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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (9): 814-818.doi: 10.3736/jcim20090903

• Original Clinical Research • Previous Articles     Next Articles

Quantified diagnositic standard for large intestinal cancer of spleen qi deficiency syndrome

Feng-gang Houa,Yi Cenb,Jian Guanb,Ling-yun Zhua,Xiao-ling Yina   

  1. a Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai 200071, China
    b Department of Traditional Chinese Medicine, Shanghai 8th Peopled Hospital, Shanghai 200035, China
  • Received:2009-05-07 Accepted:2009-07-31 Online:2009-09-20 Published:2009-09-15
  • Contact: Feng-gang Hou E-mail:fghou@hotmail.com

Objective

To set a quantified diagnostic standard for large intestinal cancer of spleen qi deficiency syndrome.
Methods

The spleen qi deficiency syndrome was identified by experts on the basis of clinical epidemiological investigation of 311 patients suffering from large intestinal cancer. Corresponding points were assigned to the correlative factors (traditional Chinese medicine symptoms) on the basis of symptom differences between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome. The best threshold was determined by receiver operating characteristic curve (ROC) according to syndrome differentiation from expert team, and the quantified diagnostic standard was established. The syndrome identification from the expert team which was regarded as golden standard was tested retrospectively.
Results

All the traditional Chinese medicine symptoms possibly related to spleen qi deficiency syndrome were analyzed based on the opinions of experts, and 28 symptoms were confirmed as candidate correlative factors. The occurrence of 11 symptoms between spleen qi deficiency syndrome and non-spleen-qi-deficiency syndrome showed statistical differences by means of crosstabs analysis (P<0.05). The 11 symptoms were filtered by logistic regression analysis, and tiredness, fatigue, loose stool, and poor appetite were finally determined as the symptoms relative to large intestinal cancer. These four symptoms were analyzed with conditional probability conversion and endowed with 16, 11, 4 and 8 points respectively. The diagnostic standard of spleen qi deficiency syndrome of large intestinal cancer was over 13 points. The sensitivity, specificity and accuracy of retrospective examination were all above 80%, and its positive likelihood ratio was 9.89.
Conclusion

The quantified diagnostic standard for spleen qi deficiency syndrome of large intestinal cancer is in accordance with clinical characteristics of large intestine cancer and the characteristics of TCM syndrome diagnosis.

Key words: Intestinal cancer, Spleen qi deficiency, Syndrome differentiation, Epidemiology

Table 1

Corresponding points of the factors related to large intestinal cancer of spleen qi deficiency syndrome"

Xj Xjk Spleen qi deficiency (n=239) Non-spleen-qi-deficiency (n=72)
Frequency P (%) Absolute lijk Frequency P (%) Absolute lijk Opposite lijk of correlative factors Points
Tiredness 0 54 22.59 3.54 66 91.67 9.62
–15.76

16
1 185 77.41 8.89 6 8.33 –0.79
Fatigue 0 108 45.19 6.55 66 91.67 9.62
–11.25

11
1 131 54.81 7.39 6 8.33 –0.79
Loose stool 0 166 69.46 8.42 61 84.72 9.28
–3.87

4
1 73 30.54 4.85 11 15.28 1.84
Poor appetite 0 131 54.81 7.39 64 88.89 9.49
–8.19

8
1 108 45.19 6.55 8 11.11 0.46

Figure 1

The best diagnosis threshold choice of large intestinal cancer patients with spleen qi deficiency syndrome"

Table 2

Corresponding value coordinates of the ROC curve"

Points (threshold) Sensitivity 1–specificity Points (threshold) Sensitivity 1–specificity
–1.00 1.000 1.000 21.50 0.590 0.042
2.00 0.941 0.333 23.50 0.586 0.042
6.00 0.874 0.208 25.50 0.494 0.042
9.50 0.862 0.139 27.50 0.360 0.042
11.50 0.837 0.097 29.50 0.339 0.042
13.50 0.824 0.083 33.00 0.280 0.028
15.50 0.808 0.083 37.00 0.054 0.000
17.50 0.690 0.042 40.00 0.000 0.000
19.50 0.661 0.042

Table 3

The best threshold of the quantified diagnosis standard"

Points (threshold) Sensitivity (%) Specificity (%) 1–specificity (%) Points
(threshold)
Sensitivity (%) Specificity (%) 1–specificity (%)
8 87.45 79.17 20.83 13 82.43 91.67 8.33
9 86.19 86.11 13.89 14 82.43 91.67 8.33
10 86.19 86.11 13.89 15 82.43 91.67 8.33
11 86.19 86.11 13.89 16 80.75 91.67 8.33
12 83.68 90.28 9.72 17 69.04 95.79 4.21

Table 4

Retrospective testing of large intestinal cancer of spleen qi deficiency syndrome"

Criteria Differentiation criteria for expert
Positive Negative Total
Quantitative criteria
Positive 197(a) 6(b) 203
Negative 42(c) 66(d) 108
Total 239 72 311
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