结构方程模型结合项目反应理论实现功能性胃肠病中医辨证量表研究
|
摘要
【目的】运用结构方程及项目反应理论研制基于辨证的中医功能性胃肠病量表。
【方法】使用中医功能性胃肠病初量表收集临床病例,包括301例患者和61例健康人。
通过文献复习,结合医家临床实践经验及诊疗规范意见,以中医基础理论及中医诊断学为指导,提出中医功能性胃肠病辨证的理论模型。模型将证型细化为9个证型：脾胃气虚证,肝郁证,气滞证,气逆证,寒证,湿证,热证,阴虚证,阳虚证,同时包括5条路径：肝郁气滞,脾虚湿阻,湿阻气滞,阴虚发热,阳虚则寒。因样本量较少,主要对脾胃气虚证,肝郁证,气滞证,湿证这4个证型进行分析。
运用结构方程模型及项目反应理论筛选条目,筛选原则为：若条目的因子负荷及鉴别度低下,试题信息函数低平,则参考中医理论后可删除。运用结构方程模型对筛选后的辨证模型进行重新拟合,分析症状及证型的关系,证型及证型的关系；运用项目反应理论对各证型进行项目分析,得出各填表人的证型能力值(包括健康人,患者),及证型能力值和标准估计误的平均值,对能力值进行独立样本t检验,以考核其区分效度。
[结果]通过结构方程模型及项目反应理论分析后,最终删除条目15条,包括：肝郁证的脉弦,湿证的苔腻,脉滑,苔滑,脾胃气虚证的自汗,喜按,舌齿痕,舌胖大,苔薄,白苔,脉细,淡红舌,脉缓,大便时干时烂,气滞证的拒按,共删除了37.5%的条目,最终模型拟合度良好(x2/DF=1.82,GFI=0.88,RMSEA=0.052),测验信息函数改变不大,达到了简化模型的目的。
根据各症状的负荷值及鉴别度得出各证型的主症和次症,肝郁证主症：心情不好病情加重,消极感受,次症：胁部不适；湿证主症：身重、头重,次症：苔厚,腹泻；脾胃气虚证主症：体乏,懒言,口淡,饮食不慎加重病情,隐痛,次症：纳呆食少,易累,早饱,吐痰涎,大便先干后烂,便溏,气滞证主症：腹中重坠感,胀闷,便后不尽感,次症：排便不畅,胀痛,痛即欲泻,胸闷。
结构方程模型的分析结果提示了功能性胃肠病疾病发展过程中证型转化的方向：郁证与气滞证、脾胃气虚证与湿证,湿证与气滞证之间的关系为直接效应,即前者证型程度越严重则后者证型程度将更严重。脾胃气虚证与气滞证之间的关系为间接效应,主要通过脾胃气虚导致湿证,湿证再影响气机导致气滞。湿证导致脾胃气虚并不明显,主要以脾胃气虚不能运化水湿致使湿阻为患,湿证未能反过来导致脾胃气虚。
健康人及患者人群,在四个证型的证型能力值的均数t检验均为P<0.05,得分差别具有统计学意义,表明本模型有区分不同属性人群的能力,区分度良好。四个证型的估计标准误均值范围为0.0—0.4,四个证型的测验均具有良好的精确性。
【结论】本量表是以功能性胃肠病的认识及临床经验为基础进行设计的,其条目分为主观条目(患者自评)及客观条目(医生评价),对临床症状的收集更全面,通过分析简化模型后量表更简洁全面。根据分析结果得到了各证型的主症及次症,证型转化关系,并形成了诊断规则,可更好地指导临床。
中医辨证模型的拟合度良好,符合中医理论,证型程度能区分健康人及患者。中医功能性胃肠病辨证量表是具有良好的区分效度的疾病特异性量表,简单明了,易于接受,易于理解和实施,便于分析,可作为临床中医功能性胃肠病辨证分型的工具。
Objective
This study was designed to develop FGID-scale based on syndrome differentiation by using structural equation model (SEM) and item response theory (IRT) methods.
Methods
Data were collected by the primary scale functional gastrointestinal disorders scale (FGID-scale), which were from 301 FGID patients and 61 healthy people.
The hypothetical model was constructed based on presented papers, clinical experience, diagnostic and treatment guide, basic theory of traditional Chinese medicine, clinical diagnosis of Chinese medicine, and so on. The model includes nine syndrome(qi deficiency, liver depression, qi stagnation, qi upward flow, cold syndrome, dampness syndrome, heat syndrome, yin deficiency, yang deficiengcy) and five paths (Stagnation of Qi due to depression of the liver, spleen deficiency with dampness retention, retention of dampness due to stagnation of QI, yin deficiency generating interior heat, yang deficiency leading to cold).
SEM and IRT were used to shorten FGID-scale. Two criteria were used to filter items for shortening scales. One is factor loadings value, the other is item discrimination parameter value. If both values are low, the item information function curve is low and flat, the item can be deleted refer to basic theory of traditional Chinese medicine. SEM is used to analyze the shortened FGID-scale model, the relationship between symptoms and syndromes, and the relationship between syndromes and syndromes. IRT was used to analyze the syndromes, to predict the abilities(include patients and healthy people), the mean of the abilities and standard error of estimation. Analysis of abilities with t-test is used to evaluate the discriminant validity.
Result
15 items were delected in the end, including wiry pulse, dense tongue coating, slippery tongue coating, slippery pulse, spontaneous sweating, like push, like to be press, teeth-marked tongue, bulgy, thin coating, white coating, veinlet, pink tongue, infrequent pulse, dry and sloppy stool from time to time, dislike of press. The shortened FGID-scale model had a good fit(x2/DF=1.82, GFI=0.88, RMSEA=0.052). The test information function does not change much. The shortend model is simpler than the first one.
According to the item's factor loadings and the item discrimination parameter, the syndromes's primary symptom and secondary symptom can be distinguished. For liver depression, primary symptom indicates that the worse the mood, the more serious the illness becomes, while the secondary symptom is the pain of hypochondrium. For dampness syndrom, primary symptom is heaviness sensation of the head and body, while the secondary symptom is thick coating and diarrhea. For qi deficiency, primary symptom includes lassitude, distinclination to talk, tasteless and insipid. Inadvertent dining results in worse illness, dull pain. Its secondary symptom includes anorexia, fatigue, easy to feel full, spit. Stool is dry and then sloppy, and chance to be loose. For qi stagnation, primary symptom marked includes abdominal heaviness, fullness, and stool tenesmus, while the secondary symptom includes difficult elimination, bursting, pain-leading diarrhea and chest distress.
The more manifested the livers depressed is, the more stagnate the qi is. The more deficient the qi is, the more stagnate it is. The more manifested the dampness syndrome is, the more deficient the qi is. Deficient of qi results in manifestated dampness syndrome, and then influences the activities of qi, and qi stagnates. However, dampness syndrome cannot cause qi deficient.
Analyzed the mean of patients and healthy people's syndrome ability with t-test (P<0.05), the mean is statistically significant difference. It indicate the model have the ability to discriminate the patients and healthy people. The discriminant validity is good.
Conclusion
The Traditional Chinese Medicine based on syndrome differentiation model has a good fit, conform the basic theory of traditional Chinese medicine the syndrome ability can discriminate the patients and healthy people. Traditional Chinese Medicine based on syndrome differentiation is a valid disease-specific instrument used for measuring the Traditional Chinese medicine curative effect.
【方法】使用中医功能性胃肠病初量表收集临床病例,包括301例患者和61例健康人。
通过文献复习,结合医家临床实践经验及诊疗规范意见,以中医基础理论及中医诊断学为指导,提出中医功能性胃肠病辨证的理论模型。模型将证型细化为9个证型：脾胃气虚证,肝郁证,气滞证,气逆证,寒证,湿证,热证,阴虚证,阳虚证,同时包括5条路径：肝郁气滞,脾虚湿阻,湿阻气滞,阴虚发热,阳虚则寒。因样本量较少,主要对脾胃气虚证,肝郁证,气滞证,湿证这4个证型进行分析。
运用结构方程模型及项目反应理论筛选条目,筛选原则为：若条目的因子负荷及鉴别度低下,试题信息函数低平,则参考中医理论后可删除。运用结构方程模型对筛选后的辨证模型进行重新拟合,分析症状及证型的关系,证型及证型的关系；运用项目反应理论对各证型进行项目分析,得出各填表人的证型能力值(包括健康人,患者),及证型能力值和标准估计误的平均值,对能力值进行独立样本t检验,以考核其区分效度。
[结果]通过结构方程模型及项目反应理论分析后,最终删除条目15条,包括：肝郁证的脉弦,湿证的苔腻,脉滑,苔滑,脾胃气虚证的自汗,喜按,舌齿痕,舌胖大,苔薄,白苔,脉细,淡红舌,脉缓,大便时干时烂,气滞证的拒按,共删除了37.5%的条目,最终模型拟合度良好(x2/DF=1.82,GFI=0.88,RMSEA=0.052),测验信息函数改变不大,达到了简化模型的目的。
根据各症状的负荷值及鉴别度得出各证型的主症和次症,肝郁证主症：心情不好病情加重,消极感受,次症：胁部不适；湿证主症：身重、头重,次症：苔厚,腹泻；脾胃气虚证主症：体乏,懒言,口淡,饮食不慎加重病情,隐痛,次症：纳呆食少,易累,早饱,吐痰涎,大便先干后烂,便溏,气滞证主症：腹中重坠感,胀闷,便后不尽感,次症：排便不畅,胀痛,痛即欲泻,胸闷。
结构方程模型的分析结果提示了功能性胃肠病疾病发展过程中证型转化的方向：郁证与气滞证、脾胃气虚证与湿证,湿证与气滞证之间的关系为直接效应,即前者证型程度越严重则后者证型程度将更严重。脾胃气虚证与气滞证之间的关系为间接效应,主要通过脾胃气虚导致湿证,湿证再影响气机导致气滞。湿证导致脾胃气虚并不明显,主要以脾胃气虚不能运化水湿致使湿阻为患,湿证未能反过来导致脾胃气虚。
健康人及患者人群,在四个证型的证型能力值的均数t检验均为P<0.05,得分差别具有统计学意义,表明本模型有区分不同属性人群的能力,区分度良好。四个证型的估计标准误均值范围为0.0—0.4,四个证型的测验均具有良好的精确性。
【结论】本量表是以功能性胃肠病的认识及临床经验为基础进行设计的,其条目分为主观条目(患者自评)及客观条目(医生评价),对临床症状的收集更全面,通过分析简化模型后量表更简洁全面。根据分析结果得到了各证型的主症及次症,证型转化关系,并形成了诊断规则,可更好地指导临床。
中医辨证模型的拟合度良好,符合中医理论,证型程度能区分健康人及患者。中医功能性胃肠病辨证量表是具有良好的区分效度的疾病特异性量表,简单明了,易于接受,易于理解和实施,便于分析,可作为临床中医功能性胃肠病辨证分型的工具。
Objective
This study was designed to develop FGID-scale based on syndrome differentiation by using structural equation model (SEM) and item response theory (IRT) methods.
Methods
Data were collected by the primary scale functional gastrointestinal disorders scale (FGID-scale), which were from 301 FGID patients and 61 healthy people.
The hypothetical model was constructed based on presented papers, clinical experience, diagnostic and treatment guide, basic theory of traditional Chinese medicine, clinical diagnosis of Chinese medicine, and so on. The model includes nine syndrome(qi deficiency, liver depression, qi stagnation, qi upward flow, cold syndrome, dampness syndrome, heat syndrome, yin deficiency, yang deficiengcy) and five paths (Stagnation of Qi due to depression of the liver, spleen deficiency with dampness retention, retention of dampness due to stagnation of QI, yin deficiency generating interior heat, yang deficiency leading to cold).
SEM and IRT were used to shorten FGID-scale. Two criteria were used to filter items for shortening scales. One is factor loadings value, the other is item discrimination parameter value. If both values are low, the item information function curve is low and flat, the item can be deleted refer to basic theory of traditional Chinese medicine. SEM is used to analyze the shortened FGID-scale model, the relationship between symptoms and syndromes, and the relationship between syndromes and syndromes. IRT was used to analyze the syndromes, to predict the abilities(include patients and healthy people), the mean of the abilities and standard error of estimation. Analysis of abilities with t-test is used to evaluate the discriminant validity.
Result
15 items were delected in the end, including wiry pulse, dense tongue coating, slippery tongue coating, slippery pulse, spontaneous sweating, like push, like to be press, teeth-marked tongue, bulgy, thin coating, white coating, veinlet, pink tongue, infrequent pulse, dry and sloppy stool from time to time, dislike of press. The shortened FGID-scale model had a good fit(x2/DF=1.82, GFI=0.88, RMSEA=0.052). The test information function does not change much. The shortend model is simpler than the first one.
According to the item's factor loadings and the item discrimination parameter, the syndromes's primary symptom and secondary symptom can be distinguished. For liver depression, primary symptom indicates that the worse the mood, the more serious the illness becomes, while the secondary symptom is the pain of hypochondrium. For dampness syndrom, primary symptom is heaviness sensation of the head and body, while the secondary symptom is thick coating and diarrhea. For qi deficiency, primary symptom includes lassitude, distinclination to talk, tasteless and insipid. Inadvertent dining results in worse illness, dull pain. Its secondary symptom includes anorexia, fatigue, easy to feel full, spit. Stool is dry and then sloppy, and chance to be loose. For qi stagnation, primary symptom marked includes abdominal heaviness, fullness, and stool tenesmus, while the secondary symptom includes difficult elimination, bursting, pain-leading diarrhea and chest distress.
The more manifested the livers depressed is, the more stagnate the qi is. The more deficient the qi is, the more stagnate it is. The more manifested the dampness syndrome is, the more deficient the qi is. Deficient of qi results in manifestated dampness syndrome, and then influences the activities of qi, and qi stagnates. However, dampness syndrome cannot cause qi deficient.
Analyzed the mean of patients and healthy people's syndrome ability with t-test (P<0.05), the mean is statistically significant difference. It indicate the model have the ability to discriminate the patients and healthy people. The discriminant validity is good.
Conclusion
The Traditional Chinese Medicine based on syndrome differentiation model has a good fit, conform the basic theory of traditional Chinese medicine the syndrome ability can discriminate the patients and healthy people. Traditional Chinese Medicine based on syndrome differentiation is a valid disease-specific instrument used for measuring the Traditional Chinese medicine curative effect.
引文
[1]吴秀艳,王天芳.中医证型诊断标准的研究思路[J].新中医,2007,39(3)：1-3
[2]马玉,王天芳,薛晓琳,等.肝郁脾虚证的症状特点及辨证标准的现代文献研究[J].中华中医药杂志,2006,21(2)：89-92
[3]孙晓敏,李晓勇,靳文,等.亚健康肾阴虚证的血浆蛋白质组学初步研究[J].四川中医,2008,26(4)：7-9
[4]申维玺.再论中医证的本质是细胞因子[J].中医杂志,2002,43(12)：888-891
[5]王颖芳,陈蔚文,劳绍贤,等.慢性胃炎脾气虚证与脾胃湿热证的差异表达基因比较[J].中国病理生理杂志,2008,24(2)：320-324
[6]李炜弘,雍小嘉,范怀昌,等.老龄肾阳虚证的差异表达基因谱分析[J].时珍国医国药,2009,20(5)：1210-1212
[7]Minjun Chen, Liping Zhao, Wei Jia, Metabonomic study on the biochemical profiles of a hydrocortisone induced animal model [J]. Journal of Proteome Research,2005,4:2391-2396
[8]韩耀风,郝元涛,方积乾,等.项目反应理论及其在生存质量研究中的应用[J].中国卫生统计,2006,23(6)：562-565
[9]Donald L., Patrick.. Patient-Reported Outcomes (PROs):An Organizing Tool for Concepts, Measures and Applications[J]. QoL Newsletter,2003,31: 1-6
[10]Hunt SM, Mckznna SP, Mcewen J, et al. The Nottingham Health Profile: validation of a health status and medical consultations [J]. Soc Sci Med, 1981,15:221-229
[!l]Bergner M, Bobbit RA, Pollard WE, et al. The sickness impact profile: validation of a health status measure[J]. Med Care,1976;14:57-67
[12]Garratt, A. M.. The SF-36 Health survey questionnaire:An outcome measure suitable for routine use within the NHS[J], British Medical Journal 1993, 306:1440-1444.
[13]WHO. The 100 Questions with response scales:WHOQOL--100,1995, WHO, Geneva.
[14]WHO. WHOQOL-Measuring Quality of Life. MSA/MNH/PSF, WHO, Geneva,1997.4
[15]The EuroQol Group, EuroQol-a new facility for the measurement of health related quality of life[J], Health policy,1990,9(6):199-208.
[16]Bonomi AE, Cella DF. A cross-cultural adaptation of the functional assessment of cancer therapy (FACT) quality of life measurement system for use in European oncology clinical trials[J]. Quality of Life Newsletter, 1995,12:5-7
[17]Scientific Advisory Committee of the Medical Outcomes Trust. Assessing Health Status and Quality of Life Instruments:Attributes and Review[J]. Quality of Life Research 2002,11:193-205.
[18]U. S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER) Center for Biologics Evaluation and Research (CBER) Center for Devices and adiological Health (CDRH). Guidance for Industry Patient-Reported Outcome Measures:Use in Medical Product Development to Support Labeling. February,2006
[19]王琦,朱燕波,薛禾生,等.中医体质量表的初步编制[J].中国临床康复,2006,10(3)：12-14
[20]王哲,胡随瑜.中医肝脏象情绪量表的编制[J].中国行为医学科学.2004,13(1)：104-106
[21]郭争鸣,肖跃群,杨小兵.应用心理测量技术编制中医阴阳人格分类测量量表的研究[J].湖南中医杂志,2006,22(1)：44-46
[22]由松,胡立胜,图娅.中医郁证(心脾两虚型)及其症状标准化研究方法探讨[J].北京中医药大学学报.2000,23(6)：51-53
[23]刘保延,何丽云,谢雁鸣,等.亚健康状态中医证型特征调查问卷的研制[J],中国中医基础医学杂志,2004,10(9)：23-29
[24]吴大嵘,郭新峰,赖世隆.生存质量评测及其在中医药疗效评价中的应用[J].广州中医药大学学报,2002,19(4)：256-260
[25]林江,张利君,郑舜华,等.慢性胃炎患者生存质量影响因子及其与中医辨证分型的关系[J].上海中医药杂志,2006,40(8)：4-5
[26]官坤祥,吴文江.肠易激综合征中医证型量表的建立与评价[J].吉林中医,2004,24(8)：6-8
[27]刘小珍,陈泽奇,郭全.肝火上炎证证型量表的初步编制[J].中国临床康复,2006,10(47)：1-3
[28]吴静.CTT、IRT和GT三种测验理论之比较[J].黑龙江教育学院学报,2008,27(12)：77-78
[29]杨志明,张雷.改进普通话测试的概化理论分析[J].湖南师范大学教育科学学报,2003,2(1)：76-82
[30]杨志明,张雷,马世哗.从多元概化理论看高考综合能力测试的改进[J].心理 学报,2004,36(2)：195-200
[31]杨志明,张雷.韦氏儿童智力量表能否测量第3因子--W1SC—CR的多元概化理论研究[J].心理学报,2003,26(2)：305-307
[32]何立国,周爱保.“青少年学生生活满意度量表”的概化理论研究[J].心理学报,2006,29(5)：1922-1202
[33]朱梁,姚定康,刘晓虹,等.概化理论在内科学临床技能考核中的应用研究[J].心理学报,2006,29(1)：246-248
[34]何宁,苗丹民,霍涌泉.透析GT信度观及其存在的问题[J].应用心理学,2007,13(1)：87-90
[35]韩耀风,郝元涛,方积乾,等.项目反应理论及其在生存质量研究中的应用[J].中国卫生统计,2006,23(6)：562-565
[36]闫宇翔,王洪源.项目反应理论在医学量表测量误差估计中的应用[J].中国卫生统计,2004,21(3)：162-164
[37]周骏,欧东明,徐淑媛,等.等级反应模型下项目特征曲线等值法在大型考试中的应用[J].心理学报,2005,37(6)：832-838
[38]孙晓敏,张厚粲.国家公务员结构化面试中评委偏差的IRT分析[J].心理学报,2006,38(4)：614-625
[39]肖玮,苗丹民,武圣君,等.应用项目反应理论对全国征兵语词推理测验的分析[J].中国行为医学科学,2007,16(6)：562-564
[40]徐思,张敏强,黎光明.基于GT和多面Rasch模型的结构化面试分析[J].心理学探新,2009,29(5)：77-82
[41]李毅.1036例消化性溃疡症状学聚类研究[J].山西中医,2009,25(10)：42-43
[42]魏魁武,王阶,朱翠玲,等.血瘀证量化诊断流行病学调查数据的判别分析[J].世界科学技术一中医药现代化,2007,9(2)：33-37
[43 ]陈建设,陈文垲.聚类分析结合logistic回归分析在中医证型诊断量化研究中的应用探讨[J].中国卫生统计,2009,26(4)：379-382
[44]黄小波,李宗信,陈文强,等.慢性疲劳综合征中医病机转化的定量分析[J].北京中医药大学学报,2007,30(9)：583-586
[45]郭蕾,王永炎,张志斌.关于证型概念的诠释[J].北京中医药大学学报,2003,26(2)：5-8
[46]朱文锋.创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6)：38-39
[47]张连文,袁世宏.隐结构模型与中医辨证研究(I)——隐结构法的基本思想及隐结构分析工具[J].北京中医药大学学报,2006,29(6)：365-369
[48]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.18
[49]王阶,邢雁伟,陈建新,等.1069例冠心病心绞痛证型因子分析方法的分类研究[J].北京中医药大学学报,2008,31(5)：344-346
[50]陈启光,申春悌,张华强,等.因子分析在中医证型规范标准研究中的应用[J].中国中医基础医学杂志,2004,10(8)：53-56
[51]史锁芳,刘秀芳,严志林,等.支气管哮喘患者中医四诊信息调查及验证性因子分析[J].中西医结合学报,2005,2(4)：363-365
[52]陈启光,申春悌,张华强,等.结构方程模型在中医证型规范标准研究中的应用[J].中国中医基础医学杂志,2005,22(1)：2-4
[53]李国春,李春婷,黄蓝洋,等.结构方程模型在慢性萎缩性胃炎中医证型分型中应用[J].中国卫生统计,2007,24(4)：357-360
[54]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.14
[55]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.17-19
[56]郭庆科,房洁.经典测验瑾论与项圈反应理论的对比研究[J].山东师大学报(自然科学版),2000,15(3)：264-266
[57]Nunnally J C.. Psychometric theory[J]. New York:McGraw-Hill,1967
[58]Bentler P M, Mooijaart A.. Choice of structural model via parsimony:A rational based on precision[J]. Psychological Bulletin,1989.315-317
[59]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.137-139
[60]Wright, B. D., Stone, M. H. Best test design. Chicago:MESA Press
[61]Hulin, C. L., Lissak, R. I., Drasgow, F. Recovery of two- and three-parameter logistic item characteristic curves:A Monte Carlo study[J]. Applied Psychological Measurement,6:249-260
[62]Swaminathan, H., Gifford, J. A. Estimation of parameters in the three-parameter latent trait model. In D. Weiss (Ed.) [J]. New horizons in testing. New York:Academic Press
[63]Drasgow, F.. An evaluation of marginal maximum likelihood estimation for the two-parameter logistic model[J]. Applied Psychological Measurement, 13:77-90
[64]Lim, R. G., Drasgow, F.. Evaluation of two methods for estimating item response theory parameters when assessing differential item functioning[J]. Journal of Applied Psychology,75:164-174
[65]Skaggs, G., Stevenson, J.. A comparison of Pseudo-Bayesian and joint maximum likelihood procedures for estimating item parameters in the three-parameter IRT model[J]. Applied Psychological Measurement,13: 391-402
[66]Swaminathan, H., Gifford, J. A.. Bayesian estimation in the three-parameter logistic model[J]. Psychometrika,51:589-601
[67]Reise, S. P., Yu, J.. Parameter recovery in the graded response model using MULTILOG[J]. Journal of Educational Measurement,27:133-144
[68]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.154-156
[69]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.139-140
[70]许婵娟.功能性消化不良的辨治[J].中华实用中西医杂志,2006,19(23)：2777—2778
[71]李予川,魏玉玲.中医药辨证治疗功能性消化不良[J].中国医药指南,2007,5(12)：570-571
[72]范汉淮.辨证分型治疗功能性消化不良45例总结[J].四川中医,2006,24(3)：52-53
[73]刘水章.中医辨证论治功能性消化不良[J].实用医技杂志,2006,13(23)：4241—4242
[74]曹东辉,杨志新.中医分型辨证治疗功能性消化不良87例分析[J].航空航天医药,2010,12(5)：279-280
L75]王柏根.赵国岑教授治疗功能性消化不良的经验[J].河南中医,2004,24(5)：19-20
[76]中华中医药学会脾胃病分会.消化不良中医诊疗共识意见[J].中国中西医结合杂志,2010,30(5)：533-537
[77]张声生,许文君,陈贞,等.基于“寒、热、虚、实”二次辨证的565例功能性消化不良证型分布特点研究[J].中华中医药杂志,2008,23(9)：833-835
[78]刘松林,梅国强,赵映前,等.功能性消化不良的中医临床辨证规律研究[J].中华中医药杂志,2004,19(8)：499-501
[79]赵丽丹.功能性消化不良的中医辨证治疗[J].光明中医,2007,22(12)：20-21
[80]李连贞,陈宪海.浅谈从肝论治功能性消化不良[J].河北中医,2001,23(3)：196—197
[81]张声生,许文君,陈贞,等.基于“寒、热、虚、实”二次辨证的565例功能性 消化不良证型分布特点研究[J].中华中医药杂志,2008,23(9)：833-835
[82]赵爱莲.辨证分型治疗肠易激综合征172例[J].江西中医药,2006,37(281)：28-29
[83]白立峰,孟雅哲.中医辨证治疗肠易激综合征125例临床体会[J].中国医药学报,2002,17(12)： 762-763
[84]罗红斌,杨枫.中医辨证治疗肠易激综合征118例[J].光明中医,2007,22(3)：4
[85]李敏雅.陆维宏辨证治疗肠易激综合征(IBS)经验拾萃[J].浙江中医药大学学报,2009,33(6)：830-831
[86]陈修保,张则彦.试述肠易激综合征的中西医治疗[J].中医临床研究,2010,24(5)：58-59
[87]刘力,沈舒文.肠易激综合征中医辨证论治[J].实用中医内科杂志,2002,16(3)：157-158
[88]中华中医药学会脾胃病分会.肠易激综合征中医诊疗共识意见[J].中华中医药杂志,2010,25(7)：1062-1065
[89]汪红兵,张声生,李振华.360例腹泻型肠易激综合征主要证型分布与不同因子关系的研究[J].中国中医药信息杂志,2010,17(3)：18-20
[90]李剑锋.肠易激综合征辨证分析[J].世界中西医结合杂志,2008,3(3)：165—167
[91]刘敏.中医药辨证治疗肠易激综合征[J].中医中药,2008,5(22)：84
[92]徐卫华,符思,王微.中医辩证治疗肠易激综合征的临床经验总结[J].中国现代医药杂志,2010,12(5)：131-132
[93]吴华清,姚保泰.肠易激综合征辨治[J].山东中医杂志,2007,26(6)：393-394
[94]贾遏春,许晓峰.肠易激综合征辨治探讨[J].光明中医,2004,19(4)：20-21
[95]骆天炯.刘沈林教授论治肠易激综合征[J].南京中医药大学学报,2002,18(2)：116-117
[96]林恒.龙祖宏治疗脾胃病举隅[J].传统医药,2004,11(1)：35
[97]罗马委员会.功能性胃肠病罗马Ill诊断标准.胃肠病学[J].2006,11(12)：761-765
[98]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.16-17
[99]邱皓政,林碧方.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009.44-90
[100]McDonald, R. P. Test theory:A unified treatment[J]. Mahwah,1999, Nj:Erlbaum
[101]McDonald, R. P. Haldane's lungs:A case study in path analysis[J]. Multivariate Behavioral Research,1997,32:1-38
[102]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.194
[103]邱皓政,林碧方.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009.74-89
[104]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.127
[105]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.50-52
[106]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.60-100
[107]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.174-181
[108]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.279
[109]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.119
[2]马玉,王天芳,薛晓琳,等.肝郁脾虚证的症状特点及辨证标准的现代文献研究[J].中华中医药杂志,2006,21(2)：89-92
[3]孙晓敏,李晓勇,靳文,等.亚健康肾阴虚证的血浆蛋白质组学初步研究[J].四川中医,2008,26(4)：7-9
[4]申维玺.再论中医证的本质是细胞因子[J].中医杂志,2002,43(12)：888-891
[5]王颖芳,陈蔚文,劳绍贤,等.慢性胃炎脾气虚证与脾胃湿热证的差异表达基因比较[J].中国病理生理杂志,2008,24(2)：320-324
[6]李炜弘,雍小嘉,范怀昌,等.老龄肾阳虚证的差异表达基因谱分析[J].时珍国医国药,2009,20(5)：1210-1212
[7]Minjun Chen, Liping Zhao, Wei Jia, Metabonomic study on the biochemical profiles of a hydrocortisone induced animal model [J]. Journal of Proteome Research,2005,4:2391-2396
[8]韩耀风,郝元涛,方积乾,等.项目反应理论及其在生存质量研究中的应用[J].中国卫生统计,2006,23(6)：562-565
[9]Donald L., Patrick.. Patient-Reported Outcomes (PROs):An Organizing Tool for Concepts, Measures and Applications[J]. QoL Newsletter,2003,31: 1-6
[10]Hunt SM, Mckznna SP, Mcewen J, et al. The Nottingham Health Profile: validation of a health status and medical consultations [J]. Soc Sci Med, 1981,15:221-229
[!l]Bergner M, Bobbit RA, Pollard WE, et al. The sickness impact profile: validation of a health status measure[J]. Med Care,1976;14:57-67
[12]Garratt, A. M.. The SF-36 Health survey questionnaire:An outcome measure suitable for routine use within the NHS[J], British Medical Journal 1993, 306:1440-1444.
[13]WHO. The 100 Questions with response scales:WHOQOL--100,1995, WHO, Geneva.
[14]WHO. WHOQOL-Measuring Quality of Life. MSA/MNH/PSF, WHO, Geneva,1997.4
[15]The EuroQol Group, EuroQol-a new facility for the measurement of health related quality of life[J], Health policy,1990,9(6):199-208.
[16]Bonomi AE, Cella DF. A cross-cultural adaptation of the functional assessment of cancer therapy (FACT) quality of life measurement system for use in European oncology clinical trials[J]. Quality of Life Newsletter, 1995,12:5-7
[17]Scientific Advisory Committee of the Medical Outcomes Trust. Assessing Health Status and Quality of Life Instruments:Attributes and Review[J]. Quality of Life Research 2002,11:193-205.
[18]U. S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER) Center for Biologics Evaluation and Research (CBER) Center for Devices and adiological Health (CDRH). Guidance for Industry Patient-Reported Outcome Measures:Use in Medical Product Development to Support Labeling. February,2006
[19]王琦,朱燕波,薛禾生,等.中医体质量表的初步编制[J].中国临床康复,2006,10(3)：12-14
[20]王哲,胡随瑜.中医肝脏象情绪量表的编制[J].中国行为医学科学.2004,13(1)：104-106
[21]郭争鸣,肖跃群,杨小兵.应用心理测量技术编制中医阴阳人格分类测量量表的研究[J].湖南中医杂志,2006,22(1)：44-46
[22]由松,胡立胜,图娅.中医郁证(心脾两虚型)及其症状标准化研究方法探讨[J].北京中医药大学学报.2000,23(6)：51-53
[23]刘保延,何丽云,谢雁鸣,等.亚健康状态中医证型特征调查问卷的研制[J],中国中医基础医学杂志,2004,10(9)：23-29
[24]吴大嵘,郭新峰,赖世隆.生存质量评测及其在中医药疗效评价中的应用[J].广州中医药大学学报,2002,19(4)：256-260
[25]林江,张利君,郑舜华,等.慢性胃炎患者生存质量影响因子及其与中医辨证分型的关系[J].上海中医药杂志,2006,40(8)：4-5
[26]官坤祥,吴文江.肠易激综合征中医证型量表的建立与评价[J].吉林中医,2004,24(8)：6-8
[27]刘小珍,陈泽奇,郭全.肝火上炎证证型量表的初步编制[J].中国临床康复,2006,10(47)：1-3
[28]吴静.CTT、IRT和GT三种测验理论之比较[J].黑龙江教育学院学报,2008,27(12)：77-78
[29]杨志明,张雷.改进普通话测试的概化理论分析[J].湖南师范大学教育科学学报,2003,2(1)：76-82
[30]杨志明,张雷,马世哗.从多元概化理论看高考综合能力测试的改进[J].心理 学报,2004,36(2)：195-200
[31]杨志明,张雷.韦氏儿童智力量表能否测量第3因子--W1SC—CR的多元概化理论研究[J].心理学报,2003,26(2)：305-307
[32]何立国,周爱保.“青少年学生生活满意度量表”的概化理论研究[J].心理学报,2006,29(5)：1922-1202
[33]朱梁,姚定康,刘晓虹,等.概化理论在内科学临床技能考核中的应用研究[J].心理学报,2006,29(1)：246-248
[34]何宁,苗丹民,霍涌泉.透析GT信度观及其存在的问题[J].应用心理学,2007,13(1)：87-90
[35]韩耀风,郝元涛,方积乾,等.项目反应理论及其在生存质量研究中的应用[J].中国卫生统计,2006,23(6)：562-565
[36]闫宇翔,王洪源.项目反应理论在医学量表测量误差估计中的应用[J].中国卫生统计,2004,21(3)：162-164
[37]周骏,欧东明,徐淑媛,等.等级反应模型下项目特征曲线等值法在大型考试中的应用[J].心理学报,2005,37(6)：832-838
[38]孙晓敏,张厚粲.国家公务员结构化面试中评委偏差的IRT分析[J].心理学报,2006,38(4)：614-625
[39]肖玮,苗丹民,武圣君,等.应用项目反应理论对全国征兵语词推理测验的分析[J].中国行为医学科学,2007,16(6)：562-564
[40]徐思,张敏强,黎光明.基于GT和多面Rasch模型的结构化面试分析[J].心理学探新,2009,29(5)：77-82
[41]李毅.1036例消化性溃疡症状学聚类研究[J].山西中医,2009,25(10)：42-43
[42]魏魁武,王阶,朱翠玲,等.血瘀证量化诊断流行病学调查数据的判别分析[J].世界科学技术一中医药现代化,2007,9(2)：33-37
[43 ]陈建设,陈文垲.聚类分析结合logistic回归分析在中医证型诊断量化研究中的应用探讨[J].中国卫生统计,2009,26(4)：379-382
[44]黄小波,李宗信,陈文强,等.慢性疲劳综合征中医病机转化的定量分析[J].北京中医药大学学报,2007,30(9)：583-586
[45]郭蕾,王永炎,张志斌.关于证型概念的诠释[J].北京中医药大学学报,2003,26(2)：5-8
[46]朱文锋.创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6)：38-39
[47]张连文,袁世宏.隐结构模型与中医辨证研究(I)——隐结构法的基本思想及隐结构分析工具[J].北京中医药大学学报,2006,29(6)：365-369
[48]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.18
[49]王阶,邢雁伟,陈建新,等.1069例冠心病心绞痛证型因子分析方法的分类研究[J].北京中医药大学学报,2008,31(5)：344-346
[50]陈启光,申春悌,张华强,等.因子分析在中医证型规范标准研究中的应用[J].中国中医基础医学杂志,2004,10(8)：53-56
[51]史锁芳,刘秀芳,严志林,等.支气管哮喘患者中医四诊信息调查及验证性因子分析[J].中西医结合学报,2005,2(4)：363-365
[52]陈启光,申春悌,张华强,等.结构方程模型在中医证型规范标准研究中的应用[J].中国中医基础医学杂志,2005,22(1)：2-4
[53]李国春,李春婷,黄蓝洋,等.结构方程模型在慢性萎缩性胃炎中医证型分型中应用[J].中国卫生统计,2007,24(4)：357-360
[54]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.14
[55]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.17-19
[56]郭庆科,房洁.经典测验瑾论与项圈反应理论的对比研究[J].山东师大学报(自然科学版),2000,15(3)：264-266
[57]Nunnally J C.. Psychometric theory[J]. New York:McGraw-Hill,1967
[58]Bentler P M, Mooijaart A.. Choice of structural model via parsimony:A rational based on precision[J]. Psychological Bulletin,1989.315-317
[59]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.137-139
[60]Wright, B. D., Stone, M. H. Best test design. Chicago:MESA Press
[61]Hulin, C. L., Lissak, R. I., Drasgow, F. Recovery of two- and three-parameter logistic item characteristic curves:A Monte Carlo study[J]. Applied Psychological Measurement,6:249-260
[62]Swaminathan, H., Gifford, J. A. Estimation of parameters in the three-parameter latent trait model. In D. Weiss (Ed.) [J]. New horizons in testing. New York:Academic Press
[63]Drasgow, F.. An evaluation of marginal maximum likelihood estimation for the two-parameter logistic model[J]. Applied Psychological Measurement, 13:77-90
[64]Lim, R. G., Drasgow, F.. Evaluation of two methods for estimating item response theory parameters when assessing differential item functioning[J]. Journal of Applied Psychology,75:164-174
[65]Skaggs, G., Stevenson, J.. A comparison of Pseudo-Bayesian and joint maximum likelihood procedures for estimating item parameters in the three-parameter IRT model[J]. Applied Psychological Measurement,13: 391-402
[66]Swaminathan, H., Gifford, J. A.. Bayesian estimation in the three-parameter logistic model[J]. Psychometrika,51:589-601
[67]Reise, S. P., Yu, J.. Parameter recovery in the graded response model using MULTILOG[J]. Journal of Educational Measurement,27:133-144
[68]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.154-156
[69]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.139-140
[70]许婵娟.功能性消化不良的辨治[J].中华实用中西医杂志,2006,19(23)：2777—2778
[71]李予川,魏玉玲.中医药辨证治疗功能性消化不良[J].中国医药指南,2007,5(12)：570-571
[72]范汉淮.辨证分型治疗功能性消化不良45例总结[J].四川中医,2006,24(3)：52-53
[73]刘水章.中医辨证论治功能性消化不良[J].实用医技杂志,2006,13(23)：4241—4242
[74]曹东辉,杨志新.中医分型辨证治疗功能性消化不良87例分析[J].航空航天医药,2010,12(5)：279-280
L75]王柏根.赵国岑教授治疗功能性消化不良的经验[J].河南中医,2004,24(5)：19-20
[76]中华中医药学会脾胃病分会.消化不良中医诊疗共识意见[J].中国中西医结合杂志,2010,30(5)：533-537
[77]张声生,许文君,陈贞,等.基于“寒、热、虚、实”二次辨证的565例功能性消化不良证型分布特点研究[J].中华中医药杂志,2008,23(9)：833-835
[78]刘松林,梅国强,赵映前,等.功能性消化不良的中医临床辨证规律研究[J].中华中医药杂志,2004,19(8)：499-501
[79]赵丽丹.功能性消化不良的中医辨证治疗[J].光明中医,2007,22(12)：20-21
[80]李连贞,陈宪海.浅谈从肝论治功能性消化不良[J].河北中医,2001,23(3)：196—197
[81]张声生,许文君,陈贞,等.基于“寒、热、虚、实”二次辨证的565例功能性 消化不良证型分布特点研究[J].中华中医药杂志,2008,23(9)：833-835
[82]赵爱莲.辨证分型治疗肠易激综合征172例[J].江西中医药,2006,37(281)：28-29
[83]白立峰,孟雅哲.中医辨证治疗肠易激综合征125例临床体会[J].中国医药学报,2002,17(12)： 762-763
[84]罗红斌,杨枫.中医辨证治疗肠易激综合征118例[J].光明中医,2007,22(3)：4
[85]李敏雅.陆维宏辨证治疗肠易激综合征(IBS)经验拾萃[J].浙江中医药大学学报,2009,33(6)：830-831
[86]陈修保,张则彦.试述肠易激综合征的中西医治疗[J].中医临床研究,2010,24(5)：58-59
[87]刘力,沈舒文.肠易激综合征中医辨证论治[J].实用中医内科杂志,2002,16(3)：157-158
[88]中华中医药学会脾胃病分会.肠易激综合征中医诊疗共识意见[J].中华中医药杂志,2010,25(7)：1062-1065
[89]汪红兵,张声生,李振华.360例腹泻型肠易激综合征主要证型分布与不同因子关系的研究[J].中国中医药信息杂志,2010,17(3)：18-20
[90]李剑锋.肠易激综合征辨证分析[J].世界中西医结合杂志,2008,3(3)：165—167
[91]刘敏.中医药辨证治疗肠易激综合征[J].中医中药,2008,5(22)：84
[92]徐卫华,符思,王微.中医辩证治疗肠易激综合征的临床经验总结[J].中国现代医药杂志,2010,12(5)：131-132
[93]吴华清,姚保泰.肠易激综合征辨治[J].山东中医杂志,2007,26(6)：393-394
[94]贾遏春,许晓峰.肠易激综合征辨治探讨[J].光明中医,2004,19(4)：20-21
[95]骆天炯.刘沈林教授论治肠易激综合征[J].南京中医药大学学报,2002,18(2)：116-117
[96]林恒.龙祖宏治疗脾胃病举隅[J].传统医药,2004,11(1)：35
[97]罗马委员会.功能性胃肠病罗马Ill诊断标准.胃肠病学[J].2006,11(12)：761-765
[98]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.16-17
[99]邱皓政,林碧方.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009.44-90
[100]McDonald, R. P. Test theory:A unified treatment[J]. Mahwah,1999, Nj:Erlbaum
[101]McDonald, R. P. Haldane's lungs:A case study in path analysis[J]. Multivariate Behavioral Research,1997,32:1-38
[102]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.194
[103]邱皓政,林碧方.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009.74-89
[104]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：教育科学出版社,2008.127
[105]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.50-52
[106]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.60-100
[107]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.174-181
[108]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.279
[109]余民宁.试题反应理论IRT及其应用[M].台湾：心理出版社,2009.119