姚家树 高明利 于静

【摘 要】目的：探究强直性脊柱炎中西医结合医疗质量控制指标的信度与效度。方法：邀请75名相关领域专家、一线医务工作者对《强直性脊柱炎中西医结合医疗质量控制指标专家共识（2021版）》中的9个条目进行测评，并于1周后再次测评和打分。采用克伦巴赫系数（Cronbach's α系数）、重测信度、内容效度、结构效度等统计学方法进行信度和效度全面验证。结果：强直性脊柱炎中西医结合医疗质量控制指标总体Cronbach's α系数為0.804，当删除己项后所有项目Cronbach's α系数范围0.736～0.814;1周后进行再次测评，强直性脊柱炎医疗质量控制指标重测信度相关系数r值范围0.615～0.855（P < 0.05）;内容效度中，条目水平内容效度值（I-CVI）和指标整体内容效度值（S-CVI）均 > 0.800;指标体系整体KMO值为0.724 > 0.05，Bartlett球形检验χ2值为389.676（P < 0.05）;经主成分分析法提取3个初始特征值 > 1的公因子，公因子的方差特征值均 > 0.4，方差贡献率分别为43.465%、19.974%、15.235%，累计方差贡献率为78.674%;以因子载荷 > 0.5作为因子选择标准，其对应因子载荷范围0.789～0.931。结论：强直性脊柱炎中西医结合医疗质量控制指标体系具有较好信度和效度，可更好地规范和指导中西医结合治疗强直性脊柱炎的临床工作。

【关键词】 强直性脊柱炎;医疗质量监控;中西医结合;信度;效度

【ABSTRACT】Objective：To explore the reliability and validity of medical quality control indicators of integrated Chinese and Western medicine for ankylosing spondylitis.Methods：Seventy-five experts in relevant fields and front-line medical workers were invited to evaluate 9 items in The Expert Consensus on Medical Quality Control Indicators of Integrated Chinese and Western Medicine for Ankylosing Spondylitis（2021 Edition），and the items were evaluated and scored again one week later.Statistical methods such as Cronbach's α coefficient，retest reliability，content validity，structural validity were used to comprehensively verify the reliability and validity.Results：The overall Cronbach's α coefficient is 0.804.When all items were deleted，the range of Cronbach's α coefficient was 0.736～0.814;After one week，the range of the retest reliability coefficient r was 0.615～0.855（P < 0.05）;In content validity，the I-CVI and the S-CVI were more than 0.800;The overall KMO value of the index system was 0.724，more than 0.05.Bartlett spherical test χ2 value was 389.676（P < 0.05）;Three common factors with initial eigenvalues（more than 1）were extracted by principal component analysis.The variance eigenvalues of common factors were more than 0.4.The variance contribution rates were 43.465%，19.974% and 15.235% respectively，and the cumulative variance contribution rate was 78.674%;The factor load（over 0.5）was taken as the factor selection standard，and the corresponding factor load range was 0.789～0.931.Conclusion：The medical quality control index system of integrated Chinese and Western medicine for ankylosing spondylitis has good reliability and validity，which can better standardize and guide the clinical work in the treatment of ankylosing spondylitis.

【Keywords】 ankylosing spondylitis;medical quality monitoring;integrated Chinese and Western medicine;reliability;validity

强直性脊柱炎（ankylosing spondylitis，AS）为慢性免疫炎性疾病，我国患病率约0.3%，多见于年轻男性[1]。本病主要累及中轴关节、骶髂关节，常伴椎间盘及周围韧带纤维化、骨性强直，不仅极大影响患者身心健康和生活质量，更对家庭、社会造成较大经济负担[2-3]。AS属中医学“脊痹”“大偻”等范畴，目前，在改善AS临床表现方面中西医结合疗法效果愈发得到肯定，可在保持患者脊柱功能、改善症状、提高生活质量等方面发挥重要作用[4]。……