高海拔地区慢性阻塞性肺疾病急性加重期中医证素关联分析  

Correlation Analysis of TCM Pattern Elements and Acute Exacerbation of Chronic Obstructive Pulmonary Disease in High Altitude Area

作　　者：陈丽 欧阳银 杨绍星 李洋 李强[1,2] 杨英琦[1,2] 冯敏 童桂蓉 张春霞 姚惠青[2] 赵永祥[2] 谭烨[1,2] Chen Li;Ouyang Yin;Yang Shaoxing;Li Yang;Li Qiang;Yang Yingqi;Feng Min;Tong Guirong;Zhang Chunxia;Yao Huiqing;Zhao Yongxiang;Tan Ye(Qinghai University,Qinghai,Xining 810000,China)

机构地区：[1]青海大学,青海西宁810000 [2]青海省中医院,青海西宁810000

出　　处：《中国中医急症》2024年第7期1145-1150,共6页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家中医药管理局青年岐黄学者培养项目(国中医药人教函[2022]256号);青海省昆仑英才高原名医团队支持项目。

摘　　要：目的探讨高海拔环境下慢性阻塞性肺疾病急性加重期(AECOPD)中医实证证素与人口学特征和临床医学资料之间的相关性。方法选取2020年10月至2021年9月青海省中医院肺病科住院患者634例,收集患者资料进行中医辨证,从证型提取证素,采用多因素Logistic回归分析各证素与人口学特征和临床医学资料之间的相关性。结果证素痰与血红蛋白(Hb)[OR=0.984,95%CI(0.977~0.992),P<0.001]呈负相关;证素饮与年龄[OR=1.041,95%CI(1.004~1.081),P=0.031]、AE次数[OR=1.288,95%CI(1.032~1.608),P=0.025]、AE时间[OR=1.036,95%CI(1.009~1.064),P=0.010]、肌钙蛋白[OR=1.015,95%CI(1.003~1.028),P=0.014]、IgM[OR=2.655,95%CI(1.317~5.352),P=0.006]呈正相关;证素浊与AE时间[OR=0.918,95%CI(0.857~0.984),P=0.016]、Hb[OR=0.967,95%CI(0.947~0.987),P=0.038]呈负相关,与血氧饱和度(SaO_(2))[OR=1.088,95%CI(1.005~1.179),P=0.002]、C3[OR=21.177,95%CI(2.12~211.517),P=0.009]呈正相关;证素瘀与mMRC(4)[OR=0.127,95%CI(0.019~0.835),P=0.032]、PLT[OR=0.995,95%CI(0.991~0.998),P=0.005]呈负相关,与PaCO_(2)[OR=1.048,95%CI(1.002~1.096),P=0.039]、Hb[OR=1.018,95%CI(1.008~1.027),P<0.001]呈正相关;证素湿与Hb[OR=1.022,95%CI(1.006~1.039),P=0.007]、降钙素原(PCT)[OR=1.802,95%CI(1.056~3.076),P=0.031]呈正相关。结论AECOPD实证证素为:痰>瘀>热>饮>浊>湿,证素以“痰”“瘀”为主。年龄越大、AE次数越多、AE时间越长、肌钙蛋白增高、IgM升高,证素饮出现的可能性较大;SaO_(2)及补体C3升高,证素浊出现的可能性较大,补体C3与证素浊有显著的相关性;PaCO_(2)及Hb升高,证素瘀出现的可能性较大;Hb与PCT同时升高,证素湿出现的可能性较大。Objective:To explore the correlation between TCM pattern elements and demographic characteristics and clinical data in acute exacerbation of chronic obstructive pulmonary disease(COPD)in high altitude area.Methods:A total of 634 in-patients in the Respiratory Department of Qinghai Hospital of TCM from October 2020 to September 2021 were selected.The data of patients were collected,and TCM pattern elements differentiation was performed.Results:There was a negative correlation between TCM sputum pattern element with serum hemoglobin(Hb)[0R=0.984,95%CI(0.977~0.992),P<0.001].There were positive correlations between TCM phlegm-retention pattern element with age[0R=1.041,95%CI(1.004~1.081),P=0.031],AE frequency[OR=1.288,95%CI(1.032~1.608),P=0.025],AE time[OR=1.036,95%CI(1.009~1.064),P=0.010],troponin[OR=1.015,95%CI(1.003~1.028),P=0.014]and IgM[0R=2.655,95%CI(1.317~5.352),P=0.006].There were negative correlations between TCM turbid phlegm pattern element and AE time[0R=0.918,95%CI(0.857-0.984),P=0.016],Hb[0R=0.967,95%CI(0.947~0.987),P=0.038],positive correlation with blood oxygen saturation(Sa02)[0R=1.088,95%CI(1.005~1.179),P<0.002],C3[0R=21.177,95%CI(2.12~211.517),P=0.009].There were negative correlations between TCM stasis pattern element and mMRC(4)[0R=0.127,95%CI(0.019-0.835),P=0.032]and PLT[OR=0.995,95%CI(0.991~0.998),P=0.005],positive correlations with PaCO,[OR=1.048,95%CI(1.002~1.096),P=0.039],Hb[0R=1.018,95%CI(1.008~1.027),P<0.001].There were positive correlations between TCM phlegm-damp pattern element and Hb[0R=1.022,95%CI(1.006~1.039),P=0.007],procalcitonin(PCT)[OR=1.802,95%CI(1.056~3.076),P=0.031].Conclusion:The TCM pattern elements of acute exacerbation of COPD is sputum>stasis>heat>phlegm-retention>turbid phlegm>phlegm-damp,and the main TCM sputum pattern elements were sputum and stasis.The older the age,the more times of AE,the longer the time of AE,the higher troponin and IgM,there is more probability of pattern element of phlegm-retention.With SaO_(2) and C3 increased,there is more possibility of patter

关 键 词：慢性阻塞性肺疾病急性加重期 证素实证 证素病证 高海拔地区 

分 类 号：R563.9[医药卫生—呼吸系统]