慢性阻塞性肺疾病不同表型中医证型分布规律探讨
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摘要
目的:调查慢性阻塞性肺疾病(COPD)的哮喘-慢阻肺重叠综合征(ACOS)表型和肺气肿表型的中医证型分布规律。方法:按照前瞻性、病例对照的研究方法,选取2015年12月至2017年3月就诊福建中医药大学附属漳州中医院呼吸科门诊与病房的COPD稳定期患者为研究对象,选择符合纳入标准和排除标准的病例共140例,ACOS表型和肺气肿表型各70例。所有患者行肺功能、胸部CT检查,填写中医四诊信息采集表,根据临床特征及中医四诊信息进行表型判断和中医证型的辨证。运用数理统计方法探讨COPD不同表型的中医证型分布规律。结果:ACOS表型以肺脾气虚证为基础证型,多见肺脾气虚兼痰浊阻肺或兼外寒内饮,肺气肿表型证型则以肺肾气阴两虚证为基础证型,多见肺肾气阴两虚兼痰浊瘀肺或兼痰浊阻肺或兼痰热瘀肺。两者的中医证型特征存在明显的差异。结论:ACOS表型和肺气肿表型的中医证型特征存在明显的差异。
Objective: To study the TCM syndromes distribution regularities of asthma chronic obstructive pulmonary disease(COPD) overlap syndrome(ACOS) phenotype and emphysema phenotype. Methods: A prospective, cross-sectional and successional case analysis study was performed. A total of 140 patients with stable COPD who met the inclusion and exclusion criteria were enrolled in Zhangzhou Affiliated TCM Hospital of Fujian University of Traditional Chinese Medicine respiratory outpatient and inpatient from December 2015 to March 2017. There were 70 patients with ACOS phenotype and emphysema phenotype, respectively. All patients underwent lung function test and chest CT scan. The information form of TCM four diagnoses had been filled. The phenotypes and TCM syndromes were identified based on the clinical features and the information of TCM four diagnoses. Mathematical and statistical methods had been used to explore the TCM syndromes distribution regularities in different phenotypes. Results: Qi deficiency of lung and spleen was the basic TCM syndrome in ACOS phenotype. Qi deficiency of lung and spleen accompanied by turbid phlegm obstructing lung or qi deficiency of lung and spleen accompanied by exogenous cold and interior fluid-retention were common TCM syndromes. Deficiency of both qi and yin of lung and kidney was basic TCM syndrome in emphysema phenotype, which mainly manifested as deficiency of both qi and yin of lung and kidney accompanied by accumulation of turbid phlegm and blood stasis obstructing or turbid phlegm obstructing lung or phlegmatic heat and blood stasis obstructing lung. Conclusion: There are significant differences in TCM syndromes between ACOS phenotype and emphysema phenotype.
Objective: To study the TCM syndromes distribution regularities of asthma chronic obstructive pulmonary disease(COPD) overlap syndrome(ACOS) phenotype and emphysema phenotype. Methods: A prospective, cross-sectional and successional case analysis study was performed. A total of 140 patients with stable COPD who met the inclusion and exclusion criteria were enrolled in Zhangzhou Affiliated TCM Hospital of Fujian University of Traditional Chinese Medicine respiratory outpatient and inpatient from December 2015 to March 2017. There were 70 patients with ACOS phenotype and emphysema phenotype, respectively. All patients underwent lung function test and chest CT scan. The information form of TCM four diagnoses had been filled. The phenotypes and TCM syndromes were identified based on the clinical features and the information of TCM four diagnoses. Mathematical and statistical methods had been used to explore the TCM syndromes distribution regularities in different phenotypes. Results: Qi deficiency of lung and spleen was the basic TCM syndrome in ACOS phenotype. Qi deficiency of lung and spleen accompanied by turbid phlegm obstructing lung or qi deficiency of lung and spleen accompanied by exogenous cold and interior fluid-retention were common TCM syndromes. Deficiency of both qi and yin of lung and kidney was basic TCM syndrome in emphysema phenotype, which mainly manifested as deficiency of both qi and yin of lung and kidney accompanied by accumulation of turbid phlegm and blood stasis obstructing or turbid phlegm obstructing lung or phlegmatic heat and blood stasis obstructing lung. Conclusion: There are significant differences in TCM syndromes between ACOS phenotype and emphysema phenotype.
引文
[1]张晓雷,王辰.重视慢性阻塞性肺疾病的筛查与管理.中华健康管理学杂志,2015,9(4):250-253
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[12]Makita H,Nasuhara Y,Nagai K,et al.Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease.Thorax,2007,62(11):932-937
[13]何毅珺.不同表型慢性阻塞性肺疾病治疗应答性差异比较.四川医学,2015,36(7):1010-1013
[14]Jeffery P K.Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease.Proc Am Thorac Soc,2004,1(3):176-183
[15]Han M K,Postma D,Mannino D M,et al.Gender and chronic obstructive pulmonary disease:Why it matters.Am J Respir Crit Care Med,2007,176(12):1179-1184
[16]蔡晓婷,时国朝,万欢英,等.慢性阻塞性肺疾病患者体重指数、呼出气一氧化氮、肺气肿评分分组特征.中国呼吸与危重监护杂志,2013,12(3):223-227
[17]洪敏俐,杨朝阳,柯庚申,等.愈肺宁方对慢性阻塞性肺疾病稳定期患者中医证素的影响.中华中医药杂志,2015,30(5):1666-1669
[18]中华中医药学会内科分会肺系病专业委员会.慢性阻塞性肺疾病中医诊疗指南(2011版).Journal of Traditional Chinese Medicine,2012,53(1):80-84
[19]张玲,李友林.“温润辛金培脾”法治疗支气管哮喘慢性持续期临证撷萃.全国中医药博士生学术交流会暨全国中医药博士生优秀论文颁奖会议,2013:1525-1528
[20]曹华琴.哮喘-COPD重叠综合征(ACOS)中医证候分布初探研究.成都:成都中医药大学,2015
[2]Lee J H,Lee Y K,kim E K,et al.Responses to inhaled long-acting betaagonist and corticosteroid according to COPD subtype.Respir Med,2010(104):542-549
[3]Benzo R,Farrell M H,Chang C C,et al.Integrating health status and survival data:The palliative effect of lung volume reduction surgery.Am J Respir Crit Care Med,2009,180(3):239-246
[4]杨荣源,李际强,刘云涛.浅议慢性阻塞性肺疾病表型研究中体现的中医学辨证理论.新中医,2014,46(7):3-4
[5]慢性阻塞性肺疾病诊治指南(2013年修订版).中国医学前沿杂志(电子版),2014,24(2):67-80
[6]李国安.慢性阻塞性肺疾病临床评估新方法及肺气肿表型的CT肺功能研究.北京:北京协和医学院,2012
[7]黄昕雯,李际强,杨荣源.慢性阻塞性肺疾病临床表型的研究进展.国际医药卫生导报,2013,19(17):2651-2655
[8]Soler-Cataluna J J,Cosio B,Izquierdo J L,et al.Consensus document on the overlap phenotype COPD-asthma in COPD.Arch Bmnconeum,2012(48):331-337
[9]中华中医药学会内科分会肺系病专业委员会.慢性阻塞性肺疾病中医证候诊断标准.中医杂志,2012,53(12):177-178
[10]Han M K,Agusti A,Calverley P M,et al.Chronic obstructive pulmonary disease phenotypes:the future of COPD.Am J Respir Crit Care Med,2010,182(5):598-604
[11]潘明鸣,孙铁英,王辰,等.慢性阻塞性肺疾病治疗反应相关的临床表型分型及其特点.中华结核和呼吸杂志,2013,36(4):293-296
[12]Makita H,Nasuhara Y,Nagai K,et al.Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease.Thorax,2007,62(11):932-937
[13]何毅珺.不同表型慢性阻塞性肺疾病治疗应答性差异比较.四川医学,2015,36(7):1010-1013
[14]Jeffery P K.Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease.Proc Am Thorac Soc,2004,1(3):176-183
[15]Han M K,Postma D,Mannino D M,et al.Gender and chronic obstructive pulmonary disease:Why it matters.Am J Respir Crit Care Med,2007,176(12):1179-1184
[16]蔡晓婷,时国朝,万欢英,等.慢性阻塞性肺疾病患者体重指数、呼出气一氧化氮、肺气肿评分分组特征.中国呼吸与危重监护杂志,2013,12(3):223-227
[17]洪敏俐,杨朝阳,柯庚申,等.愈肺宁方对慢性阻塞性肺疾病稳定期患者中医证素的影响.中华中医药杂志,2015,30(5):1666-1669
[18]中华中医药学会内科分会肺系病专业委员会.慢性阻塞性肺疾病中医诊疗指南(2011版).Journal of Traditional Chinese Medicine,2012,53(1):80-84
[19]张玲,李友林.“温润辛金培脾”法治疗支气管哮喘慢性持续期临证撷萃.全国中医药博士生学术交流会暨全国中医药博士生优秀论文颁奖会议,2013:1525-1528
[20]曹华琴.哮喘-COPD重叠综合征(ACOS)中医证候分布初探研究.成都:成都中医药大学,2015