【目的】采用文献研究、专家主观经验评价及数理统计分析三者结合以构建寻常型银屑病脾虚湿蕴证的诊断标准。【方法】 通过文献研究构建寻常型银屑病脾虚湿蕴证相关症状、体征备选条目池，运用德尔菲法对全国32位专家进行4轮问卷调查，分析专家对各备选条目意见的集中程度及协调程度。第三轮调查根据各条目的权重系数将诊断指标分为主症及次 症，形成多个证候诊断判断条件选项，再通过第四轮专家调查，明确脾虚湿蕴证的诊断模式及诊断条件。 【结果】根据专家意见集中程度、变异系数对各证候诊断备选条目进行筛选，经同类合并，形成诊断指标24个，形成主症3个 （纳呆食少、便溏、舌淡胖边有齿印） ，次症21个 （如腹胀、口淡不渴、形体肥胖、嗜睡、倦怠乏力、脉细滑、脉濡、大便完谷不化、皮损颜色淡红等） 。第四轮专家调查确认了“病位脾”“病性气虚”“病性湿”为诊断的必要条件；银屑病脾虚湿蕴证的诊断条件确定为： （1） 具有3个主要症状； （2） 具备2个主要症状+任2个次要症状。 【结论】所构建的寻常型银屑病脾虚湿蕴证的诊断标 准包含主症及次症，条件要求明确，易于临床操作，具有较好的临床适用性。

Objective To establish the diagnostic criteria for psoriasis vulgaris of spleen deficiency with dampness accumulation syndrome by using the methods of literature research，subjective experts’experience evaluation and mathematical statistical analysis together. Methods An alternative item pool of symptoms and signs related to psoriasis vulgaris of spleen deficiency with dampness accumulation syndrome was constructed on the basis of the results of literature research. A four-round questionnaire survey was carried out among 32 experts nationwide using the Delphi method，and then the concentration and coordination of the experts’opinions on each of the alternative items were analyzed. In the third round of the survey，all of diagnostic indicators were classified into primary or secondary symptoms according to the weighting coefficients of each item，and then the judgment condition options for the diagnostic criteria of the symptoms were formed. Through the fourth-round of expert survey，the diagnostic mode and diagnostic conditions of spleen deficiency with dampness accumulation syndrome were clarified. Results The alternative diagnostic indicators were screened according to the concentration degree and the variation coefficient of experts’ opinions，and 24 diagnostic indicators were obtained after merging the similar indicators，of which there were three primary symptoms （poor appetite and anorexia，loose stool，and pale and swollen tongue with tooth marks） and 21 secondary symptoms （abdominal distension，tastelessness in the mouth without thirst，obesity，drowsiness，fatigue and lack of strength，thready and smooth pulse，soft pulse，undigested food in the stool，and light-red skin lesions，etc.） . The fourth-round expert survey confirmed that the necessary conditions for the diagnosis of psoriasis vulgaris of spleen deficiency with dampness accumulation syndrome were “the disease-location of the spleen”，“the disease-nature of qi deficiency” and “the disease-nature of dampness”； the diagnostic criteria for psoriasis of spleen deficiency with dampness accumulation syndrome were as follows： （1） with three primary symptoms； （2） with two primary symptoms and any two of the secondary symptoms. Conclusion The diagnostic criteria for psoriasis vulgaris of spleen deficiency with dampness accumulation syndrome constructed in this study include both primary and secondary symptoms，with clarified conditions and being easy to be practiced clinically，and have good clinical credibility.

R275.9

国家自然科学基金联合基金重点项目 （编号：U20A20397）；广州市科技计划项目 （编号：2024A03J0726）；省部共建中医湿证国家重点实验室项目 （编号：SZ2021ZZ02，SZ2021ZZ0201）