慢性阻塞性肺疾病稳定期中医证型与合并症的关系探讨  

The Associations between Syndromes of Traditional Chinese Medicine and Comorbidity in Patients with Chronic Obstructive Pulmonary Disease at Stable Phase

作　　者：李官红 付娟娟[2] 郑玉琼[1] 吴丽华 瞿波 毛兵[2] LI Guan-hong;FU Juan-juan;ZHENG Yu-qiong;WU Li-hua;QU Bo;MAO Bing(Respiratory and Critical Care Medicine Ward 1,Chengdu of Hospital Integrated TCM&Western Medicine,Chengdu,610041;Department of Integrated Traditional Chinese and Western Medicine,West China Hospital,Sichuan University,Chengdu,610041;Department of Emergency and Critical Care,Sichuan Integrative Medicine Hospital,Chengdu,610042;Department of Senior Cadres,Affiliated Hospital of Chengdu University of Tradition-al Chinese Medicine,Chengdu,610075)

机构地区：[1]成都市中西医结合医院呼吸与危重症医学科一病区,成都610041 [2]四川大学华西医院中西医结合科,成都610041 [3]四川省中西医结合医院急危重症科,成都610042 [4]成都中医药大学附属医院老年干部科,成都610075

出　　处：《中国中西医结合杂志》2020年第5期567-574,共8页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：四川省科技厅支撑计划(No.2015SZ0130,No.2013SZ0001-5);四川省人事厅学术带头人培育基金[No.(2014)120号]。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)稳定期患者中医证型演变规律及各证型与合并症的关系。方法收集220例COPD稳定期患者,调查其临床资料、统计合并症情况,计算查尔森合并症指数(CCI),进行中医辨证分型,探讨各证型与临床症状及合并症的关系。结果随着从肺气虚证—肺脾气虚证—肺肾气虚证—肺脾肾气虚证—气阴两虚证证型演变,COPD患者年龄逐渐增高、体重指数(BMI)逐渐下降,气阴两虚证与肺气虚证比较差异有统计学意义(P<0.05);上一年急性加重次数逐渐增多,肺肾气虚证、气阴两虚证与肺气虚证比较差异有统计学意义(P<0.05);第1秒用力呼气容积(FEV1)、第1秒用力呼气量占预计值百分比(FEV1%)逐渐下降,肺肾气虚证、肺脾肾气虚证、气阴两虚证低于肺气虚证(P<0.05);改良版英国医学研究委员会呼吸问卷(mMRC)、慢阻肺患者自我评估测试问卷(CAT)评分逐渐升高,肺肾气虚证、肺脾肾气虚证、气阴两虚证显著高于肺气虚证(P<0.05);医院焦虑抑郁情绪测量表(HAD)评分亦逐渐升高,但各证型间比较差异无统计学意义(P>0.05);合并症种类增多,CCI逐渐升高,肺脾肾气虚证、气阴两虚证显著高于肺气虚证(P<0.05)。结论随着COPD患者病情的进展,中医证型随之表现为由肺气虚证—肺脾气虚证—肺肾气虚证—肺脾肾气虚证—气阴两虚证演变,临床症状逐渐加重,合并症逐渐增加,提示COPD的中医证型演变与临床症状、合并症有一定关联性。Objective To observe the development laws of chronic obstructive pulmonary disease(COPD)patients at stable phase,and the association between syndromes of traditional Chinese medicine(TCM)and clinical symptoms and co-morbidities.Methods Totally 220 stable COPD patients were collected.Clinical data were investigated and types of comor-bidities were recorded.Charlson comorbidity index(CCI)was calculated and TCM syndrome was differentiated.The associa-tion between each syndrome and comorbidities was analyzed.Results Along with the evolution of TCM syndrome[from Fei qi deficiency syndrome(FQDS)—Fei-Pi qi deficiency syndrome(FPQDS)—Fei-Shen qi deficiency syndrome(FSQDS)—Fei-Pi-Shen qi deficiency syndrome(FPSQDS)—qi-yin deficiency syndrome(QYDS)],age of COPD patients increased gradually and body mass index(BMI)decreased gradually.There was statistical significance between QYDS and FQDS(P<0.05).The frequency of acute exacerbation in the previous year increased gradually,and there was statistical significance between FSQDS/QYDS and FQDS(P<0.05).The forced expiratory volume in one second(FEV1)and forced expiratory volume in the first second of expiration(FEV1%)gradually decreased,and they were worse in FSQDS/FPSQDS/QYDS than in FQDS(P<0.05).The scores of modified Medical Research Council scale(mMRC)and COPD Assessment Test(CAT)gradually increased,and they were higher in FSQDS/FPSQDS/QYDS than in FQDS(P<0.05).The score of Hospital Anx-iety and Depression scale(HAD)gradually increased,but there was no statistical difference among 5 syndromes(P>0.05).The spectrum of comorbidities and CCI increased gradually,and they were significantly higher in FPSQDS/QYDS than in FQDS(P<0.05).Conclusions Along with the progressing of COPD,the TCM syndromes evolved from FQDS to FPQDS,FSQDS,FPSQDS to QYDS,clinical symptoms were gradually aggravated,and the comorbidities gradually increased.These findings suggested that there was a positive association between the evolution of TCM syndromes of COPD and clinical symptoms and comorbiditie

关 键 词：慢性阻塞性肺疾病 稳定期 中医证型 合并症 

分 类 号：R259[医药卫生—中西医结合]