慢性阻塞性肺疾病合并慢性肺源性心脏病急性加重中医实证关联分析  

Traditional Chinese Medicine excessive pattern correlation analysis of chronic obstructive pulmonary disease complicated acute exacerbation of chronic pulmonary heart disease

作　　者：欧阳银 李永宁 李强 柯尊友[1,2] 陈丽 杨绍星 张春霞 姚惠青[2] 赵永祥[2] 谭烨[2] Ouyang Yin;Li Yongning;Li Qiang;Ke Zunyou;Chen Li;Yang Shaoxing;Zhang Chunxia;Yao Huiqing;Zhao Yongxiang;Tan Ye(Department of Traditional Chinese Medicine,Qinghai University,Xining 810000,China;Pulmonary Disease Department,Qinghai Hospital of Traditional Chinese Medicine,Xining 810000,China)

机构地区：[1]青海大学医学院中医系,西宁810000 [2]青海省中医院肺病科,西宁810000

出　　处：《国际中医中药杂志》2022年第2期138-144,共7页International Journal of Traditional Chinese Medicine

基　　金：青海省自然科学基金(2019-ZJ-983Q);2020年青海省昆仑英才高原名医团队(青卫健办〔2021〕104号)。

摘　　要：目的探讨高海拔环境下COPD合并慢性肺源性心脏病(CPHD)急性加重期中医实证与临床特征的相关性。方法收集2016年12月-2017年11月青海省中医院肺病科COPD合并CPHD急性加重期253例住院患者的相关资料,进行中医辨证,采用多因素logistic回归分析各证型与临床特征及所收集的所有实验室指标的相关性。结果痰饮阻肺证与改良英国MRC呼吸困难指数(mMRC)评分[OR=0.419,95%CI(0.219~0.802),P=0.009]、血清降钙素原(PCT)[OR=8.132×10^(-11),95%CI(1.632×10^(-16)~4.1×10^(-5)),P<0.001]、血红蛋白(Hb)[OR=0.971,95%CI(0.952~0.989),P=0.002]、PaCO[2 OR=0.914,95%CI(0.853~0.980),P=0.011]呈负相关;痰浊阻肺证与性别[OR=0.427,95%CI(0.204~0.892),P=0.024]、Hb[OR=0.960,95%CI(0.945~0.975),P<0.001]呈负相关,与左心室射血分数(LVEF)[OR=1.061,95%CI(1.006~1.118),P=0.028]呈正相关;痰热阻肺证与Hb[OR=0.950,95%CI(0.927~0.974),P<0.001]、心功能分级[OR=0.468,95%CI(0.248~0.881),P=0.019]呈负相关,与PCT[OR=1.118×10^(8),95%CI(1.466×10^(4)~8.523×10^(11)),P<0.001]、血浆D-2聚体(D-D)[OR=2.283,95%CI(1.300~4.010),P=0.004]呈正相关;痰瘀阻肺证与心功能等级[OR=0.309,95%CI(0.167~0.570),P<0.001]呈负相关,与Hb[OR=1.060,95%CI(1.042~1.078),P<0.001]呈正相关;痰湿瘀热证与PCT[OR=1.266×10^(-13),95%CI(1.658×10^(-21)~0.100×10^(-4)),P<0.001]、SaO2[OR=0.934,95%CI(0.892~0.979),P=0.004]、LVEF[OR=0.896,95%CI(0.826~0.971),P=0.008]、D-D[OR=0.030,95%CI(0.002~0.508),P=0.015]呈负相关,与CRP[OR=1.042,95%CI(1.018~1.067),P<0.001]、RBC[OR=3.411,95%CI(1.684~6.910),P<0.001]、心功能分级[OR=8.573,95%CI(2.410~30.504),P<0.001]、肺动脉压差[OR=2.091,95%CI(1.243~3.516),P=0.005]呈正相关。结论男性患者较女性更易出现痰浊阻肺证候;PCT和D-D为痰热阻肺证患者主要危险因素;Hb升高为痰瘀阻肺证患者主要危险因素;心功能分级为痰湿瘀热证患者主要危险因素。Objective To explore the correlation between Traditional Chinese Medicine(TCM)excessive patterns and clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(COPD)complicated with chronic pulmonary heart disease(CPHD)in high altitude environment.Methods Patients with acute exacerbation of COPD complicated with CPHD admitted to the Pulmonology Department of Qinghai Provincial Hospital of Traditional Chinese Medicine from December 2016 to November 2017were selected.Demographic data and clinical medical characteristics data of the patients were collected,and TCM patterns differentiation was conducted.The correlation between each pattern type and clinical characteristics and all collected laboratory indexes were analyzed by multivariate logistic regression.Results Phlegm obstructing lung pattern showed a negative correlation relationship with mMRC score[OR=0.419,95%CI(0.219-0.802),P=0.009],PCT[OR=8.132×10^(-11),95%CI(1.632×10^(-16)-4.1×10^(-5)),P<0.001],Hb[OR=0.971,95%CI(0.952-0.989),P=0.002]andPaCO2[OR=0.914,95%CI(0.853-0.980),P=0.011];turbid phlegmob structing lungpattern showedanegative correlationr elation ship withgender(0male,1female)[OR=0.427,95%CI(0.204-0.892),P=0.024],Hb[OR=0.960,95%CI(0.945-0.975),P<0.001],and there was a positive correlation relationship with LVEF[OR=1.061,95%CI(1.006-1.118),P=0.028];phlegm-heat obstructing lung pattern showed a negative correlation relationship with Hb[OR=0.950,95%CI(0.927-0.974),P<0.001]and cardiac function grade[OR=0.468,95%CI(0.248,0.881),P=0.019],and there was a positive correlation relationship with PCT[OR=1.118×10^(8),95%CI(1.466×10^(4)-8.523×10^(11)),P<0.001]and D-D[OR=2.283,95%CI(1.300-4.010),P=0.004];there was a negative correlation between phlegm and stasis blocking lung pattern with cardiac function grade[OR=0.309,95%CI(0.167-0.570),P<0.001],and there was a positive correlation relationship withHb[OR=1.060,95%CI(1.042-1.078),P<0.001];there was anega tivecorrelationbet ween wetphlegm and blood stasis heat pattern with PCT[OR=

关 键 词：肺疾病 慢性阻塞性 慢性阻塞性肺疾病急性加重 心脏病 慢性肺源性心脏病急性加重 高海拔地区 辨证分型 

分 类 号：R259[医药卫生—中西医结合]