关键词: 皮炎, 特应性, 血虚, 风燥, 诊断, 评分量表, 证候要素, 层次分析法

Abstract: 【Abstract】 Objective To preliminarily develop a diagnostic scale for atopic dermatitis （AD） with the syndrome of wind dryness due to blood deficiency. Methods A systematic search of Chinese and English databases was conducted to standardize terminology and establish an initial item pool. The Delphi method was applied, involving 3 rounds of expert consultation questionnaires, and core diagnostic items were selected based on criteria including importance scores, full-score ratios, and coefficients of variation. The analytic hierarchy process （AHP） was then used to construct a three-level hierarchical model, calculate the weights of the items, and convert them into corresponding scores, thereby establishing the scoring criteria for the diagnostic scale of AD with the syndrome of wind dryness due to blood deficiency. For clinical validation and optimization, 154 patients with AD were recruited. Diagnoses made independently by 2 experts based on their clinical experience served as the reference standard, while 2 additional physicians scored each patient according to the diagnostic items. Receiver operating characteristic curves were plotted to determine the diagnostic threshold, followed by internal validation. Results A total of 754 articles were initially retrieved through the literature search. After the removal of duplicates and screening of titles and abstracts, irrelevant articles were excluded. Following the full-text review and secondary screening, 32 articles were ultimately included. A total of 37 experts participated in all 3 rounds of consultation, with a mean duration of professional practice of 27 years; 35 （94.6%） held senior professional titles. Regions represented by the experts included East China （n = 13）, South China （n = 2）, Central China （n = 6）, North China （n = 8）, Northwest China （n = 2）, Southwest China （n = 4）, and Northeast China （n = 2）. Through the 3 rounds of expert consultation, 14 core diagnostic items were identified. The three-level hierarchical model was constructed using the AHP, comprising a goal level, a criterion level （3 domains）, and a sub-criterion level （14 items）. Based on the assigned weights, the diagnostic scoring system for AD with the syndrome of wind dryness due to blood deficiency was successfully established, comprising 3 major items （3 points each）, 7 secondary items （2 points each）, and 4 additional items （1 point each）. Receiver operating characteristic curve analysis determined the optimal diagnostic threshold to be 15 points, yielding an area under the curve of 0.859 （95% CI: 0.794 - 0.924）, with a sensitivity of 88.3%, specificity of 89.6%, accuracy of 89.0%, false-positive rate of 10.4%, and false-negative rate of 11.7%. Conclusion The diagnostic scale developed in this study demonstrates good performance in internal validation and clinical feasibility, providing quantitative evidence for the identification of AD with the syndrome of wind dryness due to blood deficiency.

Key words: Dermatitis, atopic, Blood deficiency, Wind dryness, Diagnosis, Rating scale, Symptomatic elements, Analytical hierarchy process