重症社区获得性肺炎患者中医临床证候分布规律研究  

Distribution of Clinical Traditional Chinese Medicine Syndromes in Patients with Severe Community-acquired Pneumonia

作　　者：张晨曦 关胜男 谢凯 张康 王海峰[2,3] ZHANG Chenxi;GUAN Shengnan;XIE Kai;ZHANG Kang;WANG Haifeng(Henan University of Chinese Medicine,Zhengzhou 450000,China;Department of Respiratory Medicine,the First Affiliated Hospital of Henan University of CM,Zhengzhou 450000,China;Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province&Education Ministry of P.R.China,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学,河南省郑州市450000 [2]河南中医药大学第一附属医院呼吸科,河南省郑州市450000 [3]呼吸疾病中医药防治省部共建协同创新中心,河南省郑州市450000

出　　处：《中国全科医学》2022年第21期2640-2645,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81774222,82074411);国家中医药科学研究重大专项(20-21ZYZD04);河南中医药科学研究专项课题(拔尖人才)(2019ZYBJ05);2022年度河南省高校科技创新团队支持计划(22IRTSTHN029)。

摘　　要：背景重症社区获得性肺炎(SCAP)病情进展迅速,具有病死率高、并发症多、经济负担重等问题,尽管临床诊疗方案不断优化,其发病率和死亡率仍高居不下,目前中医药治疗SCAP具有显著的临床疗效,但尚未建立规范化的临床诊疗方案,缺乏对SCAP的临床证型分布规律的研究。目的研究SCAP的临床中医症状特征,探讨其中医证型分布规律,为临床诊治提供思路和依据。方法选取2012年12月至2021年3月河南中医药大学第一附属医院呼吸科住院的SCAP患者为研究对象,汇总其症状、体征,采用SPSS 26.0软件对数据进行因子分析和聚类分析。结果共纳入166例患者,其中男119例,女47例,男女比例2.53∶1;平均年龄(70.1±15.8)岁,整理病例后得出13种不同的证型,痰热壅肺证所占比例较高为34.33%(57/166),咳嗽、咳痰症状涵盖了50%以上患者。对症状和体征进行因子分析共选取出12个公因子,累计方差贡献率达62.842%。通过聚类分析将公因子聚为4类,分别是痰热壅肺证、邪陷正脱证、气阴两虚证、痰湿阻肺证4个主要的SCAP临床分型。结论SCAP患者男性比例较大,临床证型以痰热壅肺证、邪陷正脱证、气阴两虚证、痰湿阻肺证4个证型为主。Background Severe community-acquired pneumonia(SCAP)progresses rapidly,with high mortality,multiple complications,and heavy economic burden.Despite the continuous improvement of clinical diagnosis and treatment programs,its morbidity and mortality remain high.Traditional Chinese Medicine(TCM)has proven its significant clinical efficacy in treating SCAP,but there is still no a standardized TCM-based clinical diagnosis and treatment protocol for SCAP,and insufficient research on the distribution of clinical TCM syndromes of SCAP.Objective To study the characteristics and distribution of clinical TCM symptoms of SCAP,providing ideas for clinical diagnosis and treatment of SCAP.Methods SCAP inpatients were recruited from Department of Respiratory Medicine,the First Affiliated Hospital of Henan University of CM from December 2012 to March 2021.Their symptoms and signs were summarized.Factor analysis and cluster analysis were performed on the data using SPSS Statistics(version 26.0).Results One hundred and sixty-six patients were included,including 119 men and 47 women,the ratio is 2.53∶1,with an average age of(70.1±15.8)years old.Altogether,13 TCM syndromes were summarized,among which phlegm-heat obstructed lung syndrome had a high prevalence〔34.33%(57/166)〕;cough and expectoration were prevalent in more than 50%of the patients.Twelve common factors were obtained by factor analysis of TCM symptoms,explaining 62.842%of the total variance.By cluster analysis,the common factors were clustered into four major categories:phlegm-heat obstructed lung syndrome,xiexian-zhengtuo syndrome,qi-yin deficiency syndrome,and phlegm-damp obstructed lung syndrome.Conclusion Men is accounting for a larger percentage of SCAP.Clinical TCM syndromes of SCAP mainly include phlegm-heat obstructed lung syndrome,xiexian-zhengtuo syndrome,qi-yin deficiency syndrome,and phlegm-damp obstructed lung syndrome.

关 键 词：社区获得性肺炎 证候 肺疾病 因素分析 统计学 聚类分析 

分 类 号：R563.1[医药卫生—呼吸系统]