气管支气管结核中医证型分布特征临床研究  

Clinical correlation of distribution characteristics of traditional Chinese medicine syndromes in tracheobronchial tuberculosis

作　　者：李玲 王涛 陈志 LI Ling;WANG Tao;CHEN Zhi(Department of Tuberculosis Medical,the Eighth Medical Center of Chinese General Hospital,Beijing 100091)

机构地区：[1]中国人民解放军总医院第八医学中心结核医学部,北京100091

出　　处：《河北中医》2024年第3期391-395,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：国家科技重大专项(民口)课题(编号:2018ZX10722-301-005)。

摘　　要：目的探讨气管支气管结核(TBTB)中医证型分布特征及与临床分型等的相关性。方法纳入TBTB患者272例,统计一般情况及中医证型分布;统计比较不同中医证型的TBTB类型、TBTB病灶位置分布、肺泡灌洗液(BALF)涂片荧光染色菌量及BALF病原学检验结果。结果272例TBTB患者,4种中医证型的例数分布、体质量指数(BMI)、年龄比较差异均无统计学意义(P>0.05)。其中在性别构成比上,女性分布高于男性,有显著性差异(χ^(2)=3.859,P<0.001),男女比例约1∶2.4。4个中医证型间TBTB分型存在差异性(P均<0.05),肺阴亏虚型以炎症浸润型为主(32.8%),阴虚火旺型以肉芽增殖型为主(41.7%),气阴两虚型以溃疡坏死型为主(27.3%),阴阳两虚型以瘢痕狭窄型为主(31.4%),管壁软化型、淋巴结瘘型发生率均偏低,均在气阴两虚型中发生率最高。4个中医证型间TBTB分布位置存在差异性(P均<0.05),肺阴亏虚型病灶位于右下叶支气管的比例最多(31.3%),阴虚火旺型病灶位于左主支气管最多(30.6%),气阴两虚型病灶位于左上叶支气管最多(28.8%),阴阳两虚型病灶位于右主支气管最多(30.0%)。抗酸染色菌量由高到低依次为阴阳两虚型>气阴两虚型>阴虚火旺型>肺阴亏虚型。其中肺阴亏虚型与阴虚火旺型比较差异无统计学意义(P>0.05),气阴两虚型、阴阳两虚型与肺阴亏虚型、阴虚火旺型比较差异均有统计学意义(P<0.05,P<0.01),气阴两虚型与阴阳两虚型比较差异有统计学意义(P<0.05),阴阳两虚型痰菌量高于气阴两虚型。4个中医证型GeneXpert阳性率、结核分枝杆菌脱氧核糖核酸(TB-DNA)阳性率、结核分枝杆菌环介导等温扩增技术(TB-LAMP)阳性率、分离培养阳性率两两比较差异均无统计学意义(P>0.05)。结论不同中医证型的TBTB电子支气管镜下表现存在差异性,不仅表现在TBTB类型上,也表现在不同好发位置、菌量表达上,可作为临床辨证及用药参考。Objective To explore the distribution characteristics of traditional Chinese medicine(TCM)syndromes in tracheobronchial tuberculosis(TBTB)and its clinical correlation.Methods A total of 272 TBTB patients were recruited.Their general condition and distribution of TCM syndromes were observed.The distribution of TCM syndromes in TBTB patients with different classification of TBTB were compared.The distribution of TCM syndromes in TBTB patients with different foci were compared.The bronchoalveolar lavage fluid(BALF)staining bacterial smears with fluorescent antibody of TBTB patients with different TCM syndromes were compared.Pathogenic test results of BALF in TBTB patients with different TCM syndromes were compared.Results There were 272 TBTB patients involving 4 types of TCM syndromes.No significant differences in the distribution of 4 types of TCM syndromes,body mass index(BMI)and age were detected among the four groups(P>0.05).The proportion of female TBTB patients was significantly higher than that of males(χ^(2)=3.859,P<0.001),with the male-to-female ratio of 1∶2.4.There was a significant difference in the classification of TBTB among the 4 types of TCM syndromes(P<0.05).TBTB patients with the TCM syndrome type of lung Yin deficiency were mainly categorized into the inflammatory infiltration type(32.8%);those with the TCM syndrome type of Yin deficiency and fire hyperactivity were mainly categorized into the granulation proliferation type(41.7%);those with the TCM syndrome type of deficiency of both Qi and Yin were mainly categorized into the ulcer necrotic type;those with the TCM syndrome type of deficiency of both Yin and Yang were mainly categorized into the scar stenosis type.The proportions of wall softening type and lymph node fistula type were relatively low,which were mainly discovered in TBTB patients with the TCM syndrome type of deficiency of both Qi and Yin.A significant difference was detected in the TBTB classification among patients with 4 types of TCM syndromes(P<0.05).The foci of TBTB patient

关 键 词：结核 气管疾病 支气管疾病 辨证 

分 类 号：R52[医药卫生—内科学] R562.1[医药卫生—临床医学] R562.2R241