF, and it is the most common type of arrhythmia. Atrial fibrillation itself is not a lethal arrhythmia, but it can lead to serious complications such as stroke, myocardial infarction, heart failure, and dementia, posing a significant threat to the health and lives of people worldwide, greatly increasing the medical burden on society[1-2]. For a long time, the combined diagnosis of atrial fibrillation in traditional Chinese and Western medicine has suffered from a lack of unified standards, strong subjectivity, insufficient quantification, and inadequate integration with modern medical indicators. This study takes pathological factors as the entry point, constructs a diagnostic item pool through literature research, and then conducts two rounds of Delphi method expert questionnaire surveys to screen diagnostic items for different pathological factors of atrial fibrillation. Finally, through mathematical statistics, it forms a combined diagnostic scale for common pathological factors of atrial fibrillation in traditional Chinese and Western medicine, providing guidance for the combined diagnosis of atrial fibrillation and exploring ideas and methods for research in combined diagnosis.
资料与方法
Materials and Methods
文献研究
LiteratureResearch
文献检索
Literature search
计算机检索近30年（1990-2020年）中国知网（CNKI）、万方数据平台（WANFANG DATA）、维普中文期刊服务平台（VIP）、中国生物医学文献数据库（SinoMed）收录的心房颤动相关文献。检索词为：心房颤动、房颤、心房纤颤、心悸、怔忡、病理因素、气虚、血虚、阴虚、阳虚、气滞、血瘀、痰浊、中医、诊断、中西医结合、证候、证型、辨证、证素，以“AND”、“OR”逻辑运算符连接。
A computer search was conducted for literature related to atrial fibrillation indexed in the China National Knowledge Infrastructure (CNKI), Wanfang Data Platform, VIP Chinese Journal Service Platform, and SinoMed Biomedical Literature Database over the past 30 years (1990-2020). The search terms included: atrial fibrillation, AF, atrial flutter, palpitations, arrhythmia, pathological factors, qi deficiency, blood deficiency, yin deficiency, yang deficiency, qi stagnation, blood stasis, phlegm turbidity, traditional Chinese medicine, diagnosis, integrated traditional and Western medicine, syndromes, syndrome types, syndrome differentiation, and syndrome elements, connected by "AND" and "OR" logical operators.
文献纳入标准
LiteratureInclusion Criteria
（1）包含明确心房颤动中医证型及相对应的症状、体征和/或理化指标的文献；（2）有明确的中医和/或西医诊断标准的文献。
（1）Literature that includes clear Traditional Chinese Medicine (TCM) syndromes of atrial fibrillation and corresponding symptoms, signs, and/or physical and chemical indicators;（2）Literature with clear TCM and/or Western medicine diagnostic criteria.
文献排除标准
Exclusion criteria for literature
（1）重复发表的论文或重复使用研究数据的文献（只保留发表刊物级别较高的文献）；（2）非CN期刊收录的文献；（3）只有证名而无辨证相关条目的文献；（4）无证型相关诊断标准的文献；（5）动物实验研究、个案报道、临床经验、综述。
（1）Papers that are published repeatedly or literature that reuses research data (only retaining literature from higher-level publications);（2）Literature not included in CN journals;（3）Literature that only has evidence but no relevant dialectical entries;（4）Literature without evidence-based diagnostic criteria;（5）Animal experimental studies, case reports, clinical experiences, reviews.
文献筛选与数据提取
Literature Screeningand Data Extraction
将下载的文献题录导入NoteExpress 3.2.0.7629软件，根据纳入及排除标准阅读每一篇文献的题目、摘要进行初筛，再逐篇阅读全文进行复筛。使用Microsoft Excel软件建立文献资料提取表，将最终纳入的文献进行数据录入、校对和清理，提取内容为：作者姓名、发表年份、文献标题、文献来源、证型、症状、体征、主要理化检查结果及相关中西医诊断标准。参照GB/T 16751.2-1997《中医临床诊疗术语 证候部分》[3]、《中医诊断学》（第9版）[4]，对证名、症状、体征的表达进行规范处理；参照《内科学》（第8版）[5]、《心房颤动：目前的认识和治疗的建议-2018》[1]对西医理化指标的表达进行规范处理；将临床意义相近的条目进行同义合并，将复合条目进行拆分处理。
Import the downloaded literature citations intoNoteExpress3.2.0.7629 software, read the title and abstract of each literature according to the inclusion and exclusion criteria for initial screening, and then read each article in full for re-screening. UseMicrosoftExcel software to create a literature data extraction table, enter, proofread, and clean the data of the final included literature, extracting the following content: author name, publication year, literature title, literature source, evidence type, symptoms, signs, main physicochemical examination results, and relevant Chinese and Western medicine diagnostic criteria. Refer toGB/T16751.2-1997“Terminology of Clinical Diagnosis and Treatment in Traditional Chinese MedicineSymptom Section”[3], “Diagnosis in Traditional Chinese Medicine” (9thEdition)[4], standardizing the expression of disease names, symptoms, and signs; referring to “Internal Medicine” (8thEdition)[5], “Atrial Fibrillation: Current Understanding and Treatment Recommendations-2018”[1] standardizing the expression of Western medical physical and chemical indicators; merging entries with similar clinical significance, splitting composite entries for processing.It seems there is no source text provided for translation. Please provide the text you would like to have translated
德尔菲法专家问卷咨询
Delphi Method Expert Questionnaire Consultation
确定条目池
Determine the entry pool
通过前期文献系统评价与研究小组研讨，选择频次≥2的条目纳入条目池。
Through the preliminary literature systematic review andresearch groupdiscussions, entries with a frequency≥2were included in the entry pool.
问卷设计
Questionnaire Design
在前述文献研究提取不同病理因素诊断条目池的基础上，开展研究团队研讨会，进一步补充和确定诊断条目，并制定专家咨询问卷。咨询问卷包括研究者声明、研究背景介绍、专家基本信息表、问卷填写说明、待筛选诊断条目重要性评价、熟悉程度、判断依据、修改建议、补充意见等。其中条目重要性评价采用Likert 5级评分法（4分-非常重要、3分-比较重要、2分-一般重要、1分-比较不重要、0分-极不重要）；专家熟悉程度分为很熟悉（1分）、较为熟悉（0.8分）、一般熟悉（0.6分）、不太熟悉（0.4分）、不熟悉（0.2分）；专家判断依据分别为临床经验（0.8分）、理论分析（0.6分）、参考国内外资料（0.4分）、直觉（0.2分）。
Based on the extraction of different pathological factors from the aforementioned literature research to form a pool of diagnostic entries, a research team seminar was held to further supplement and confirm the diagnostic entries, and to develop an expert consultation questionnaire. The consultation questionnaire includes a researcher statement, research backgroundintroduction, expert basic information form, questionnaire filling instructions, importance evaluation of the diagnostic entries to be screened,familiarity level,judgment basis, modification suggestions, and additionalcomments. Among them, the importance evaluation of the entries uses theLikert5level scoring method (4points - very important,3points - relatively important,2points - generally important,1point - relatively unimportant,0points - extremely unimportant); the expert familiarity level is divided into very familiar (1point), relatively familiar (0.8points), generally familiar (0.6points), not very familiar (0.4points), and unfamiliar (0.2points); the expert judgment basis includes clinical experience (0.8points), theoretical analysis (0.6points), reference to domestic and international materials (0.4points), intuition (0.2points).It seems there is no source text provided for translation. Please provide the text you would like to have translated
专家遴选
Expert Selection
为保证研究质量，确定专家遴选原则为：（1）具备副高级及以上职称；（2）从事房颤临床诊疗或中医证候标准化工作不少于10年。
To ensure the quality of the research, the criteria for selecting experts are as follows:（1）Must have a title of associate senior or above；（2）Engaged inAtrial Fibrillationclinical diagnosis and treatment or traditional Chinese medicinestandardization workfor no less than10years。
匿名处理
Anonymous processing
为了避免专家之间互相影响或权威专家意见对其他专家的干扰，保证各位专家意见的平等性、独立性与真实性，本研究中调查专家在招募阶段与调查阶段均互相匿名，独立参与调查。
In order to avoid mutual influence among experts or interference from authoritative experts' opinions on other experts, and to ensure the equality, independence, and authenticity of each expert's opinion, this study conducted the survey with experts remaining anonymous during both the recruitment and survey phases, participating independently in the investigation。
统计分析
Statistical analysis
基于问卷结果，使用Microsoft Excel软件计算专家积极系数、权威程度、集中程度、协调程度、综合权重[6]。专家积极系数即问卷的有效回收率（%）。权威程度通常采用权威系数（Q）表示，权威系数（Q）=（熟悉程度+判断依据）/2。集中程度包括均数（）和满分比（%）（K），其中均数（）=（x1+ x2+…xn）/n，n为专家人数， xn为第n位专家对条目的重要性评分；满分比（K）=n(x=4)/N×100%，N为专家人数，n(x=4)为对条目的重要性评分为非常重要的专家人数。协调程度采用变异系数（CV）表示，变异系数（CV）=SD/，SD为条目重要性评分的标准差。综合权重反映纳入诊断量表的条目的重要性占比，综合权重=条目二轮总评分/所有条目二轮总评分。
Based on the questionnaire results, usingMicrosoftExcelsoftware to calculate the expert positivity coefficient, authority level, concentration level, coordination level, comprehensive weight[6]. The expert positivity coefficient is the effective recovery rate of the questionnaire (%).The authority level is usually represented by the authority coefficient (Q), the authority coefficient (Q)=（Familiarity level+Judgment basis）/2.The degree of concentration includes the mean (）and the full score ratio (%）（K），where the mean (）=（x1+x2+…xn）/n，n is the number of experts, xn is the nth expert's score of importance for the item; the full score ratio (K）=n(x=4)/N×<100%，N is the number of experts，n(x=4) is the number of experts who rated the importance of the item as very important. The degree of coordination is represented by the coefficient of variation (CV), the coefficient of variation (CV)=SD/，SD is the standard deviation of the importance ratings of the items. The comprehensive weight reflects the proportion of importance of the items included in the diagnostic scale， the comprehensive weight= total score of the second round of items/ total score of all items in the second round.It seems there is no source text provided for translation. Please provide the text you would like to have translated
诊断量表拟定
Drafting of diagnostic scales
综合权重等比扩大100倍后四舍五入得到整数权重，基于条目整数权重及研究小组研讨，结合条目均数、满分比、变异系数进行调整，最终确定各病理因素不同诊断条目权重及诊断阈值，从而得出诊断量表。
Comprehensive weight is expanded proportionally100timesafterrounding to obtain integer weights, based on the integer weights of the items and discussions within the research group, adjustments are made in conjunction with the item mean, full score ratio, and coefficient of variation, ultimately determining the different diagnostic weightsof pathological factorsand diagnostic thresholds, thus deriving the diagnostic scale.
结果
Result
文献研究
Literature research
文献筛选结果
Literature screening results
一共检索到文献6526篇，其中CNKI 2598篇（软件自动除重后剩余1683篇），SinoMed 1928篇（软件自动除重后剩余1925篇），WANFANG DATA 1112篇（软件自动除重后剩余1101篇），VIP 896篇（软件自动除重后剩余895篇）。合并后得到文献共5604篇，再次进行数据库间除重后，纳入文献3554篇进行初筛。初筛剔除文献3032篇，剩余522篇进入复筛。复筛剔除文献共407篇，最终纳入文献115篇。
A total of6526documents were retrieved, among whichCNKI2598documents (after automatic deduplication by the software, remaining1683documents),SinoMed1928documents (after automatic deduplication by the software, remaining1925documents),WANFANGDATA1112documents (after automatic deduplication by the software, remaining1101documents),VIP896documents (after automatic deduplication by the software, remaining895documents).After merging,the total number of documents is5604documents. After further deduplication between databases,3554documents were included for initial screening. The initial screening excluded3032documents, leaving522documents forfurther screening.The further screening excluded a total of407documents, and finally115documents were included.
条目池确定
Entry pool determined
选择频次≥2的条目纳入条目池，条目按频次降序排列。
Selection frequency≥2entries are included in the entry pool, and entries are sorted in descending order by frequency.
（1）血瘀病理因素诊断条目池
(1)BloodStasisPathologicalFactorsDiagnosis Item Pool
中医诊断条目：心悸、舌质紫暗、心胸疼痛、胸闷、脉结、脉涩、舌有瘀斑瘀点、唇甲青紫、脉代、脉弦、痛有定处、痛引肩背内臂、面色黧黑、心痛如刺、心烦、面色晦暗、脉细、舌下络脉曲张、皮下瘀斑、肌肤甲错、病程日久、入夜尤甚。理化指标：心电图诊断、纤维蛋白原升高、PT异常、D-二聚体升高、APTT异常、CRP升高、同型半胱氨酸升高、血小板计数异常、CHA2DS2-VASc评分≥4分、AT3异常、INR＜2、HAS-BLED评分≥3分、血栓弹力图提示高凝状态。
Traditional Chinese Medicine diagnostic items: palpitations, dark purple tongue, chest pain, chest tightness, pulse knotty, pulse rough, tongue with ecchymosis and spots, lips and nails cyanotic, pulse alternate, pulse string-like, pain with a fixed location, pain radiating to shoulder, back, and inner arm, dark complexion, stabbing heart pain, irritability, dull complexion, fine pulse, sublingual collateral veins distended, subcutaneous ecchymosis, skin and nails abnormal, long course of disease, worse at night.Electrocardiogram diagnosis, elevated fibrinogen,PTabnormal,D-dimer elevated,APTTabnormal,CRPelevated, homocysteine elevated, abnormal platelet count,CHA2DS2-VAScscore≥4points,AT3abnormal,INR＜2,HAS-BLEDscore≥3points, thromboelastography suggests a hypercoagulable state.
（2）气虚病理因素诊断条目池
(2)Qi DeficiencyPathologicalFactor Diagnosis Item Pool
中医诊断条目：心悸不安、气短、神疲乏力、胸闷、脉结、自汗、脉细、脉代、脉弱、头晕、苔白、舌淡、脉虚、面白、少气懒言、舌有齿痕、动则加重、心胸隐痛。理化指标：心电图诊断、LVEF值正常、左心房内径正常、BNP正常、CHA2DS2-VASc评分≤2分、HAS-BLED评分≤2分。
Traditional Chinese Medicine diagnostic items: palpitations, shortness of breath, fatigue, chest tightness, pulse knotting, spontaneous sweating, thin pulse, pulse replacement, weak pulse, dizziness, white tongue coating, pale tongue, deficient pulse, pale face, little speech, tongue with tooth marks, worsens with movement, hidden chest pain. Physical and chemical indicators: electrocardiogram diagnosis,LVEF value normal, left atrial diameter normal,BNP normal,CHA2DS2-VASc score≤2 points,HAS-BLED score≤2 points.
（3）阴虚病理因素诊断条目池
(3)Diagnosis Item Pool for Yin Deficiency Pathological Factors
中医诊断条目：心悸、脉细、舌红、少苔、口干、盗汗、胸闷、脉数、潮热或五心烦热、失眠、头晕、心烦、多梦、脉结、脉代、脉促、颧红、耳鸣、腰膝酸软、大便干、心胸隐痛、形体消瘦。理化指标：心电图诊断、静息心室率≥110bpm、全血粘度升高、甲状腺功能异常。
Traditional Chinese Medicine diagnostic items: palpitations, thin pulse, red tongue, little coating, dry mouth, night sweats, chest tightness, rapid pulse, tidal fever or five hearts heat, insomnia, dizziness, irritability, vivid dreams, knotty pulse, intermittent pulse, rapid pulse,red cheeks, tinnitus, soreness in the lower back and knees, dry stool, hidden pain in the chest, and emaciation. Physical and chemical indicators: electrocardiogram diagnosis, resting ventricular rate≥110bpm, increased whole blood viscosity, abnormal thyroid function.
（4）痰浊病理因素诊断条目池
(4)Diagnosis of pathological factors for phlegm-dampness
中医诊断条目：心悸、苔腻、脉滑、多痰、苔白、胸闷如窒、脉弦、精神疲倦、心烦、失眠、脉结、头晕、口干、口苦、苔滑、身体困重、脘痞或腹胀、体胖、恶心、呕吐痰涎、纳呆。理化指标：心电图诊断、甘油三酯升高、低密度脂蛋白胆固醇升高、高密度脂蛋白胆固醇降低、总胆固醇升高、全血粘度升高。
Traditional Chinese Medicine diagnostic items: palpitations, greasy tongue, slippery pulse, excessive phlegm, white tongue, chest tightness like suffocation, string-like pulse, mental fatigue, irritability, insomnia, knotty pulse, dizziness, dry mouth, bitter mouth, slippery tongue, heavy body, epigastric distension or abdominal bloating, obesity, nausea, vomiting phlegm and saliva, poor appetite. Physical and chemical indicators: electrocardiogram diagnosis, elevated triglycerides, elevated low-density lipoprotein cholesterol, decreased high-density lipoprotein cholesterol, elevated total cholesterol, increased whole blood viscosity.
（5）阳虚病理因素诊断条目池
(5)Yang DeficiencyPathologicalFactor Diagnosis Entry Pool
中医诊断条目：心悸怔忡、畏冷肢凉、气短、胸闷、脉沉、脉弱、舌淡、浮肿、面色㿠白、苔白、脉细、舌胖大、脉结、小便短少、脉代、神疲乏力、舌质紫暗、大便溏、小便清长、面唇青紫、自汗、恶心呕吐、苔滑、喘息或不能平卧、遇寒加重、动则加重、舌有齿痕。理化指标：心电图诊断、LVEF值降低、左心房内径增大、 左心室舒张末期内径增大、FS值降低、BNP升高、E/A降低、TNF-α升高、IL-6升高。
Traditional Chinese Medicine diagnostic items: palpitations, cold intolerance with cold limbs, shortness of breath, chest tightness, deep pulse, weak pulse, pale tongue, edema, pale complexion, white coating, thin pulse, enlarged tongue, knotted pulse, scanty urination, intermittent pulse, fatigue, dark purple tongue, loose stools , clear and prolonged urination, cyanosis of the face and lips, spontaneous sweating, nausea and vomiting, slippery coating, wheezing or inability to lie flat, worsening with cold, worsening with movement, tongue with tooth marks. Physiological and chemical indicators: electrocardiogram diagnosis, LVEF value decreased, enlarged left atrial diameter, enlarged left ventricular end-diastolic diameter, FS value decreased, BNP elevated, E/A decreased, TNF-α elevated, IL-6 elevated.
（6）气滞病理因素诊断条目池
(6)Diagnosis Item Pool for Qi Stagnation Pathological Factors
中医诊断条目：心悸、心胸胀痛或窜痛、胸闷、情志抑郁、头晕、脉弦、急躁易怒、气短、颤抖、舌红、脉涩、脉结、苔黄、脉代、善太息、舌象正常、随情志诱发或加重。理化指标：心电图诊断、甲状腺功能异常、生活质量评分降低、组织因子升高。
Traditional Chinese Medicine diagnostic items: palpitations, chest tightness or stabbing pain, chest oppression, emotional depression, dizziness, wiry pulse, irritability, shortness of breath, trembling, red tongue, rough pulse, knotted pulse, yellow coating, intermittent pulse, tendency to sigh, tongueappearancenormal, induced or worsened by emotions. Physical and chemical indicators: electrocardiogram diagnosis, thyroid function abnormalities, reduced quality of life scores, elevated tissue factor.
德尔菲专家问卷
Delphi Expert Questionnaire
专家基本情况
Basic Information of Experts
本研究进行了2轮问卷咨询，25位专家参与了咨询，分别来自湖南、广东、广西、江西、四川、安徽、上海、天津等8个省、自治区或直辖市，覆盖了华北、华东、中南、西南4个行政地理分区。咨询的专家均长期在临床和科研工作中从事房颤中西医结合诊疗与中医证候标准化工作。专家构成情况见表1。
This study conducted2 rounds of questionnaire consultations,25 experts participated in the consultations, coming from Hunan, Guangdong, Guangxi, Jiangxi, Sichuan, Anhui, Shanghai, Tianjin, and other8 provinces, autonomous regions, or municipalities, covering the North China, East China, Central South, Southwest4 administrative geographical divisions. The consulted experts have long been engaged in atrial fibrillation integrated traditional Chinese and Western medicine diagnosis and treatment and the standardization of traditional Chinese medicine syndrome criteria. The composition of experts is shown in Table 1.
表1 专家构成情况
Table1Composition of Experts
轮次 | 性别 | 年龄（岁） | 职称 | 专业 | 研究领域 | ||||||
男 | 女 | ＜50 | ≥50 | 副高级 | 高级 | 中医诊断 | 中医心血 管内科 | 中西医结合心血管内科 | 临床 | 科研 | |
第一轮 | 14 | 1 | 11 | 4 | 7 | 8 | 4 | 8 | 3 | 11 | 4 |
第二轮 | 8 | 2 | 9 | 1 | 7 | 3 | 1 | 8 | 1 | 9 | 1 |
专家积极系数
ExpertPositive Coefficient
第一轮问卷共发送15份，收回有效问卷15份，专家积极系数为100%；第二轮问卷共发送10份，收回有效问卷10份，专家积极系数为100%。二轮问卷的专家积极系数均为100%，说明专家对本研究的关注程度和积极性较高。
The first round of questionnaires sent15copies, with valid questionnaires returned15copies, and the expert engagement coefficient is100%; the second round of questionnaires sent10copies, with valid questionnaires returned10copies, and the expert engagement coefficient is100%. The expert engagement coefficient for the second round of questionnaires is100%, indicating a high level of attention and enthusiasm from the experts towards this research.
专家权威程度
Expert authority level
第一轮问卷熟悉程度=0.99，判断依据=1.67，权威系数（Q）=1.33；第二轮问卷熟悉程度=0.96，判断依据=1.62，权威系数（Q）=1.29。二轮问卷的专家权威系数均在0.70以上，说明专家权威程度较高，对本领域较为熟悉，研究结果可靠性和权威度较高[7]。
First Round QuestionnaireFamiliarity Level=0.99，Basis for Judgment=1.67，Authority Coefficient (Q)=1.33；Second Round QuestionnaireFamiliarity Level=0.96，Basis for Judgment=1.62，Authority Coefficient (Q)=1.29. The expert authority coefficients of the second round questionnaire are all within0.70or above, indicating a high level of authority among experts, familiarity with the field, and a higher reliability and authority of the research results[7]。It seems there is no source text provided for translation. Please provide the text you would like to have translated
条目筛选
Entry Screening
本研究参考本领域相关文献[6,8]，并结合研究实际，确定条目筛选标准。第一轮专家咨询的条目纳入标准如下：均数≥2.0、满分比≥25%、变异系数≤0.4。对全部符合以上3个标准的条目，直接纳入第二轮问卷调查；对上述3个标准只符合2个者：若满足均数≥2.0且满分比≥25%，而变异系数＞0.4的条目，认为虽然专家对此条目评价波动性较大，但总体对此条目做出较高评价，或给满分的专家比例较大，暂保留进入第二轮问卷调查；若满足均数≥2.0且变异系数≤0.4的条目，而满分比＜25%的条目，认为虽然给出满分的专家比例较小，条目相对重要性较大且专家意见较为统一，暂保留进入第二轮问卷调查；不满足上述条件的条目予以剔除。
This study references relevant literature in this field[68], and based on the actual research, determines the criteria for item selection.The inclusion criteria for the first round of expertconsultation are as follows: mean≥2.0, full score ratio≥25%, and coefficient of variation≤0.4. For all items that meet the above3 criteria, they will be directly included in the second round of the questionnaire survey; for those that only meet2 of the above3 criteria: if the mean≥2.0 and the full score ratio≥25%, while the coefficient of variation >0.4 entries, it is believed that although the expert evaluations for this entry vary greatly, the overall evaluation is relatively high, or the proportion of experts giving full marks is large, and it will temporarily remain for the second round of the questionnaire survey; if the mean≥2.0 and the coefficient of variation≤0.4 for entries, while the proportion of full marks＜25% for entries, it is believed that although the proportion of experts giving full marks is small, the relative importance of the entry is large and the experts' opinions are relatively unified, it will temporarily remain for the second round of the questionnaire survey; entries that do not meet the above conditions will be excluded.It seems there is no source text provided for translation. Please provide the text you would like to have translated
第二轮专家咨询的条目纳入标准如下：均数≥2.5、满分比≥30%、变异系数≤0.3。全部符合以上3个标准的条目予以保留，否则将条目剔除。
The second round of expertconsultation entry inclusion criteria are as follows: mean≥2.5, full score ratio≥30%, and coefficient of variation≤0.3. All entries that meet the above3 criteria will be retained; otherwise, the entries will be excluded.
值得说明的是，虽然理化指标“心电图诊断”在每一个病理因素中都得到较高的均分，但是部分专家给出0分，认为其对不同病理因素的诊断无特异性和区分度，且条目变异系数较大。故经研究小组商讨，决定去除“心电图诊断”，仅将其作为诊断心房颤动的必要前提。
It is worth noting that although the physical and chemical indicators“electrocardiogram diagnosis” received a high average score across all pathological factors, some experts gave it a0 score, believing that it lacks specificity and differentiation for different pathological factors, and that the coefficient of variation for the items is quite large. Therefore, after discussions among the research team, it was decided to remove“electrocardiogram diagnosis”, considering it only as a necessary prerequisite for diagnosing atrial fibrillation.
（1）血瘀病理因素诊断条目筛选结果
(1)Diagnosis of pathological factors for blood stasis
在第二轮咨询中，“心悸”条目变异系数为0.377＞0.3，经研究小组研讨后，认为“心悸”为血瘀病理因素临床常见条目，决定保留。经过两轮专家咨询，剔除的条目为：心电图诊断、面色晦暗、脉结、脉代、痛引肩背内臂、纤维蛋白原升高、血小板计数异常、APTT异常、PT异常、脉弦、AT3异常、INR＜2、HAS-BLED评分≥3分、心烦、脉细、同型半胱氨酸升高、CRP升高；最终纳入诊断量表的条目为：心痛如刺、舌质紫暗、舌有瘀斑瘀点、舌下络脉曲张、痛有定处、脉涩、心悸、唇甲青紫、心胸疼痛、入夜尤甚、病程日久、胸闷、皮下瘀斑、肌肤甲错、面色黧黑、血栓弹力图提示高凝状态、D-二聚体升高、CHA2DS2-VASc评分≥4分。血瘀病理因素诊断条目筛选流程及结果见表2。
In the second round of consultation, the coefficient of variation for the entry "palpitations" is 0.377 > 0.3, after discussion by the research group, it was concluded that "palpitations" is a clinically common entry for blood stasis pathological factors, and it was decided to retain it. After two rounds of expert consultation, the entries removed were: electrocardiogram diagnosis, dark complexion, pulse knot, pulse 代, pain radiating to shoulder and inner arm, elevated fibrinogen, abnormal platelet count, APTT abnormal, PT abnormal, pulse string, AT3 abnormal, INR < 2, HAS-BLED score ≥3 points, restlessness, thin pulse, elevated homocysteine, CRP elevated; the final entries included in the diagnostic scale were: stabbing chest pain, purple dark tongue, tongue with stasis spots, sublingual collateral veins varicosity, pain with a fixed location, rough pulse, palpitations, cyanosis of lips and nails, chest pain, worse at night, long course of disease, chest tightness, subcutaneous ecchymosis, skin and nail changes, dark complexion, thromboelastography suggesting a hypercoagulable state, D- dimer elevated, CHA2DS2-VASc score ≥4 points.BloodStasisPathological factor diagnosis entry screening process and results see Table2.It seems there is no source text provided for translation. Please provide the text you would like to have translated
表2 血瘀病理因素诊断条目筛选结果
Table2BloodEcchymosisPathological Factors Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
心悸* | 3.800 | 86.667 | 0.143 | 3.400 | 80.000 | 0.377 | 是 | 0.058 | 6 |
心痛如刺* | 3.667 | 73.333 | 0.163 | 4.000 | 100.000 | 0.000 | 是 | 0.061 | 6 |
脉涩* | 3.667 | 66.667 | 0.129 | 3.700 | 70.000 | 0.124 | 是 | 0.059 | 6 |
心胸疼痛* | 3.600 | 66.667 | 0.170 | 3.600 | 60.000 | 0.136 | 是 | 0.058 | 6 |
痛有定处* | 3.600 | 60.000 | 0.136 | 3.900 | 90.000 | 0.077 | 是 | 0.060 | 6 |
舌质紫暗* | 3.600 | 60.000 | 0.136 | 4.000 | 100.000 | 0.000 | 是 | 0.060 | 6 |
舌下络脉曲张* | 3.600 | 60.000 | 0.136 | 3.900 | 90.000 | 0.077 | 是 | 0.060 | 6 |
心电图诊断 | 3.533 | 66.667 | 0.203 | 3.400 | 70.000 | 0.353 | 否b | ||
舌有瘀斑瘀点* | 3.467 | 53.333 | 0.178 | 4.000 | 100.000 | 0.000 | 是 | 0.059 | 6 |
唇甲青紫* | 3.400 | 46.667 | 0.180 | 3.600 | 70.000 | 0.184 | 是 | 0.058 | 6 |
病程日久* | 3.333 | 40.000 | 0.179 | 3.500 | 60.000 | 0.192 | 是 | 0.055 | 6 |
入夜尤甚* | 3.267 | 33.333 | 0.176 | 3.800 | 80.000 | 0.105 | 是 | 0.056 | 6 |
面色晦暗 | 3.267 | 40.000 | 0.208 | 3.000 | 40.000 | 0.394 | 否b | ||
血栓弹力图提示高凝状态* | 3.267 | 46.667 | 0.236 | 3.600 | 70.000 | 0.184 | 是 | 0.055 | 6 |
胸闷* | 3.200 | 53.333 | 0.346 | 3.500 | 70.000 | 0.230 | 是 | 0.053 | 5 |
肌肤甲错* | 3.067 | 46.667 | 0.366 | 3.300 | 50.000 | 0.237 | 是 | 0.051 | 5 |
脉结 | 3.067 | 33.333 | 0.325 | 2.700 | 30.000 | 0.440 | 否b | ||
D-二聚体升高* | 3.067 | 40.000 | 0.346 | 3.400 | 60.000 | 0.235 | 是 | 0.051 | 5 |
皮下瘀斑* | 3.000 | 40.000 | 0.365 | 3.500 | 60.000 | 0.192 | 是 | 0.051 | 5 |
脉代 | 2.933 | 26.667 | 0.340 | 2.500 | 30.000 | 0.573 | 否b | ||
CHA2DS2-VASc评分≥4分* | 2.800 | 33.333 | 0.436 | 3.400 | 60.000 | 0.235 | 是 | 0.049 | 5 |
面色黧黑* | 2.667 | 26.667 | 0.468 | 3.100 | 30.000 | 0.226 | 是 | 0.046 | 5 |
痛引肩背内臂 | 2.600 | 20.000 | 0.440 | / | / | / | 否a | ||
纤维蛋白原升高 | 2.333 | 33.333 | 0.676 | 3.000 | 50.000 | 0.422 | 否b | ||
血小板计数异常 | 1.933 | 26.667 | 0.789 | / | / | / | 否a | ||
APTT异常 | 1.800 | 26.667 | 0.912 | / | / | / | 否a | ||
PT异常 | 1.800 | 26.667 | 0.912 | / | / | / | 否a | ||
脉弦 | 1.733 | 0.000 | 0.713 | / | / | / | 否a | ||
AT3异常 | 1.600 | 20.000 | 0.963 | / | / | / | 否a | ||
INR＜2 | 1.400 | 20.000 | 1.069 | / | / | / | 否a | ||
HAS-BLED评分≥3分 | 1.400 | 13.333 | 1.037 | / | / | / | 否a | ||
心烦 | 1.267 | 0.000 | 0.887 | / | / | / | 否a | ||
脉细 | 1.267 | 0.000 | 0.933 | / | / | / | 否a | ||
同型半胱氨酸升高 | 1.200 | 13.333 | 1.186 | / | / | / | 否a | ||
CRP升高 | 1.200 | 13.333 | 1.147 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items included in the final diagnosis scale;a refers to items removed in the first round;b refers to items removed in the second round;/ represents items not included in this round of scoring.
（2）气虚病理因素诊断条目筛选结果
(2)Diagnosis entry screening results for Qi deficiency pathological factors
在第一轮问卷调查后剔除的理化指标“HAS-BLED评分≤2分”，第二轮专家重新给出了较高的评价，结合研究小组研讨，决定在第二轮继续咨询。经过两轮专家咨询，剔除的条目为：心电图诊断、脉细、舌有齿痕、胸闷、头晕、心胸隐痛、脉结、脉代、面白、BNP正常、LVEF值正常、左心房内径正常；最终纳入诊断量表的条目为：气短、神疲乏力、心悸不安、少气懒言、动则加重、脉弱、舌淡、自汗、脉虚、苔白、CHA2DS2-VASc评分≤2分、HAS-BLED评分≤2分。气虚病理因素诊断条目筛选流程及结果见表3。
After the first round of the questionnaire survey, the eliminated physical and chemical indicators “HAS-BLED score ≤2 points,” in the second round the experts gave a higher evaluation again, and combined with the research group discussion, it was decided to continue consulting in the second round. After two rounds of expert consultation, the eliminated items were: electrocardiogram diagnosis, thin pulse, tongue with tooth marks, chest tightness, dizziness, chest pain, pulse knot, pulse replacement, pale face, BNP normal, LVEF value normal, left atrial diameter normal; the final items included in the diagnostic scale were: shortness of breath, fatigue, palpitations, reluctance to speak, worsening with activity, weak pulse, pale tongue, spontaneous sweating, weak pulse, white coating, CHA2DS2-VASc score ≤2 points, HAS-BLED score ≤2 points. The selection process and results of the diagnostic items for Qi deficiency pathological factors are shown in Table 3.
表3 气虚病理因素诊断条目筛选结果
Table3Qi DeficiencyPathological Factors Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
气短* | 3.867 | 86.667 | 0.088 | 3.800 | 80.000 | 0.105 | 是 | 0.098 | 10 |
心悸不安* | 3.667 | 80.000 | 0.191 | 3.400 | 60.000 | 0.235 | 是 | 0.091 | 9 |
神疲乏力* | 3.533 | 73.333 | 0.290 | 3.800 | 80.000 | 0.105 | 是 | 0.093 | 9 |
少气懒言* | 3.400 | 46.667 | 0.180 | 3.600 | 60.000 | 0.136 | 是 | 0.089 | 9 |
心电图诊断 | 3.333 | 66.667 | 0.341 | 3.100 | 70.000 | 0.509 | 否b |
| |
动则加重* | 3.200 | 60.000 | 0.415 | 3.600 | 60.000 | 0.136 | 是 | 0.086 | 9 |
自汗* | 3.133 | 46.667 | 0.347 | 3.300 | 40.000 | 0.194 | 是 | 0.082 | 8 |
舌淡* | 3.133 | 33.333 | 0.229 | 3.400 | 40.000 | 0.144 | 是 | 0.083 | 8 |
脉弱* | 3.067 | 40.000 | 0.346 | 3.500 | 50.000 | 0.143 | 是 | 0.083 | 8 |
脉虚* | 3.000 | 46.667 | 0.439 | 3.300 | 50.000 | 0.237 | 是 | 0.080 | 8 |
脉细 | 2.933 | 40.000 | 0.403 | 3.000 | 50.000 | 0.422 | 否b | ||
苔白* | 2.867 | 20.000 | 0.334 | 3.200 | 30.000 | 0.188 | 是 | 0.077 | 8 |
舌有齿痕 | 2.800 | 26.667 | 0.396 | 2.400 | 10.000 | 0.464 | 否b | ||
CHA2DS2-VASc评分≤2分* | 2.667 | 40.000 | 0.524 | 3.100 | 30.000 | 0.268 | 是 | 0.073 | 7 |
胸闷 | 2.600 | 26.667 | 0.462 | 2.900 | 40.000 | 0.360 | 否b | ||
头晕 | 2.200 | 13.333 | 0.580 | / | / | / | 否a | ||
HAS-BLED评分≤2分* | 2.133 | 20.000 | 0.637 | 3.000 | 30.000 | 0.298 | 是 | 0.064 | 6 |
心胸隐痛 | 2.067 | 6.667 | 0.624 | / | / | / | 否a | ||
脉结 | 2.067 | 20.000 | 0.672 | / | / | / | 否a | ||
脉代 | 2.000 | 20.000 | 0.730 | / | / | / | 否a | ||
面白 | 1.933 | 6.667 | 0.581 | / | / | / | 否a | ||
BNP正常 | 1.333 | 6.667 | 1.049 | / | / | / | 否a | ||
LVEF值正常 | 1.333 | 6.667 | 1.049 | / | / | / | 否a | ||
左心房内径正常 | 1.200 | 6.667 | 1.106 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items included in the final diagnosis scale;a refers to the first round of item removal;b refers to the second round of item removal;/ represents items not included in this round of scoring。
（3）阴虚病理因素诊断条目筛选结果
(3)Diagnosis item screening results for Yin deficiency pathological factors
在第一轮问卷调查后剔除的理化指标“全血粘度升高”，第二轮专家重新给出了较高的评价，结合研究小组研讨，决定在第二轮继续咨询。经过两轮专家咨询，剔除的条目为：脉数、心电图诊断、多梦、失眠、形体消瘦、脉促、耳鸣、大便干、腰膝酸软、脉结、头晕、脉代、胸闷、心胸隐痛、甲状腺功能异常；最终纳入诊断量表的条目为：潮热或五心烦热、舌红、少苔、心悸、盗汗、脉细、口干、心烦、颧红、静息心室率≥110bpm、全血粘度升高。阴虚病理因素诊断条目筛选流程及结果见表4。
After the first round of the questionnaire survey, the physicochemical indicator “increased whole blood viscosity” was excluded, but in the second round the experts gave a higher evaluation again, and combined with the research group discussions, it was decided to continue consulting in the second round. After two rounds of expert consultation, the excluded items were: pulse rate, electrocardiogram diagnosis, vivid dreams, insomnia, weight loss, rapid pulse, tinnitus, dry stool, lower back and knee soreness, pulse knot, dizziness, pulse replacement, chest tightness, chest pain, thyroid dysfunction; the final items included in the diagnostic scale were: hot flashes or five hearts heat, red tongue, little coating, palpitations, night sweats, thin pulse, dry mouth, irritability, flushed cheeks, resting ventricular rate ≥110 bpm, increased whole blood viscosity. The screening process and results for the diagnostic items of Yin deficiency pathological factors are shown in Table 4.
表4 阴虚病理因素诊断条目筛选结果
Table4Yin DeficiencyPathological Factors Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
心悸* | 3.867 | 93.333 | 0.129 | 3.600 | 80.000 | 0.222 | 是 | 0.102 | 10 |
舌红* | 3.800 | 80.000 | 0.105 | 3.700 | 80.000 | 0.173 | 是 | 0.102 | 10 |
潮热或五心烦热* | 3.733 | 86.667 | 0.182 | 3.900 | 90.000 | 0.077 | 是 | 0.103 | 10 |
少苔* | 3.733 | 80.000 | 0.154 | 3.800 | 90.000 | 0.158 | 是 | 0.102 | 10 |
盗汗* | 3.667 | 73.333 | 0.163 | 3.600 | 60.000 | 0.136 | 是 | 0.098 | 10 |
口干* | 3.467 | 66.667 | 0.295 | 3.400 | 50.000 | 0.195 | 是 | 0.093 | 9 |
脉细* | 3.467 | 53.333 | 0.178 | 3.600 | 60.000 | 0.136 | 是 | 0.095 | 10 |
脉数 | 3.400 | 53.333 | 0.209 | 2.600 | 20.000 | 0.428 | 否b |
| |
心烦* | 3.333 | 46.667 | 0.210 | 3.300 | 30.000 | 0.139 | 是 | 0.090 | 9 |
心电图诊断 | 3.200 | 60.000 | 0.382 | 2.900 | 50.000 | 0.522 | 否b | ||
多梦 | 3.067 | 53.333 | 0.403 | 3.000 | 40.000 | 0.333 | 否b | ||
失眠 | 3.000 | 53.333 | 0.422 | 3.200 | 60.000 | 0.337 | 否b | ||
颧红* | 2.933 | 46.667 | 0.422 | 3.200 | 30.000 | 0.188 | 是 | 0.082 | 8 |
形体消瘦 | 2.667 | 13.333 | 0.426 | / | / | / | 否a | ||
静息心室率≥110bpm* | 2.667 | 33.333 | 0.506 | 3.100 | 30.000 | 0.226 | 是 | 0.077 | 8 |
脉促 | 2.533 | 13.333 | 0.453 | / | / | / | 否a | ||
耳鸣 | 2.400 | 6.667 | 0.451 | / | / | / | 否a | ||
大便干 | 2.400 | 13.333 | 0.500 | / | / | / | 否a | ||
腰膝酸软 | 2.267 | 6.667 | 0.546 | / | / | / | 否a | ||
脉结 | 2.200 | 13.333 | 0.580 | / | / | / | 否a | ||
头晕 | 2.067 | 6.667 | 0.544 | / | / | / | 否a | ||
脉代 | 2.000 | 13.333 | 0.683 | / | / | / | 否a | ||
胸闷 | 1.800 | 0.000 | 0.544 | / | / | / | 否a | ||
心胸隐痛 | 1.733 | 0.000 | 0.648 | / | / | / | 否a | ||
全血粘度升高* | 1.667 | 13.333 | 0.867 | 2.900 | 30.000 | 0.286 | 是 | 0.058 | 6 |
甲状腺功能异常 | 1.400 | 6.667 | 0.933 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items included in the final diagnosis scale;a indicates items removed in the first round;b indicates items removed in the second round;/ represents items not included in this round of scoring.
（4）痰浊病理因素诊断条目筛选结果
(4)Diagnosis entry screening results for phlegm-damp pathological factors
经过两轮专家咨询，剔除的条目为：心电图诊断、苔白、脉弦、低密度脂蛋白胆固醇升高、全血粘度升高、呕吐痰涎、纳呆、精神疲倦、恶心、脉结、高密度脂蛋白胆固醇降低、口干、口苦、失眠、心烦；最终纳入诊断量表的条目为：苔腻、脉滑、胸闷如窒、心悸、苔滑、身体困重、多痰、体胖、脘痞或腹胀、甘油三酯升高、总胆固醇升高。痰浊病理因素诊断条目筛选流程及结果见表5。
After two rounds of expert consultation, the excluded items are: electrocardiogram diagnosis、white coating、string pulse、elevated low-density lipoprotein cholesterol、increased whole blood viscosity、vomiting phlegm、edema、mental fatigue、nausea、knotty pulse、decreased high-density lipoprotein cholesterol、dry mouth、bitter mouth、insomnia、irritability; the final items included in the diagnostic scale are: greasy coating, slippery pulse, chest tightness likeasphyxia、palpitations, slippery coating, heavy body, excessive phlegm, obesity,epigastric fullness or abdominal distension、elevated triglycerides, elevated total cholesterol.The screening process and results of the pathological factors for phlegm turbidity diagnosis items are shown in Table5。
表5 痰浊病理因素诊断条目筛选结果
Table5Phlegm-HeatPathological Factor Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
心悸* | 3.867 | 93.333 | 0.129 | 3.500 | 70.000 | 0.230 | 是 | 0.091 | 9 |
苔腻* | 3.800 | 80.000 | 0.105 | 3.900 | 90.000 | 0.077 | 是 | 0.094 | 9 |
胸闷如窒* | 3.733 | 73.333 | 0.118 | 3.700 | 80.000 | 0.173 | 是 | 0.091 | 9 |
脉滑* | 3.667 | 66.667 | 0.129 | 3.900 | 90.000 | 0.077 | 是 | 0.092 | 9 |
多痰* | 3.533 | 66.667 | 0.228 | 3.600 | 70.000 | 0.184 | 是 | 0.087 | 9 |
苔滑* | 3.533 | 73.333 | 0.290 | 3.700 | 80.000 | 0.173 | 是 | 0.088 | 9 |
身体困重* | 3.467 | 53.333 | 0.178 | 3.700 | 70.000 | 0.124 | 是 | 0.087 | 9 |
心电图诊断 | 3.133 | 53.333 | 0.384 | 2.800 | 50.000 | 0.549 | 否b | ||
脘痞或腹胀* | 3.000 | 40.000 | 0.385 | 3.300 | 50.000 | 0.273 | 是 | 0.076 | 8 |
苔白 | 3.000 | 53.333 | 0.471 | 3.500 | 80.000 | 0.344 | 否b | ||
体胖* | 2.933 | 26.667 | 0.340 | 3.400 | 60.000 | 0.235 | 是 | 0.076 | 8 |
头晕* | 2.867 | 33.333 | 0.334 | 3.300 | 40.000 | 0.194 | 是 | 0.074 | 7 |
甘油三酯升高* | 2.867 | 20.000 | 0.334 | 3.100 | 30.000 | 0.226 | 是 | 0.072 | 7 |
总胆固醇升高* | 2.800 | 26.667 | 0.373 | 2.900 | 30.000 | 0.286 | 是 | 0.070 | 7 |
脉弦 | 2.733 | 26.667 | 0.365 | 2.800 | 30.000 | 0.350 | 否b | ||
低密度脂蛋白胆固醇升高 | 2.667 | 20.000 | 0.403 | / | / | / | 否a | ||
全血粘度升高 | 2.667 | 20.000 | 0.403 | / | / | / | 否a | ||
呕吐痰涎 | 2.533 | 20.000 | 0.497 | / | / | / | 否a | ||
纳呆 | 2.533 | 26.667 | 0.497 | 2.900 | 40.000 | 0.421 | 否b | ||
精神疲倦 | 2.333 | 26.667 | 0.599 | 2.600 | 20.000 | 0.428 | 否b | ||
恶心 | 2.133 | 20.000 | 0.703 | / | / | / | 否a | ||
脉结 | 2.000 | 6.667 | 0.632 | / | / | / | 否a | ||
高密度脂蛋白胆固醇降低 | 2.000 | 13.333 | 0.707 | / | / | / | 否a | ||
口干 | 0.933 | 0.000 | 1.266 | / | / | / | 否a | ||
口苦 | 0.867 | 6.667 | 1.569 | / | / | / | 否a | ||
失眠 | 0.867 | 0.000 | 1.323 | / | / | / | 否a | ||
心烦 | 0.733 | 0.000 | 1.532 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items included in the final diagnosticscale;aindicates items removed in thefirstround;bindicates items removed in thesecondround;/ indicates items not included in this round of scoring.
（5）阳虚病理因素诊断条目筛选结果
(5)Diagnosis entry screening results for Yang deficiency pathological factors
在第一轮问卷调查后剔除的理化指标“LVEF值降低”、“BNP升高”、“左心房内径增大”，第二轮专家重新给出了较高的评价，结合研究小组研讨，决定在第二轮继续咨询。第一轮专家提出“遇寒加重”应表述为“畏寒喜暖”，研究小组讨论后决定采纳此建议。经过两轮专家咨询，剔除的条目为：心电图诊断、胸闷、脉细、动则加重、喘息或不能平卧、脉代、小便短少、舌质紫暗、脉结、面唇青紫、苔滑、FS值降低、E/A降低、左心室舒张末期内径增大、恶心呕吐、TNF-α升高、IL-6升高；最终纳入诊断量表的条目为：畏冷肢凉、心悸怔忡、畏寒喜暖、舌胖大、神疲乏力、脉沉、舌淡、面色㿠白、苔白、脉弱、小便清长、舌有齿痕、浮肿、气短、大便溏、自汗、LVEF值降低、BNP升高、左心房内径增大。阳虚病理因素诊断条目筛选流程及结果见表6。
After the first round of the questionnaire survey, the eliminated physical and chemical indicators “LVEF value decreased”,”“BNP increased,”“enlarged left atrial diameter””, the experts in the second round gave a higher evaluation again. Combined with the research group discussion, it was decided to continue consulting in the second round. The experts in the first round suggested that “worsening in cold” should be expressed as “sensitive to cold and prefers warmth”, and after discussion, the research group decided to adopt this suggestion. After two rounds of expert consultation, the eliminated items were: electrocardiogram diagnosis, chest tightness, thin pulse, worsening with movement, wheezing or inability to lie flat, pulse alternans, decreased urination, purple and dark tongue, pulse knot, cyanosis of the face and lips, slippery tongue coating, FS value decreased, E/A decreased, enlarged left ventricular end-diastolic diameter, nausea and vomiting, TNF-α increased, IL-6 increased; the final items included in the diagnostic scale were: sensitivity to cold and cool limbs, palpitations, sensitive to cold and prefers warmth, enlarged tongue, fatigue and weakness, deep pulse, pale tongue, ashen complexion, white tongue coating, weak pulse, clear and long urination, tongue with tooth marks, edema, shortness of breath, loose stools,” spontaneous sweating, LVEF value decreased, BNP increased, enlarged left atrial diameter. The screening process and results of the pathological factors for Yang deficiency diagnosis are shown in Table 6.
表6 阳虚病理因素诊断条目筛选结果
Table6Yang DeficiencyPathological Factors Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
畏冷肢凉* | 3.933 | 93.333 | 0.063 | 3.900 | 90.000 | 0.077 | 是 | 0.063 | 6 |
心悸怔忡* | 3.867 | 93.333 | 0.129 | 3.800 | 90.000 | 0.158 | 是 | 0.062 | 6 |
神疲乏力* | 3.400 | 46.667 | 0.180 | 3.600 | 70.000 | 0.184 | 是 | 0.056 | 6 |
面色㿠白* | 3.400 | 40.000 | 0.144 | 3.400 | 60.000 | 0.235 | 是 | 0.055 | 6 |
遇寒加重* | 3.333 | 46.667 | 0.210 | 3.900 | 90.000 | 0.077 | 是 | 0.057 | 6 |
舌胖大* | 3.333 | 53.333 | 0.303 | 3.700 | 70.000 | 0.124 | 是 | 0.056 | 6 |
脉弱* | 3.267 | 46.667 | 0.305 | 3.600 | 70.000 | 0.184 | 是 | 0.054 | 5 |
脉沉* | 3.267 | 46.667 | 0.305 | 3.700 | 70.000 | 0.124 | 是 | 0.055 | 6 |
气短* | 3.200 | 53.333 | 0.284 | 3.100 | 40.000 | 0.268 | 是 | 0.046 | 5 |
舌淡* | 3.200 | 40.000 | 0.234 | 3.700 | 70.000 | 0.124 | 是 | 0.055 | 6 |
苔白* | 3.200 | 40.000 | 0.234 | 3.600 | 70.000 | 0.184 | 是 | 0.054 | 5 |
心电图诊断 | 3.200 | 46.667 | 0.327 | 3.100 | 50.000 | 0.394 | 否b | ||
小便清长* | 3.133 | 33.333 | 0.229 | 3.600 | 70.000 | 0.184 | 是 | 0.054 | 5 |
浮肿* | 3.000 | 40.000 | 0.422 | 3.600 | 70.000 | 0.184 | 是 | 0.052 | 5 |
舌有齿痕* | 3.000 | 46.667 | 0.439 | 3.700 | 70.000 | 0.124 | 是 | 0.053 | 5 |
自汗* | 2.800 | 13.333 | 0.325 | 3.100 | 30.000 | 0.226 | 是 | 0.051 | 5 |
大便溏* | 2.733 | 20.000 | 0.365 | 3.400 | 40.000 | 0.144 | 是 | 0.048 | 5 |
胸闷 | 2.667 | 33.333 | 0.447 | 2.500 | 20.000 | 0.369 | 否b | ||
脉细 | 2.667 | 33.333 | 0.468 | 2.700 | 40.000 | 0.407 | 否b | ||
动则加重 | 2.600 | 26.667 | 0.462 | 2.900 | 40.000 | 0.360 | 否b | ||
LVEF值降低* | 2.533 | 20.000 | 0.497 | 3.400 | 40.000 | 0.144 | 是 | 0.047 | 5 |
喘息或不能平卧 | 2.400 | 26.667 | 0.605 | 2.700 | 40.000 | 0.470 | 否b | ||
脉代 | 2.400 | 20.000 | 0.585 | / | / | / | 否a | ||
BNP升高* | 2.400 | 20.000 | 0.544 | 2.900 | 30.000 | 0.286 | 是 | 0.042 | 4 |
小便短少 | 2.333 | 33.333 | 0.694 | 3.200 | 60.000 | 0.390 | 否b | ||
舌质紫暗 | 2.333 | 26.667 | 0.639 | 1.800 | 30.000 | 0.956 | 否b | ||
脉结 | 2.200 | 13.333 | 0.603 | / | / | / | 否a | ||
面唇青紫 | 2.133 | 6.667 | 0.564 | / | / | / | 否a | ||
苔滑 | 2.133 | 13.333 | 0.660 | / | / | / | 否a | ||
左心房内径增大* | 2.067 | 20.000 | 0.695 | 2.900 | 30.000 | 0.286 | 是 | 0.039 | 4 |
FS值降低 | 2.000 | 13.333 | 0.683 | / | / | / | 否a | ||
E/A降低 | 1.867 | 13.333 | 0.728 | / | / | / | 否a | ||
左心室舒张末期内径增大 | 1.733 | 13.333 | 0.828 | / | / | / | 否a | ||
恶心呕吐 | 1.067 | 0.000 | 1.159 | / | / | / | 否a | ||
TNF-α升高 | 0.933 | 13.333 | 1.436 | / | / | / | 否a | ||
IL-6升高 | 0.933 | 13.333 | 1.436 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items included in the final diagnosis scale;a indicates items removed in the first round;b indicates items removed in the second round;/ represents items not included in this round of scoring.
（6）气滞病理因素诊断条目筛选结果
(6)Diagnosis entry screening results for pathological factors of Qi stagnation
在第一轮问卷调查后剔除的理化指标“生活质量评分降低”，第二轮专家重新给出了较高的评价，结合研究小组研讨，决定在第二轮继续咨询。经过两轮专家咨询，剔除的条目为：心悸、心电图诊断、舌象正常、脉结、气短、脉代、脉涩、舌红、头晕、苔黄、甲状腺功能异常、颤抖、组织因子升高；最终纳入诊断量表的条目为：胸闷、心胸胀痛或窜痛、情志抑郁、善太息、随情志诱发或加重、脉弦、急躁易怒、生活质量评分降低。气滞病理因素诊断条目筛选流程及结果见表7。
After the first round of the questionnaire survey, the eliminated physical and chemical indicator "reduced quality of life score" received a higher evaluation from experts in the second round. Combined withthe research groupdiscussion, it was decided to continue consulting in the second round.After two rounds of expert consultation, the eliminated items were: palpitations、electrocardiogram diagnosis、normal tongue appearance、pulse knot、shortness of breath、pulse replacement、pulse roughness、red tongue、dizziness、yellow coating、thyroid dysfunction、tremors、increased tissue factor;the final items included in the diagnostic scale were:chest tightness、chest pain or stabbing pain, emotional depression, tendency to sigh, triggered or worsened by emotions, wiry pulse, irritability, reduced quality of life score。The selection process and results of the pathological factors for qi stagnation diagnosis items are shown in Table7。
表7 气滞病理因素诊断条目筛选结果
Table7Qi StagnationPathological Factors Diagnosis Entry Screening Results
条目 | 第一轮（15人） | 第二轮（10人） | 是否纳入 | 综合权重 | 整数权重 | ||||
均数 | 满分比（%） | 变异 系数 | 均数 | 满分比（%） | 变异 系数 | ||||
心悸 | 3.933 | 93.333 | 0.063 | 3.300 | 70.000 | 0.385 | 否b | ||
胸闷* | 3.733 | 73.333 | 0.118 | 3.800 | 80.000 | 0.105 | 是 | 0.138 | 14 |
心胸胀痛或窜痛* | 3.667 | 86.667 | 0.276 | 3.800 | 80.000 | 0.105 | 是 | 0.137 | 14 |
情志抑郁* | 3.600 | 66.667 | 0.170 | 3.500 | 70.000 | 0.230 | 是 | 0.131 | 13 |
善太息* | 3.467 | 60.000 | 0.232 | 3.900 | 90.000 | 0.077 | 是 | 0.134 | 13 |
随情志诱发或加重* | 3.400 | 60.000 | 0.259 | 3.700 | 70.000 | 0.124 | 是 | 0.129 | 13 |
脉弦* | 3.267 | 53.333 | 0.325 | 3.500 | 50.000 | 0.143 | 是 | 0.123 | 12 |
心电图诊断 | 3.267 | 53.333 | 0.325 | 2.700 | 50.000 | 0.575 | 否b | ||
急躁易怒* | 3.067 | 53.333 | 0.403 | 3.300 | 60.000 | 0.273 | 是 | 0.116 | 12 |
舌象正常 | 2.933 | 26.667 | 0.291 | 2.800 | 30.000 | 0.416 | 否b | ||
脉结 | 2.667 | 20.000 | 0.403 | / | / | / | 否a | ||
气短 | 2.600 | 40.000 | 0.558 | 2.200 | 30.000 | 0.727 | 否b | ||
脉代 | 2.600 | 20.000 | 0.417 | / | / | / | 否a | ||
脉涩 | 2.467 | 20.000 | 0.531 | / | / | / | 否a | ||
生活质量评分降低* | 2.000 | 13.333 | 0.730 | 3.300 | 30.000 | 0.139 | 是 | 0.093 | 9 |
舌红 | 1.933 | 20.000 | 0.789 | / | / | / | 否a | ||
头晕 | 1.667 | 13.333 | 0.894 | / | / | / | 否a | ||
苔黄 | 1.667 | 13.333 | 0.894 | / | / | / | 否a | ||
甲状腺功能异常 | 1.200 | 0.000 | 0.972 | / | / | / | 否a | ||
颤抖 | 1.067 | 6.667 | 1.209 | / | / | / | 否a | ||
组织因子升高 | 0.733 | 0.000 | 1.266 | / | / | / | 否a | ||
注：*为最终纳入诊断量表的条目；a为第一轮剔除的条目；b为第二轮剔除的条目；/代表条目未进入此轮评分。
Note:*Items that are finally included in the diagnosticscale;arepresents items removed in the firstround;brepresents items removed in the secondround;/ represents items not included in this round of scoring.
诊断量表拟定
Drafting of diagnostic scales
经过前两轮专家问卷调查及研究小组研讨，认为气滞病理因素仅有的1项理化指标“生活质量评分降低”不符合临床诊断的习惯，对气滞病理因素的诊断的意义也不大，不能达到中西医结合诊断的要求，故删除气滞病理因素。
After the first two rounds of expert questionnaire surveys and discussions by the research group, it was concluded that the only physical and chemical indicator of the pathological factor of Qi stagnation, "decreased quality of life score," does not conform to the habits of clinical diagnosis, and its significance for the diagnosis of Qi stagnation pathological factors is also limited, and it cannot meet the requirements for the combined diagnosis of traditional Chinese and Western medicine, so the pathological factor of Qi stagnation is removed.
血瘀病理因素中西医结合诊断量表
BloodStasisCombined Diagnosis Scale of Pathological Factors in Traditional Chinese and Western Medicine
诊断心房颤动血瘀病理因素必须同时满足以下条件：（1）有明确心电图诊断心房颤动；（2）主症/主要指标≥3条，且次症/次要指标≥2条，或主症/主要指标≥2条，且次症/次要指标≥3条；（3）舌脉≥1条；（4）条目总积分≥24分。血瘀病理因素中西医结合诊断量表见表8。
Diagnosis of atrial fibrillation bloodstasis pathological factors must simultaneously meet the following conditions: (1) there is a clear electrocardiogram diagnosis of atrial fibrillation; (2) main symptoms/main indicators≥3 items, and secondary symptoms/secondary indicators≥2 items, or main symptoms/main indicators≥2 items, and secondary symptoms/secondary indicators≥3 items; (3) tongue pulse≥1 item; (4) total score of items≥24 points. Bloodstasis pathological factors combined Chinese and Western medicine diagnostic scale see table8.
表8 血瘀病理因素中西医结合诊断量表
Table8BloodStasisPathological Factors Combined Diagnosis Scale of Traditional Chinese and Western Medicine
中医诊断条目 | 权重 | 西医理化指标 | 权重 | ||
主症 | 心痛如刺 | 6 | 主要指标 | 血栓弹力图提示高凝状态 | 6 |
痛有定处 | 6 | ||||
心悸 | 5 | ||||
唇甲青紫 | 5 | ||||
心胸疼痛 | 5 | ||||
次症 | 入夜尤甚 | 4 | 次要指标 | D-二聚体升高 | 4 |
病程日久 | 4 | CHA2DS2-VASc评分≥4分 | 3 | ||
胸闷 | 3 | ||||
皮下瘀斑 | 3 | ||||
肌肤甲错 | 3 | ||||
面色黧黑 | 2 | ||||
舌脉 | 舌质紫暗 | 6 | |||
舌有瘀斑瘀点 | 6 | ||||
舌下络脉曲张 | 6 | ||||
脉涩 | 6 | ||||
气虚病理因素中西医结合诊断量表
Diagnosis Scale for Qi Deficiency Pathological Factors in Integrated Traditional and Western Medicine
诊断心房颤动气虚病理因素必须同时满足以下条件：（1）有明确心电图诊断心房颤动；（2）主症/主要指标≥3条，且次症/次要指标≥1条，或主症/主要指标≥2条，且次症/次要指标≥2条；（3）舌象≥1条；（4）脉象≥1条；（5）条目总积分≥36分。气虚病理因素中西医结合诊断量表见表9。
To diagnose the pathological factors of Qi deficiency in atrial fibrillation, the following conditions must be met simultaneously: （1）There must be a clear electrocardiogram diagnosis of atrial fibrillation; （2）The main symptoms/main indicators≥3 items，and the secondary symptoms/secondary indicators≥1 item, or the main symptoms/main indicators≥2 items，and the secondary symptoms/secondary indicators≥2 items; （3）Tongue appearance≥1 item; （4）Pulse appearance≥1 item; （5）Total score of items≥36 points. The combined diagnosis scale of Qi deficiency pathological factors in traditional Chinese and Western medicine is shown in Table9。
表9 气虚病理因素中西医结合诊断量表
Table9Pathological Factors of Qi DeficiencyIntegrated Diagnosis Scale of Traditional Chinese and Western Medicine
中医诊断条目 | 权重 | 西医理化指标 | 权重 | ||
主症 | 气短 | 10 | 主要指标 | CHA2DS2-VASc评分≤2分 | 7 |
神疲乏力 | 9 | ||||
心悸不安 | 8 | ||||
少气懒言 | 8 | ||||
次症 | 动则加重 | 7 | 次要指标 | HAS-BLED评分≤2分 | 6 |
自汗 | 6 | ||||
舌脉 | 舌淡 | 6 | |||
脉弱 | 6 | ||||
脉虚 | 5 | ||||
苔白 | 4 | ||||
阴虚病理因素中西医结合诊断量表
Diagnosis Scale for Yin Deficiency Pathological Factors in Integrated Traditional and Western Medicine
诊断心房颤动阴虚病理因素必须同时满足以下条件：（1）有明确心电图诊断心房颤动；（2）主症/主要指标≥3条，且次症/次要指标≥2条，或主症/主要指标≥2条，且次症/次要指标≥3条；（3）舌脉≥1条；（4）条目总积分≥42分。阴虚病理因素中西医结合诊断量表见表10。
To diagnose the pathological factors of Yin deficiency in atrial fibrillation, the following conditions must be met simultaneously: （1）There must be a clear electrocardiogram diagnosis of atrial fibrillation; （2）the main symptoms/main indicators≥3 items, and the secondary symptoms/secondary indicators≥2 items, or the main symptoms/main indicators≥2 items, and the secondary symptoms/secondary indicators≥3 items; （3）Tongue and pulse≥1 item; （4）Total score of items≥42 points.The combined diagnosis scale for Yin deficiency pathological factors in traditional Chinese and Western medicine is shown in Table10.
表10 阴虚病理因素中西医结合诊断量表
Table10Pathology of Yin DeficiencyIntegrated Diagnosis Scale of Traditional Chinese and Western Medicine
中医诊断条目 | 权重 | 西医理化指标 | 权重 | ||
主症 | 潮热或五心烦热 | 10 | 主要指标 | 静息心室率≥110bpm | 8 |
心悸 | 10 | ||||
盗汗 | 9 | ||||
次症 | 口干 | 7 | 次要指标 | 全血粘度升高 | 6 |
心烦 | 6 | ||||
颧红 | 5 | ||||
舌脉 | 舌红 | 10 | |||
少苔 | 10 | ||||
脉细 | 8 | ||||
痰浊病理因素中西医结合诊断量表
Phlegm-damp pathological factors combined Chinese and Western medicine diagnostic scale
诊断心房颤动痰浊病理因素必须同时满足以下条件：（1）有明确心电图诊断心房颤动；（2）主症/主要指标≥3条，且次症/次要指标≥2条，或主症/主要指标≥2条，且次症/次要指标≥3条；（3）舌脉≥1条；（4）条目总积分≥32分。痰浊病理因素中西医结合诊断量表见表11。
To diagnose phlegm-damp pathological factors in atrial fibrillation, the following conditions must be met simultaneously: （1）There must be a clear electrocardiogram diagnosis of atrial fibrillation; （2）The main symptoms/main indicators≥3 items, and the secondary symptoms/secondary indicators≥2 items, or the main symptoms/main indicators≥2 items, and the secondary symptoms/secondary indicators≥3 items; （3）Tongue pulse≥1 item; （4）Total score of items≥32 points. The combined diagnosis scale for phlegm-damp pathological factors in traditional Chinese and Western medicine is shown in Table11。
表11 痰浊病理因素中西医结合诊断量表
Table11Pathological Factors of Phlegm-DampnessIntegrated Diagnosis Scale of Traditional Chinese and Western Medicine
中医诊断条目 | 权重 | 西医理化指标 | 权重 | ||
主症 | 胸闷如窒 | 8 | 主要指标 | 甘油三酯升高 | 7 |
心悸 | 8 | ||||
身体困重 | 7 | ||||
多痰 | 7 | ||||
次症 | 体胖 | 4 | 次要指标 | 总胆固醇升高 | 6 |
脘痞或腹胀 | 4 | ||||
头晕 | 3 | ||||
舌脉 | 苔腻 | 9 | |||
脉滑 | 8 | ||||
苔滑 | 7 | ||||
阳虚病理因素中西医结合诊断量表
Diagnosis Scale for Yang Deficiency Pathological Factors in Integrated Traditional Chinese and Western Medicine
诊断心房颤动阳虚病理因素必须同时满足以下条件：（1）有明确心电图诊断心房颤动；（2）主症/主要指标≥3条，且次症/次要指标≥3条，或主症/主要指标≥2条，且次症/次要指标≥4条；（3）舌象≥1条；（4）脉象≥1条；（5）条目总积分≥28分。阳虚病理因素中西医结合诊断量表见表12。
To diagnose the pathological factors of Yang deficiency in atrial fibrillation, the following conditions must be met simultaneously: （1）There must be a clear electrocardiogram diagnosis of atrial fibrillation; （2）The main symptoms/primary indicators≥3 items, and the secondary symptoms/secondary indicators≥3 items, or the main symptoms/primary indicators≥2 items, and the secondary symptoms/secondary indicators≥4 items; （3）Tongue appearance≥1 item; （4）Pulse appearance≥1 item; （5）Total score of items≥28 points. The combined diagnostic scale for Yang deficiency pathological factors in traditional Chinese and Western medicine is shown in Table12.
表12 阳虚病理因素中西医结合诊断量表
Table12PathologicalFactors of Yang Deficiency: Integrated Diagnosis Scale of Traditional Chinese and Western Medicine
中医诊断条目 | 权重 | 西医理化指标 | 权重 | ||
主症 | 畏冷肢凉 | 6 | 主要指标 | LVEF值降低 | 5 |
心悸怔忡 | 6 | ||||
畏寒喜暖 | 5 | ||||
神疲乏力 | 5 | ||||
次症 | 面色㿠白 | 4 | 次要指标 | BNP升高 | 4 |
小便清长 | 4 | 左心房内径增大 | 3 | ||
浮肿 | 3 | ||||
气短 | 3 | ||||
大便溏 | 2 | ||||
自汗 | 2 | ||||
舌脉 | 舌胖大 | 5 | |||
舌淡 | 4 | ||||
苔白 | 4 | ||||
舌有齿痕 | 4 | ||||
脉弱 | 4 | ||||
脉沉 | 4 | ||||
讨论
Discussion
《国家标准化发展纲要》行动计划（2024—2025年）提出，要进一步完善中医药标准体系，推进中医病证诊断、临床疗效评价等标准制修订[9]。根据2020年ESC房颤诊断和管理指南[10]，房颤的西医诊断以心电图或者动态心电图为金标准，并根据病史、临床表现、实验室检查、危险因素等对房颤进行分类、风险及治疗评估等，如CHA2DS2-VASc评分、HAS-BLED评分等，以实现诊断的客观化、标准化、个体化。而中医学长期以来对于房颤没有深入的认识，根据本病的临床表现，多属中医学心悸、怔忡、胸痹、眩晕、喘证范畴，业内习惯将房颤辨证归入心悸病[11-12]，且各版辨证标准之间多有出入，至今尚无权威的房颤中西医结合辨证标准，导致其临床辨证多依赖于医者个人经验与主观判断，可见标准之繁杂混乱程度[13]。
The "National Standardization Development Outline" action plan (2024—2025) proposes to further improve the traditional Chinese medicine standard system, and promote the formulation and revision of standards for diagnosis of traditional Chinese medicine diseases and clinical efficacy evaluation[9]. According to the 2020 ESC guidelines for the diagnosis and management of atrial fibrillation[10], the Western medical diagnosis of atrial fibrillation is based on electrocardiogram or dynamic electrocardiogram as the gold standard, and classifies atrial fibrillation based on medical history, clinical manifestations, laboratory tests, risk factors, etc., for risk and treatment assessment, such asCHA2DS2-VASc score, HAS-BLED score, etc., to achieve objective, standardized, and individualized diagnosis.Traditional Chinese medicine has long lacked an in-depth understanding of atrial fibrillation. Based on the clinical manifestations of this condition, it mostly falls under the categories of palpitations, anxiety, chestpain, dizziness, and asthma in traditional Chinese medicine. Within the industry, atrial fibrillation is commonly classified as a type of palpitations[11-12], and there are many discrepancies among the various diagnostic standards, with no authoritative combined diagnostic standard for atrial fibrillation in both Western and Chinese medicine to date, leading to its clinical diagnosis largely relying on the personal experience and subjective judgment of the physician, highlighting the complexity and confusion of the standards[13].It seems there is no source text provided for translation. Please provide the text you would like to have translated
房颤通常继发于多种疾病，受基础疾病和继发疾病的影响，随病程、性别[14]、年龄、体质[15]、环境的差异而表现出复杂多变的临床特征。在疾病过程中很少有单纯的证，不同的证通常相兼、错杂为患，且有先后、主次之分，随个体差异、疾病阶段而有变化。而临床中常常出现“辨证”总体正确，却因为缺乏对核心病机的把握，而遗漏治疗重点的情况，导致疗效不佳。因此房颤辨治复杂，其辨证体系亟需革新。
Atrial fibrillation is usually secondary to various diseases, influenced by underlying conditions and secondary diseases, and exhibits complex and variable clinical features depending on the course of the disease, gender[14], age, constitution[15], and environmental differences. In the course of the disease, there are rarely simple syndromes, and different syndromes usually coexist and intertwine, with distinctions in priority and sequence, varying with individual differences and disease stages. In clinical practice, there often appears a situation where the “syndrome differentiation” is generally correct, but due to a lack of grasping the core pathogenesis, the key points of treatment are overlooked, leading to poor efficacy. Therefore, the differentiation and treatment of atrial fibrillation is complex, and its differentiation system urgently needs innovation.
在中医学理论体系中，病理因素既属于病因概念，又贯穿于整个病理过程。病理因素与证素辨证的内涵有着密切联系，朱文锋教授曾提出“病理因素也是对证型的一种划分”的观点，当某些临床表现归属于相应的病性证素，又符合某病理因素特点，即可诊断为该病理因素。规范房颤的病理因素诊断标准，再根据临床实际对病理因素进行应证组合，能准确把握房颤病理本质，执简驭繁，把握复杂、动态的证，有效避免临床辨证的经验性、主观性和盲目性，简化辨证，补充现有辨证体系的不足。而基于计量诊断理论研制诊断量表[16]，可将模糊、非线性、定性的主观诊断规范成明确、线性、定量的客观标准，具有较强的可靠性、实用性和可重复性[17]。
In the theoretical system of Traditional Chinese Medicine, pathological factors belong to the concept of etiology and run through the entire pathological process.Pathological factors are closely related to the connotation of syndrome differentiation and syndrome, Professor Zhu Wenfeng once proposed the view that "pathological factors are also a classification of syndrome types." When certain clinical manifestations belong to the corresponding disease syndrome elements and also meet the characteristics of certain pathological factors, they can be diagnosed as that pathological factor. The diagnostic criteria for the pathological factors of atrial fibrillation can accurately grasp the pathological essence of atrial fibrillation, and by combining the pathological factors according to clinical practice, it effectively avoids the empirical, subjective, and blind nature of clinical syndrome differentiation, simplifies syndrome differentiation, and supplements the deficiencies of the existing syndrome differentiation system.Based on measurement diagnosis theory, diagnostic scales[16] can transform vague, nonlinear, qualitative subjective diagnoses into clear, linear, and quantitative objective standards, possessing strong reliability, practicality and repeatability[17].It seems there is no source text provided for translation. Please provide the text you would like to have translated
随着微观辨证与病证结合诊断的发展，中医证候研究开始重视结合微观指标，探寻对证候诊断敏感性与特异性高的指标，为诊断提供更多的方法和客观依据，从而提高辨证的精确度[18-19]。近年来发现部分理化指标对与房颤辨证存在紧密联系[20-21]，可补充传统中医四诊的不足，协助辨证。
With the development of micro-differentiation and the combination of syndrome and disease diagnosis, traditional Chinese medicine syndrome research has begun to emphasize the integration of micro-indicators, exploring indicators with high sensitivity and specificity for syndrome diagnosis, providing more methods and objective basis for diagnosis, thereby improving the accuracy of differentiation[18-19]. In recent years, it has been found that some physicochemical indicators are closely related to the differentiation of atrial fibrillation[20-21], which can supplement the shortcomings of the four examinations in traditional Chinese medicine, assisting in differentiation.
本研究基于病证结合模式，以病理因素为切入点，采用文献系统回顾与德尔菲专家咨询制定了心房颤动常见病理因素中西医结合诊断量表，补充了房颤辨证体系。基于本量表进行房颤辨证，可实现病理因素客观量化诊断。根据量表积分确定病理因素的轻重多寡，可在复杂的临床表现中提炼出核心病机，合理分配治疗重点；又可参考积分相对变化，把握动态病机，及时调控。从而做到“同证异治”[22]，实现房颤精准个体化诊疗。
This study is based on the combination of disease and syndrome patterns, using pathological factors as the entry point,andadoptsa systematic literature review and Delphi expertconsultation to develop a combined Chinese and Western medicine diagnostic scale for common pathological factors of atrial fibrillation, supplementing thesyndrome differentiation system.Based on this scale for atrialfibrillationsyndrome differentiation,it can achieveobjective quantificationof pathological factorsdiagnosis.Determiningthe severityand quantity of pathological factors based on the scale score canextract core pathogenesis from complex clinical manifestations,reasonably allocate treatmentfocus;it can alsorefer to the relative changes in scores,grasp dynamic pathogenesis,and adjustin a timely manner.Thus,achieving“same syndrome, different treatment”[22]realizespreciseindividualizeddiagnosis and treatment of atrialfibrillation.
根据文献研究和德尔菲法专家咨询的结果，发现心房颤动的病机本质属于本虚标实，本虚表现为气虚、阴虚、阳虚，标实则为血瘀、痰浊、气滞等。本虚可能与静息心室率增快、LVEF值降低、BNP升高、全血粘度升高等理化指标相关，并表现为CHA2DS2-VASc评分≤2分、HAS-BLED评分≤2分等心房颤动危险性较低的状态；标实理化指标表现为血栓弹力图高凝状态、D-二聚体升高、总胆固醇升高、甘油三酯升高等，并表现为CHA2DS2-VASc评分≥4分等心房颤动危险性较高的状态。而本虚与标实之间理化指标的差异也体现了疾病由轻到重的病理变化，心房颤动的前期轻症阶段可能以本虚为主、虚中夹实，到了后期重症阶段，则以虚实并重的病理状态为多见，但“本虚标实”贯穿本病始终。
According to the literature research and the results of expert consultation using the Delphi method, it was found that the pathogenesis of atrial fibrillation essentially belongs to deficiency and excess, with deficiency manifested as Qi deficiency, Yin deficiency, and Yang deficiency, while excess is represented by blood stasis, phlegm turbidity, and Qi stagnation, among others.This virtual possibility may be related to increased resting heart rate, LVEF value decrease, BNP increase, elevated whole blood viscosity, and other physicochemical indicators, and is manifested as CHA 2 DS 2 - VASc score ≤ 2 points, HAS - BLED score ≤ 2 points, indicating a lower risk of atrial fibrillation; the marked physicochemical indicators show a hypercoagulable state in thromboelastography, D - dimer increase, total cholesterol increase, triglyceride increase, etc., and are manifested as CHA 2 DS 2 - VASc score ≥ 4 points, indicating a higher risk of atrial fibrillation.The difference in the physiological and chemical indicators between the root deficiency and the manifest excess also reflects the pathological changes of the disease from mild to severe,the early stageof atrial fibrillation may primarily exhibit root deficiency with some manifest excess, while in the later stageof severe cases, a pathological state of both deficiency and excess is more common, but "root deficiency and manifest excess" runs through the entire course of this disease.It seems there is no source text provided for translation. Please provide the text you would like to have translated
本研究存在局限：（1）未开展临床调查探索条目客观权重和诊断阈值，而是基于文献研究、专家调查与组内研讨，通过相对主观的方式确定条目权重和诊断阈值；（2）未对诊断量表的诊断效能进行检验；（3）未基于病理因素的轻重程度进行分级诊断；（4）德尔菲专家咨询未提前设置“共识”与研究中止的条件[23-24]，而是提前预设两轮次咨询，可能导致部分条目因轮次过少而未得到充分共识。后续可开展多中心、大样本临床调查探索条目客观权重和诊断阈值，基于轻重程度设置分级诊断，并探索不同病理因素兼杂组合证的诊断标准。
This studyhaslimitations:(1) No clinical investigation was conductedto explore the objective weights of items and diagnostic thresholds, but rather based onliterature research, expert surveys, and group discussions, determining theweightsand diagnostic thresholds in a relativelysubjective manner;(2) The diagnostic effectiveness of the diagnostic scale was nottested;(3) No graded diagnosis was conducted based onthe severity of pathological factors;(4The Delphi expertconsultation did not set conditions for "consensus" and termination of the study in advance[23-24], but rather pre-set two rounds of consultation,whichmayresult in some items notachieving sufficient consensus due to the limited number of rounds.Subsequent multi-center, large-sample clinical investigations can be conductedto explore the objective weights of items and diagnostic thresholds，set graded diagnoses based on severity，andexplore diagnostic criteria for different pathological factors combinedwithmixedcombinations。It seems there is no source text provided for translation. Please provide the text you would like to have translated
参考文献
References
[1] 黄从新, 张澍, 黄德嘉,等. 心房颤动:目前的认识和治疗的建议-2018[J]. 中国心脏起搏与心电生理杂志,2018,32(04):315-368
Huang Congxin, Zhang Shu, Huang Dejia, et al. Current Understanding and Treatment Recommendations for Atrial Fibrillation - 2018[J]. Chinese Journal of Cardiac Pacing and Electrophysiology 2018; 32(04): 315-368..
[2] LLOYD-JONES D M, WANG T J, LEIP E P, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study[J]. Circulation, 2004,110(9):1042-1046
LLOYD-JONES D M, WANG T J, LEIP E P, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation, 2004; 110(9): 1042-1046..
[3] GB/T 16751.2-1997,中医临床诊疗术语 证候部分[S]
GBT 167512-1997 Traditional Chinese Medicine Clinical Diagnosis and Treatment Terminology, Symptom Section [S].
[4] 陈家旭.中医诊断学[M].北京:中国中医药出版社,2012
Chen Jiaxu's Traditional Chinese Medicine Diagnosis [M]. Beijing: China Traditional Chinese Medicine Publishing House, 2012..
[5] 葛均波, 徐永健.内科学.第8版[M].北京:人民卫生出版社,2013
Ge Junbo, Xu Yongjian, Internal Medicine, 8th Edition [M]. Beijing: People's Health Publishing House, 2013..
[6] 张颖, 季聪华, 李秋爽,等. 中医临床实践指南制修订中德尔菲法的统计分析方法[J]. 中华中医药杂志,2018,33(01):249-251
Zhang Ying, Ji Conghua, Li Qiushuang, et al. Statistical analysis methods of the Delphi method in the formulation and revision of clinical practice guidelines for traditional Chinese medicine. Chinese Journal of Traditional Chinese Medicine 2018, 33(01): 249-251..
[7] 方格, 周旋, 陈家旭,等. 基于德尔菲法和层次分析法构建肝郁气滞证诊断量表[J]. 中医杂志,2022,63(16):1525-1531
Fang Ge, Zhou Xuan, Chen Jiaxu, et al. Construction of a diagnostic scale for liver qi stagnation syndrome based on the Delphi method and analytic hierarchy process. Journal of Traditional Chinese Medicine 2022; 63(16): 1525-1531..
[8] T/CACM 1336-2020,基于病证结合的中医证临床诊断标准研制与应用规范[S]
Development and Application Standards for Clinical Diagnosis Criteria of Traditional Chinese Medicine Based on the Combination of Disease and Syndrome [S].
[9] 贯彻实施《国家标准化发展纲要》行动计划（2024—2025年）[J]. 工程建设标准化,2024(05):48-56
[9] Implementation of the "National Standardization Development Outline" Action Plan (2024-2025) [J]. Engineering Construction Standardization 2024(05):48-56.
[10] HINDRICKS G, POTPARA T, DAGRES N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021,42(5):373-498
HINDRICKS G, POTPARA T, DAGRES N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021; 42(5): 373-498..
[11] 吴勉华, 周学平.中医内科学[M].北京:中国中医药出版社,2017
Wu Mianhua, Zhou Xueping. Traditional Chinese Medicine Internal Science [M]. Beijing: China Traditional Chinese Medicine Publishing House, 2017..
[12] 心悸的诊断依据、证候分类、疗效评定——中华人民共和国中医药行业标准《中医内科病证诊断疗效标准》(ZY/T001.1-94)[J]. 辽宁中医药大学学报,2016,18(08):7
[12] Diagnostic criteria for palpitations, classification of syndromes, and evaluation of efficacy—Standards for the diagnosis and efficacy of traditional Chinese medicine internal diseases in the People's Republic of China (ZYT0011-94) [J]. Journal of Liaoning University of Traditional Chinese Medicine 2016 18(08):7.
[13] 李哲山, 刘聪. 心房颤动中医证候及用药规律文献研究[J]. 中国卫生标准管理,2019,10(15):94-97
Li Zheshan, Liu Cong. Literature Study on Traditional Chinese Medicine Syndromes and Medication Patterns in Atrial Fibrillation [J]. China Health Standard Management 2019 10(15): 94-97..
[14] 张艺楠. HFpEF合并房颤中医证型分布规律与临床特征及其和HFrEF合并房颤对比研究[D]. 北京:北京中医药大学,2020
Zhang Yinan. A Study on the Distribution Patterns and Clinical Characteristics of Traditional Chinese Medicine Syndromes in HFpEF Combined with Atrial Fibrillation and Comparison with HFrEF Combined with Atrial Fibrillation [D]. Beijing University of Chinese Medicine, 2020..
[15] 张婧倩. 心房颤动与中医体质的相关性研究[D]. 北京:北京中医药大学,2012
Zhang Jingqian. Research on the Correlation between Atrial Fibrillation and Traditional Chinese Medicine Constitution [D]. Beijing: Beijing University of Chinese Medicine, 2012..
[16] 刘强, 高颖. 证候诊断量表的理论基础[J]. 中华中医药杂志,2010,25(07):989-992
Liu Qiang, Gao Ying. The Theoretical Basis of Symptom Diagnosis Scale [J]. Chinese Journal of Traditional Chinese Medicine 2010, 25(07): 989-992..
[17] 赵灵燕, 毕力夫, 陈建新,等. 2型糖尿病中医证候要素诊断量表的研制及考评[J]. 北京中医药大学学报,2018,41(10):848-853
Zhao Lingyan, Bi Lifu, Chen Jianxin, et al. Development and evaluation of a diagnostic scale for traditional Chinese medicine syndromes in type 2 diabetes mellitus. Journal of Beijing University of Chinese Medicine 2018, 41(10): 848-853..
[18] 钟俐芹, 盛丹, 刘旺华,等. 从微观到“近”微观辨证：源流、争议及展望[J]. 中国中医药信息杂志,2024,31(03):8-12
Zhong Liqin, Sheng Dan, Liu Wanghua, et al. From Micro to "Near" Micro Dialectics: Origins, Controversies, and Prospects [J]. Journal of Chinese Medicine and Pharmacy Information 2024, 31(03): 8-12..
[19] 陶嘉磊, 袁斌, 汪受传. 中医证候学研究的技术方法及其运用现状[J]. 中华中医药杂志,2018,33(07):2982-2985
Tao Jialei, Yuan Bin, Wang Shouchuan. Technical methods and current application status of research on traditional Chinese medicine syndrome differentiation [J]. Chinese Journal of Traditional Chinese Medicine 2018, 33(07): 2982-2985..
[20] 黄飞翔, 刘茂亿, 吴镇宗, 欧阳秋芳, 林清. 阵发性心房颤动中医证型与左室质量指数及心率变异性的临床研究. 中西医结合心脑血管病杂志. 2023. 21(18): 3384-3387
Huang Feixiang, Liu Maoyi, Wu Zhenzong, Ouyang Qiufang, Lin Qing. Clinical study on the TCM syndrome types of paroxysmal atrial fibrillation and their relationship with left ventricular mass index and heart rate variability. Journal of Integrated Traditional and Western Medicine for Cardiovascular and Cerebrovascular Diseases. 2023. 21(18): 3384-3387..
[21] 姚美丹, 张洁, 黄尉威, 关卓骥, 冼绍祥, 陈洁. 慢性心力衰竭合并房颤证候分布与心脏结构及功能特征分析. 中华中医药杂志. 2023. 38(04): 1769-1773
Yao Meidan, Zhang Jie, Huang Weiwei, Guan Zhuoji, Xian Shaoxiang, Chen Jie. Analysis of the distribution of syndromes in chronic heart failure combined with atrial fibrillation and the characteristics of cardiac structure and function. Chinese Journal of Traditional Chinese Medicine. 2023 38(04): 1769-1773.
[22] 李金霞, 周小青, 赖丽娜,等. “同证异治”内涵析辨[J]. 中国中医基础医学杂志,2021,27(12):1868-1870+1974
Li Jinxia, Zhou Xiaoqing, Lai Lina, et al. "Analysis and Distinction of the Connotation of 'Same Evidence, Different Treatment'" [J]. Journal of Basic Traditional Chinese Medicine 2021, 27(12): 1868-1870 + 1974..
[23] DIAMOND I R, GRANT R C, FELDMAN B M, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies[J]. J Clin Epidemiol, 2014,67(4):401-409
[23] DIAMOND I R, GRANT R C, FELDMAN B M, et al. Defining consensus: a systematic review recommends methodological criteria for reporting of Delphi studies[J]. J Clin Epidemiol, 2014; 67(4): 401-409.
[24] JüNGER S, PAYNE S A, BRINE J, et al. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review[J]. Palliat Med, 2017,31(8):684-706
JÜNGER S, PAYNE S A, BRINE J, et al. Guidance on Conducting and Reporting Delphi Studies (CREDES) in palliative care Recommendations based on a methodological systematic review. Palliat Med, 2017; 31(8): 684-706..