肺结节临床症状及中医证候分布特征  

Clinical symptoms and distribution characteristics traditional Chinese medicine syndromes of pulmonary nodules

作　　者：李玥 张馨月 何姝霖 赵元辰[3] 刘瑞[2] 花宝金[2] LI Yue;ZHANG Xin-yue;HE Shu-lin;ZHAO Yuan-chen;LIU Rui;HUA Bao-jin(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Department of Oncology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Respiratory Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院广安门医院肿瘤科,北京100053 [3]中国中医科学院广安门医院呼吸科,北京100053

出　　处：《中国中药杂志》2023年第17期4782-4788,共7页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金项目(82274609,82074338,82174465);国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-C-202205);中国中医科学院科技创新工程项目(CI2021A01810,CI2021B009)。

摘　　要：采用横断面研究综合2种辨证方式,采用χ2检验、系统聚类与Apriori算法关联分析,从肺结节数量、大小、性质、稳定性等角度研究肺结节患者临床症状及中医证候分布特征。结果显示,肺结节常见临床症状为乏力(77.35%)、烦躁(75.40%),将40个症状聚类可得3个症状组(消化系统症状、呼吸系统症状、情志及全身症状)、8个主要症状群。寒热辨证方面,寒热错杂证(63.43%)占比更高;病性辨证方面,证候分型前2位的是气虚证(88.03%)、气郁证(83.17%),阳虚证(60.52%)多于阴虚证(50.16%);肺结节数量方面,孤立性肺结节痰证(78.67%)、阳虚证(69.33%)占比更高;肺结节大小方面,随肺结节平均直径增大,痰证占比减少,而阳虚证、血瘀证占比增加,平均直径<10 mm者气郁证分布多(85.02%,P=0.044),平均直径≥10 mm者寒证分布多(16.67%,P=0.024);肺结节性质方面,伴随肺结节实性成分增多,气郁证与热证占比减少,阴虚证与寒热错杂证占比升高,血瘀证在含实性成分的结节中占比更高;肺结节稳定性方面,肺结节进展者湿证(72.97%)、血瘀证(37.84%)、寒热错杂证(70.27%)占比更高,新发结节者气逆证(52.00%,P=0.007)、寒热错杂证(66.00%,P=0.008)占比更高。同时,关联11个证候,得到4个常见复合证型(气虚气郁证、气郁痰凝证、气虚痰凝证、气虚湿阻证),其中气虚证、气郁证与其他证候均存在关联。结果表明,肺结节主要临床症状以乏力、烦躁为主,主要证候以气虚证、气郁证、阳虚证、寒热错杂证为主,证候分布特点与肺结节大小、有无新发结节具有显著相关性,常见复合证型为气虚气郁证、气郁痰凝证、气虚痰凝证、气虚湿阻证。A cross-sectional study method combined with two types of traditional Chinese medicine(TCM)syndrome differentiation methods was adopted to investigate the clinical symptoms and distribution characteristics of TCM syndromes in patients with pulmonary nodules from the perspectives of number,size,nature,and stability of pulmonary nodules by using theχ~2 test,systematic clustering and Apriori algorithm correlation analysis.The common clinical symptoms of pulmonary nodules were fatigue(77.35%)and irritability(75.40%),and 40 symptoms were clustered into 3 groups(digestive system symptoms,respiratory system symptoms,and emotional and systemic symptoms)and 8 major symptom categories.The proportion of cold and heat in complexity syndrome(63.43%)was higher based on cold-heat syndrome differentiation.The top two syndromes were Qi deficiency syndrome(88.03%)and Qi depression syndrome(83.17%)based on disease syndrome differentiation.Yang deficiency syndrome(60.52%)was more than Yin deficiency syndrome(50.16%).There were higher proportions of phlegm syndrome(78.67%)and Yang deficiency syndrome(69.33%)of so-litary pulmonary nodules in terms of the number of pulmonary nodules.In terms of size,the proportion of phlegm syndrome decreased as the mean diameter of pulmonary nodules increased,while the proportions of Yang deficiency syndrome and blood stasis syndrome increased.The distribution of Qi depression syndrome was more in those with mean diameter<10 mm(85.02%,P=0.044)and cold syndrome was more in those with mean diameter≥10 mm(16.67%,P=0.024).In terms of the nature of pulmonary nodules,the proportions of Qi depression syndrome and heat syndrome decreased with the increase in solid components of pulmonary nodules,while the proportions of Yin deficiency syndrome and cold and heat in complexity syndrome increased.The blood stasis syndrome accounted for a higher proportion of pulmonary nodules with solid components.In terms of the stability of pulmonary nodules,dampness syndrome(72.97%),blood stasis syndrome(37.84%),and cold a

关 键 词：肺结节 证候 病性辨证 寒热辨证 临床症状 

分 类 号：R259[医药卫生—中西医结合]