隐源性机化性肺炎的中医临床表现、证候及病位特征的回顾性研究  

A retrospective study on clinical manifestations,syndromes and location characteristics of cryptogenic organizing pneumonia in TCM

作　　者：李雪[1] 刘建[1] 刘萌[1] 王玉光[1] LI Xue;LIU Jian;LIU Meng;WANG Yuguang(Department of Respiratory Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院呼吸科,北京100010

出　　处：《北京中医药》2024年第7期754-759,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：首都卫生发展科研专项项目(首发2020-2-2233);高层次公共卫生技术人才建设项目(2022-2-016)。

摘　　要：目的分析隐源性机化性肺炎(COP)患者的中医临床表现、证候及病位特征。方法选择2015年4月—2022年3月首都医科大学附属北京中医医院诊断的COP患者56例,对其中医四诊信息及辨证资料进行回顾性分析。结果56例患者中常规体检时发现的无症状者2例,余首发症状共7种,以咳嗽和喘憋为最常见症状;其次为咳痰,气短和发热。56例患者共涉及21种症状,其中,喘、咳嗽、汗出、咳痰、胸闷和气短为主要症状,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者胸闷比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者汗出、渴而多饮和腰膝酸软比例高(P<0.05,P<0.01)。56例患者中舌淡最多,白苔为最主要舌苔,脉弦和脉滑为最主要脉象,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者中脉弦的比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者中脉弦、脉滑和脉数的比例高(P<0.01,P<0.05)。56例患者中48例为虚实夹杂证,5例为虚证,3例为实证。虚证以气虚为主,其次为阴虚、阳虚。结合脏腑辨证,证候类型出现频率最高的是肺气虚,其次是肾阴虚、脾气虚,出现频率均超过30%。虚证以两证或三证同时出现,主要为肺脾气虚兼夹肾阴虚证和脾气虚兼夹肾阴虚占比较高。实证以寒饮停肺、痰湿阻肺、气郁伤肺和瘀阻肺络为主,出现频率均超过25%。证型组合主要为痰湿阻肺兼夹气郁伤肺和寒饮停肺兼夹瘀阻肺络证。与未合并纤维化患者比较,合并纤维化患者中肾阳虚证、瘀阻肺络证的比例高(P<0.05,P<0.01),气郁伤肺证的比例低(P<0.01);与未服用糖皮质激素的患者比较,服用糖皮质激素的患者肾阴虚证的比例高(P<0.01),肺阳虚证、瘀阻肺络证的比例低(P<0.05)。56例患者病位分布以肺居多,其次为肾、脾和胃。其中,与未服用糖皮质激素患者比较,�Objective To analyze the clinical manifestations,syndromes and location characteristics of cryptogenic organizing pneumonia(COP)in TCM.Methods Four TCM diagnostic information and syndrome differentiation data of the patients diagnosed with COP were collected from April 2015 to March 2022 and a retrospective study was made on them.Results Among 56 patients,2 cases were found during routine physical examination,and the rest had 7 first symptoms,with cough and suffocation as the most common symptoms;then the sputum,shortness of breath and fever.There were 21 symptoms in 56 patients,including wheezing,cough,sweating,expectoration,chest tightness and shortness of breath with the frequency of occurrence more than 50%.The percentage of chest tightness was significantly lower in patients with fibrosis than in patients without fibrosis(P<0.05);The percentage of sweating,thirst and polydipsia,weakness of lower back and knees was significantly higher in patients who took glucocorticoids than in patients who didn’t take glucocorticoids(P<0.05,P<0.01).Among 56 patients,pale tongue is the most common,white coating is the most important,and string-taut pulse and rolling pulse are the most important,with the frequency exceeding 50%.Compared with the patients without fibrosis,the proportion of middle chords in patients with fibrosis was lower(P<0.05).Compared with patients who did not take glucocorticoid,the proportion of pulse string,pulse slip and pulse number in patients who took glucocorticoid was higher(P<0.05,P<0.01).Among 56 cases,48 belong to mixed deficiency and excess syndrome,5 deficiency syndrome,3 excess syndrome.Deficiency syndrome is mainly qi deficiency,followed by yin deficiency and yang deficiency.Combined with syndrome differentiation of zang-fu,the highest frequency of syndrome types is lung qi deficiency,followed by kidney yin deficiency and spleen qi deficiency,with the frequency exceeding 30%.Deficiency syndrome occurred in two or three syndromes at the same time,mainly for lung and spleen deficiency with

关 键 词：隐源性机化性肺炎 症状 证候 病位 糖皮质激素 肺纤维化 

分 类 号：R259[医药卫生—中西医结合]