间质性肺病不同中医证型胸部HRCT评分差异及临床意义

The Difference of Chest HRCT Score in Different TCM Syndromes of Interstitial Lung Disease and its Clinical Significance

目的探讨间质性肺疾病(ILD)中医证型的胸部高分辨率CT(HRCT)评分差异及其临床意义。方法回顾性分析具有完备的四诊资料且均行胸部HRCT的644例ILD的临床资料。根据弥漫性间质性肺病(DILD)诊断标准(2012年版)中医辨证为痰浊阻肺证、痰热蕴肺证、阴虚内热证、肺气虚证、肺肾气虚证、肺肾气阴两虚证及血瘀证7个证型,根据Salvatore等介绍的方法对胸部HRCT影像学表现进行评分,比较不同证型HRCT评分差异,并根据结果分析其临床意义。结果ILD患者中医证型频次最高的为痰热蕴肺证,其次为血瘀证、痰浊阻肺证、肺肾气虚证、肺肾气阴两虚证、肺气虚证,频次最低的为阴虚内热证。ILD的7个中医证型中肺肾气阴两虚证的HRCT得分最高。结论ILD中肺肾气阴两虚证影像学病变最严重。

Objective To study the difference of chest HRCT score and its clinical significance in TCM syndromes of interstitial lung disease.Methods We retrospectively analyzed the clinical data of 644 patients with interstitial lung disease with complete four diagnosis data and chest HRCT.According to the diagnostic criteria for diffuse interstitial lung disease(2012 edition),the TCM syndromes are phlegm turbid obstructive lung syndrome,phlegm heat accumulation lung syndrome,yin deficiency internal heat syndrome,lung qi deficiency syndrome,lung and kidney qi deficiency syndrome,lung and kidney qi and yin deficiency syndrome,and Seven syndrome types of blood stasis syndrome.The HRCT imaging performance of the chest was scored according to the method introduced by Salvatore Mary,etc.The HRCT scores of different syndrome types were compared,and their clinical significance was analyzed according to the results.Results The highest frequency of TCM syndromes in patients with interstitial lung disease is phlegm-heat accumulation lung syndrome,followed by blood stasis syndrome,phlegm turbid obstruction lung syndrome,lung-kidney deficiency syndrome,lung-kidney deficiency syndrome,and lung-qi deficiency syndrome The lowest frequency is heat deficiency syndrome.The seven types of TCM syndromes of interstitial lung disease have the highest HRCT scores in the deficiency of lung,kidney,qi and yin.Conclusion In interstitial lung disease,the most serious imaging lesions are lung Kidney Qi Yin deficiency.