儿童社区获得性肺炎常见证型及其证候的专家调查研究

doi:10.20274/j.cnki.issn.1674-3865.2025.06.008

Abstract

Abstract:

Objective To screen for the TCM syndrome types and primary and secondary symptoms of community-acquired pneumonia (CAP) in children by using the Delphi method, and to provide evidence and reference for the establishment of diagnostic conditions for CAP in children. Methods Based on the Delphi method, literature and books were retrieved to formulate expert inquiry questionnaires. Expert consultation was conducted, and the results of expert consultation were evaluated from multiple perspectives such as the mean, variable coefficient, and coordination coefficient. Combined with the clinical experience of experts, the items were modified to form the key points of TCM syndrome typing and diagnosis of CAP in children. Results A total of 23 experts from 18 provinces in China were selected for questionnaire surveys. The recovery rate of this round of questionnaires was 92%, the positive coefficient of experts was 92%, and the authority coefficient was 0.96. Based on the mean values of each item and the coefficient of variation and combined with the clinical experience of experts, after appropriate deletion of the items, 8 syndrome types were finally determined: wind-cold lung closure, wind-heat lung closure, phlegm-heat lung closure, toxic-heat lung closure, Yin-deficiency lung heat, lung-spleen qi deficiency, damp-heat lung closure, and heat-pathogen lung closure, with the core diagnostic items being 10 to 24, including 3 to 21 primary symptoms and 2 to 17 secondary symptoms. Conclusion This study summarizes the diagnostic items of eight TCM syndrome types of CAP in children, integrating the macroscopic syndrome differentiation of traditional Chinese medicine with the modern microscopic syndrome differentiation, which can provide a basis for the establishment of diagnostic conditions and the construction of diagnostic criteria for the syndrome in the later stage.

Key words: Community-acquired pneumonia, Delphi method, Syndrome, Child

CLC Number:

R725.6

Jinrun LUO, Shiyao ZHANG, Xuefeng WANG, Xiuying ZHANG, Xinran FENG, Yanyan NI, Zhifan TIAN. Expert investigation and research on the common syndrome types and symptoms of CAP in children[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(6): 503-511.

Figures/Tables 14

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Table 7

Table 8

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Table 11

Table 12

Table 13

Consensus diagnostic entries for primary symptoms and secondary symptoms of CAP in children based on a Delphi method expert questionnaire"

证型	主症	次症
风寒闭肺证	日间咳嗽；流清涕；无汗；小便清长；夜间咳嗽；鼻塞；恶寒；痰白；痰清稀；苔薄白；脉浮紧	气促；打喷嚏；头身痛；舌淡红；指纹浮红
风热闭肺证	日间咳嗽；咽红；脉浮数	流浊涕；夜间咳嗽；鼻塞；口渴口干；纳少；痰黄；痰黏稠；睡眠欠佳；中热；大便秘结；少痰；心烦不宁；面红；小便黄；吞咽时咽痛；舌质红；指纹浮紫
痰热闭肺证	痰黄；日间咳嗽；夜间咳嗽；喉间痰鸣；痰黏稠；气促；高热；喘憋；舌质红；苔黄腻；脉滑数；指纹紫滞	纳少；睡眠欠佳；口渴口干；咽红；面红；大便秘结；小便黄；多痰；心烦不宁；烦躁不安；持续发热；夜卧不安
热邪闭肺证	大便秘结；痰黄；痰黏稠；咽红；口渴口干；气促；舌质红	胸闷；心烦不宁；小便黄
毒热闭肺证	高热；喘憋；口渴口干；日间咳嗽；夜间咳嗽；大便秘结；面红；鼻煽；气促；烦躁不安；痰黄；小便黄；痰黏稠；咽红；持续发热；唇绀；舌质红；舌干；舌苔黄；脉洪数；指纹紫滞	睡眠欠佳；胸闷
湿热闭肺证	日间咳嗽；多痰；口中黏腻；气促；夜间咳嗽；身热不扬；纳少；纳呆	喉间痰鸣；痰黏稠；大便溏薄；胸闷；睡眠欠佳；肢体倦怠
阴虚肺热证	干咳；夜间咳嗽；低热；少痰；盗汗；舌苔少；脉细数	日间咳嗽；纳少；睡眠欠佳；大便秘结；口渴口干；舌质红；舌干
肺脾气虚证	神疲乏力；日间咳嗽；咳嗽无力；纳少；咳嗽反复，迁延不愈；自汗；肢体倦怠；舌淡	大便溏薄；气短；多汗；面色白；夜间咳嗽；纳呆；面萎黄；苔薄白；指纹淡红

Table 13

References 30

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判断依据	对专家做出判断的影响程度
判断依据	大	中	小
理论知识	0.3	0.2	0.1
实践经验	0.5	0.4	0.3
参考国内外文献	0.1	0.1	0.1
个人直觉	0.1	0.1	0.1

项目	人数	构成比(%)	项目	人数	构成比(%)
性别			身份
男	7	30.43	硕导	4	17.39
女	16	69.57	博导	19	82.61
年龄（岁）			工作性质
<50	4	17.39	医疗	23	100.00
50～<60	5	21.74	科研	20	86.96
≥60	14	60.87	教学	23	100.00
学历			专业工作年限(年)
本科	3	13.04	10～<20	2	8.70
硕士	6	26.09	20～<30	4	17.39
博士	14	60.87	≥30	17	73.91

证型	W值	χ²值	P值
风寒闭肺证	0.483	355.190	<0.001
风热闭肺证	0.409	414.043	<0.001
痰热闭肺证	0.508	572.385	<0.001
热邪闭肺证	0.334	322.452	<0.001
毒热闭肺证	0.412	379.257	<0.001
湿热闭肺证	0.295	230.980	<0.001
阴虚肺热证	0.516	450.819	<0.001
肺脾气虚证	0.453	364.298	<0.001

证型	均值	满分比	变异系数
风寒闭肺证	4.09	0.61	0.35
风热犯肺证	4.18	0.70	0.37
痰热闭肺证	5.00	1.00	0.00
热邪闭肺证	4.09	0.57	0.37
毒热闭肺证	4.86	0.87	0.07
湿热闭肺证	4.23	0.52	0.24
阴虚肺热证	4.45	0.70	0.23
肺脾气虚证	4.68	0.74	0.14

条目	均值	满分比	变异系数	条目	均值	满分比	变异系数	条目	均值	满分比	变异系数
日间咳嗽	4.57	0.61	0.13	喉间痰鸣	3.26	0.22	0.42	小便量多	3.17	0.17	0.40
流清涕	4.74	0.74	0.09	中热	3.61	0.22	0.34	喘憋	3.52	0.26	0.41
无汗	4.65	0.70	0.12	气促	4.00	0.30	0.25	纳少	3.26	0.22	0.42
小便清长	4.04	0.43	0.25	鼻煽	3.43	0.17	0.39	恶心呕吐	2.74	0.13	0.53
夜间咳嗽	4.26	0.48	0.19	纳呆	3.09	0.09	0.40	头身痛	4.00	0.35	0.26
鼻塞	4.65	0.70	0.12	面色白	3.83	0.39	0.32	苔薄白	4.61	0.74	0.19
恶寒	4.74	0.74	0.09	低热	3.17	0.13	0.41	舌淡红	4.43	0.61	0.21
痰白	4.52	0.65	0.16	反复发热	2.43	0.09	0.64	舌干	1.61	0.00	0.81
痰清稀	4.57	0.70	0.16	持续发热	2.61	0.04	0.59	脉浮紧	4.70	0.74	0.12
睡眠欠佳	3.04	0.13	0.44	夜卧不安	2.70	0.09	0.45	指纹浮红	4.39	0.65	0.26
痰黏稠	2.22	0.09	0.71	打喷嚏	4.17	0.43	0.24	指纹淡红	2.74	0.22	0.63

Expert investigation and research on the common syndrome types and symptoms of CAP in children

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条目	均值	满分比	变异系数	条目	均值	满分比	变异系数	条目	均值	满分比	变异系数
日间咳嗽	4.78	0.83	0.11	少痰	3.61	0.13	0.26	头身痛	3.00	0.13	0.45
流浊涕	4.39	0.61	0.21	心烦不宁	3.48	0.09	0.23	喘憋	2.83	0.04	0.52
夜间咳嗽	4.04	0.43	0.23	喉间痰鸣	3.17	0.13	0.36	痰清稀	1.43	0.04	0.84
恶风	3.87	0.35	0.30	面红	3.87	0.35	0.28	烦躁不安	3.00	0.13	0.40
鼻塞	3.96	0.43	0.28	小便黄	3.91	0.35	0.28	小便量少	2.61	0.04	0.50
口渴口干	4.17	0.48	0.22	胸闷	2.65	0.04	0.48	唇绀	2.39	0.00	0.59
咽红	4.87	0.87	0.07	持续发热	3.43	0.13	0.31	打喷嚏	2.96	0.04	0.39
纳少	3.39	0.09	0.26	低热	2.48	0.00	0.51	舌质红	4.43	0.61	0.20
痰黄	4.26	0.52	0.25	鼻煽	3.22	0.22	0.46	苔薄黄	4.78	0.61	0.30
微有汗出	3.74	0.39	0.37	多汗	2.17	0.00	0.60	苔薄白	4.39	0.09	0.83
痰黏稠	3.87	0.26	0.24	吞咽时咽痛	3.70	0.17	0.26	舌苔黄	4.04	0.17	0.42
睡眠欠佳	3.26	0.00	0.23	纳呆	2.61	0.04	0.38	脉浮数	3.87	0.74	0.12
气促	3.91	0.39	0.34	夜卧不安	3.09	0.17	0.40	脉滑数	3.96	0.04	0.49
中热	4.00	0.35	0.29	反复发热	2.70	0.09	0.49	指纹浮紫	4.17	0.57	0.29
大便秘结	3.70	0.22	0.25	干咳	3.43	0.17	0.35	指纹紫滞	4.87	0.17	0.57

条目	均值	满分比	变异系数	条目	均值	满分比	变异系数	条目	均值	满分比	变异系数
高热	4.17	0.61	0.35	心烦不宁	3.48	0.09	0.29	腹胀	2.83	0.04	0.38
夜间咳嗽	3.70	0.35	0.39	中热	3.43	0.09	0.36	胸痛	2.65	0.04	0.45
面红	3.91	0.48	0.38	多痰	3.26	0.17	0.39	肌肉酸痛	2.83	0.04	0.42
日间咳嗽	4.09	0.48	0.35	喉间痰鸣	3.13	0.13	0.39	舌质红	4.48	0.74	0.26
大便秘结	4.09	0.39	0.28	持续发热	3.74	0.26	0.30	舌淡红	1.74	0.00	0.82
痰黄	4.35	0.65	0.28	小便黄	3.91	0.35	0.30	苔黄	4.09	0.52	0.35
痰黏稠	4.30	0.65	0.29	吞咽时咽痛	3.74	0.35	0.32	苔薄黄	3.30	0.22	0.50
咽红	4.48	0.78	0.27	反复发热	3.26	0.13	0.36	苔黄腻	3.22	0.22	0.49
口渴口干	4.30	0.57	0.27	肢体倦怠	3.13	0.09	0.36	舌干	3.65	0.30	0.38
纳少	3.30	0.09	0.38	鼻塞	2.87	0.00	0.41	脉浮数	3.57	0.43	0.48
微有汗出	3.26	0.09	0.35	鼻煽	3.39	0.17	0.34	脉数	3.57	0.35	0.46
气促	4.09	0.43	0.28	流浊涕	3.48	0.30	0.39	脉滑数	3.13	0.17	0.43
胸闷	3.48	0.13	0.30	唇绀	2.96	0.22	0.51	指纹淡紫	3.26	0.26	0.46
睡眠欠佳	3.26	0.04	0.31	夜卧不安	3.17	0.17	0.38
恶风	2.65	0.09	0.53	纳呆	3.00	0.04	0.33

条目	均值	满分比	变异系数	条目	均值	满分比	变异系数	条目	均值	满分比	变异系数
神疲乏力	4.87	0.87	0.07	夜间咳嗽	4.09	0.43	0.23	肢体倦怠	4.57	0.70	0.16
日间咳嗽	4.70	0.74	0.12	反复发热	2.57	0.09	0.59	胸闷	3.17	0.09	0.40
咳嗽无力	4.78	0.87	0.13	自汗	4.57	0.70	0.17	夜卧不安	2.83	0.13	0.48
低热	3.83	0.43	0.34	痰黏稠	2.65	0.13	0.63	小便清长	3.17	0.22	0.44
纳少	4.52	0.65	0.16	痰白	4.04	0.52	0.33	舌淡	4.65	0.78	0.17
大便溏薄	4.26	0.61	0.29	痰清稀	3.74	0.43	0.37	苔薄白	4.43	0.70	0.26
气短	4.26	0.52	0.24	小便量少	2.39	0.13	0.65	舌淡红	3.35	0.35	0.56
多汗	4.30	0.52	0.20	纳呆	4.26	0.52	0.20	苔白腻	3.61	0.35	0.43
睡眠欠佳	3.65	0.30	0.32	喉间痰鸣	3.52	0.26	0.38	脉细无力	4.17	0.70	0.37
面色白	4.35	0.61	0.24	心烦不宁	2.43	0.09	0.59	指纹淡红	4.43	0.65	0.20
咳嗽反复迁延不愈	4.70	0.78	0.15	气促	2.74	0.09	0.53	脉细数	2.35	0.26	0.87
少痰	3.48	0.26	0.41	面萎黄	4.26	0.48	0.20	舌苔少	1.83	0.13	1.00

条目	均值	满分比	变异系数	条目	均值	满分比	变异系数	条目	均值	满分比	变异系数
干咳	4.83	0.83	0.08	咽红	3.52	0.30	0.39	持续发热	2.13	0.09	0.71
夜间咳嗽	4.65	0.70	0.12	面红	3.22	0.26	0.47	气促	1.74	0.04	0.97
低热	4.48	0.61	0.18	口渴口干	4.09	0.39	0.23	夜卧不安	3.04	0.17	0.51
日间咳嗽	4.04	0.30	0.20	喉间痰鸣	1.61	0.00	0.74	面萎黄	1.91	0.09	0.85
少痰	4.78	0.78	0.09	多汗	3.00	0.17	0.53	肢体倦怠	2.26	0.04	0.72
盗汗	4.52	0.65	0.17	心烦不宁	3.61	0.22	0.34	胸闷	2.00	0.00	0.74
纳少	3.74	0.26	0.27	反复发热	3.22	0.17	0.47	舌质红	4.48	0.70	0.25
睡眠欠佳	3.83	0.30	0.26	小便黄	3.48	0.22	0.35	舌苔少	4.78	0.78	0.09
痰清稀	1.39	0.04	1.01	咳嗽无力	2.87	0.17	0.58	舌干	4.43	0.61	0.24
痰黄	2.78	0.13	0.56	纳呆	2.78	0.04	0.42	脉细数	4.65	0.74	0.15
小便量少	2.61	0.13	0.60	鼻煽	1.65	0.00	0.83	指纹紫滞	2.96	0.22	0.61
痰黏稠	3.22	0.13	0.45	中热	2.22	0.09	0.72	指纹淡红	2.43	0.22	0.75
大便秘结	3.78	0.22	0.25	吞咽时咽痛	2.17	0.04	0.67	脉细无力	3.04	0.35	0.64

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