实验室指标对慢性阻塞性肺疾病急性加重期中医证候的鉴别作用  

Differentiation of TCM syndrome in acute exacerbation of COPD by laboratory indexes

作　　者：张鹏[1] 徐佳[1] 刘文娟[1] 樊茂蓉[2] 何沂[2] 王雅平[1] 吴晶[1] 张何锐 孙合乐 李琦[1] ZHANG Peng;XU Jia;LIU Wen-juan;FAN Mao-rong;HE Yi;WANG Ya-ping;WU Jing;ZHANG He-rui;SUN He-yue;LI Qi(Department of Clinical Laboratory,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Pulmonary Diseases,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Bejing 100091;College of Medical Laboratory,Hebei North University,Zhangjiakou 075000)

机构地区：[1]中国中医科学院西苑医院检验科,北京100091 [2]中国中医科学院西苑医院肺病科,北京100091 [3]河北北方学院医学检验学院,张家口075000

出　　处：《北京中医药》2023年第2期208-213,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：北京市海淀区卫生健康发展科研培育计划(HP2022-30-504001)。

摘　　要：目的观察慢性阻塞性肺疾病急性加重期(AECOPD)患者中医证候与检验指标的相关性,并探讨检验指标鉴别证候的诊断价值。方法收集2018年11月―2020年8月在中国中医科学院西苑医院肺病科就诊符合AECOPD诊断标准的患者1693例,其中接受血常规、凝血功能及血生化指标检测者分别为642、580、471例。依照中医辨证分型,痰热蕴肺证接受血常规、凝血功能及血生化指标检测者分别为331、306、254例;痰瘀互结证接受血常规、凝血功能及血生化指标检测者分别为116、104、92例;肺脾肾虚证接受血常规、凝血功能及血生化指标检测者分别为195、170、125例。比较AECOPD3种中医证候患者血常规、凝血功能及血生化指标的变化,绘制受试者工作特征(ROC)曲线,评价所观察指标在不同证候中的诊断性能。结果痰热蕴肺证淋巴细胞计数(Lym#)和总蛋白(TP)高于肺脾肾虚证(P<0.05),肺脾肾虚证红细胞体积分布宽度CV(RDW-CV)、红细胞体积分布宽度SD(RDW-SD)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、B型钠尿肽前体(NT-pro BNP)高于痰热蕴肺证(P<0.05);痰瘀互结证红细胞平均体积(MCV)、RDW-SD、D-D、NT-pro BNP、尿酸(UA)高于痰热蕴肺证(P<0.05),痰热蕴肺证平均血红蛋白浓度(MCHC)高于痰瘀互结证(P<0.05);痰瘀互结证MCV、UA高于肺脾肾虚证(P<0.05)。在痰热蕴肺证和肺脾肾虚证进行比较时,Lym#+RDW-CV+RDW-SD、APTT+D-D、TP+NT-pro BNP曲线下面积(AUC)分别是0.608、0.585、0.585,灵敏度分别为81.3%、73.5%、78.0%,特异度分别为35.4%、43.5%、37.6%;在痰热蕴肺证和痰瘀互结证进行比较时,MCV+MCHC+RDW-SD、D-D、UA+NT-pro BNP的AUC分别是0.606、0.574、0.629,灵敏度分别为73.4%、65.4%、72.8%,特异度分别为46.6%、53.8%、46.7%;在痰瘀互结证和肺脾肾虚证进行比较时,MCV、UA的AUC分别是0.571、0.588,灵敏度分别为30.2%、60.9%,特异度分别为83.6%、56.0%。结论Lym#、TP、RDW-CV�Objective To observe the correlation between different TCM syndrome types and laboratory indexes in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),and explore its differential diagnosis value for different TCM syndrome types.Methods A collection of 1693 patients(642 cases received blood routine test,580 cases received coagulation test,471 cases received biochemical test)who met the diagnostic criteria for acute exacerbation of COPD in the Department of Pulmonology,Xiyuan Hospital,China Academy of Chinese Medical Sciences from November 2018 to August 2020,were divided into 3 groups according to syndrome differentiation of TCM,namely,phlegm-heat accumulating in the lung group of 331,306 and 254 cases received blood routine,coagulation and biochemical test,phlegm-blood stasis accumulating group of 116,104 and 92 cases received blood routine,coagulation and biochemical test,and lung,spleen and kidney deficiency group of 195,195 and 125 cases received blood routine,coagulation and biochemical test.The blood routine,coagulation and biochemical indicators in patients with acute exacerbation of COPD of three groups were compared,the receiver’s operating characteristic(ROC)curve were drawn,and the diagnostic performance of the observed indicators in different syndromes was evaluated.Results Lym#and TP in the phlegm-heat accumulating in the lung group were higher than those in the lung-spleen-kidney deficiency group(P<0.05),RDW-CV,RDW-SD,APTT,D-D,NT-pro BNP in the lung-spleen-kidney deficiency group were higher than those in the phlegm-heat accumulating in the lung group(P<0.05);MCV,RDW-SD,D-D,NT-pro BNP and UA in the phlegm-blood stasis accumulating group were higher than those in the phlegm-heat accumulating in the lung group(P<0.05),and the phlegm-heat accumulating in the lung group had higher MCHC than the phlegm-blood stasis accumulating group(P<0.05);MCV and UA of the phlegm-blood stasis accumulating group were higher than those of the lung,spleen and kidney deficiency group(P<0.05)

关 键 词：慢性阻塞性肺疾病急性加重期 中医证候 实验室指标 

分 类 号：R259[医药卫生—中西医结合]