발표논문

제목 [기능성 소화불량증] 기능성 소화불량증 환자에게서 혀의 coating을 정량적으로 측정하는 설진 기계 연구: 임상 연구
기능성 소화불량증 환자에게서 혀의 coating을 정량적으로 측정하는 설진 기계 연구: 임상 연구
Tongue diagnosis system for quantitative assessment of tongue coating in patients with functional dyspepsia: A clinical trial
저자 김주연, 한가진, 고석재, 남동현, 박재우, 류봉하, 김진성
저널명 ournal of Ethnopharmacology
Volume 155, Issue 1, 8 August 2014, Pages 709-713
게재일 2014.08.08.
논문소개
-초록정리
Ethnopharmacological relevance : Tongue diagnosis is a significant procedure to examine the physiological and pathological changes of the human body in oriental medicine. However, the conventional method of tongue diagnosis including direct observation of tongue has limitations because of various external factors and subjective factors. Therefore, the current study investigated the usefulness of the tongue diagnosis system (TDS) as a diagnostic tool for evaluating tongue coating thickness (TCT) by assessing the agreement between the TDS and a gold standard established by assessors using the conventional method.

Materials and methods : The present study was designed as a prospective clinical trial including 60 patients with functional dyspepsia. The TDS was used to capture tongue images twice within a 30-min interval to assess its reproducibility. Tongue coating percentage was measured by the TDS, and TCT was classified as either no coating, thin coating, or thick coating according to the existing diagnostic criteria. After both TDS examinations, the weight of tongue coating was quantitatively measured, and the correlation between the actual quantity of tongue coating and the percentage of the coating measured by the TDS was analyzed using Pearson's correlation. After collecting tongue images in all 60 patients, tongue coating was evaluated using a conventional method by 5 well-trained assessors to establish the gold standard for evaluating TCT, which allowed us to assess the diagnostic agreement between the TDS and the gold standard. After 2 weeks, TCT evaluation was repeated by the same assessors using the same images but in a random order.

Results : The agreement between the TDS and the gold standard for evaluating TCT was almost perfect (weighted kappa, 0.840), as was the reproducibility of the TDS (weighted kappa, 0.851). The percentage of tongue coating measured by the TDS was significantly correlated with the weight of tongue coating (r=0.442, p <0.001). The levels of intra-rater reliability ranged from substantial to almost perfect (range of weighted kappa, 0.777-0.923). The inter-rater reliability of 5 assessors was moderate (weighted kappa, 0.563).

Conclusions : The present study demonstrated that the TDS can be used as a diagnostic tool for the objective and standardized evaluation of TCT in actual clinical practice.
페이지 URL http://www.sciencedirect.com/science/article/pii/S0378874114004589
연구가 가지는 의의 설진은 한의학의 중요한 진단 도구 중의 하나로서 수천년 한의학 역사 속의 많은 고서들에게서 찾아볼 수 있지만 그 주관성으로 많은 논란이 되어 왔다. 하지만 그 색감이나 형태가 정량화하기 힘들어 객관성과 재현성에 대한 본격적인 연구는 없는 실정이다. 본 연구는 혀의 코팅상태를 촬영하여 정량적으로 분석한 다음 수치화를 하는 TDS라는 기계를 이용하여 설진의 객관화, 정량화를 시도한 연구이다. 본 논문은 비록 일부분이기는 하지만 한의학의 주관적 전유물로만 여겨져 왔던 설진을 일부 정량화하는데 성공하여 앞으로 한의 진단의 새로운 국면을 열었다는 데에 의의를 가지고 있다.

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