肺结核中医辨证证型与X线影像及痰菌关系的研究

Study of relationship between syndrome differentiation typing in traditional Chinese medicine and X-ray image with sputum examination in pulmonary tuberculosis

目的探讨肺结核中医辨证证型与X线影像及痰菌检查的关系。方法将688例肺结核患者进行中医辨证,分为肺阴亏虚型、阴虚火旺型、气阴两虚型和阴阳两虚型,分析各证型与胸部X线征象和痰中抗酸杆菌的关系。结果688例患者中肺阴亏虚型404例(58.7%),X线影像以小范围的增殖、渗出灶为主;阴虚火旺型204例(29.7%),X线影像见病灶扩大,干酪样病灶和空洞性病灶较其他类型多见;气阴两虚型67例(9.7%),X线示广泛纤维化样病灶发生率较高(47.3%);阴阳两虚型13例(1.9%),见于疾病晚期,肺组织损伤严重者。4型的痰涂片抗酸杆菌阳性率依次是(19.2%,63.1%,13.5%,3.9%),各证型间比较有显著性差异(P<0.01)。结论肺结核中医辨证证型与X线影像及痰中抗酸杆菌存在一定的关系,X线胸片和痰菌检查对肺结核中医辨证分型诊断客观化有一定的参考价值。

Objective It is to approach the relationship between TCM syndrome differentiation typing and X-ray image with sputum examination in pulmonary tuberculosis. Methods According to TCM syndrome differentiation typing, 688 patients were divided into Lung Yin deficiency type, Yin deficiency fire burnt type, both Qi Yin deficiency type and both YinYang deficiency type. The relationship between TCM and X-ray image as well as acid-fast bacillus from sputum specimens was observed. Results 688 cases include： Lung Yin deficiency type in 404（58.7 % ）, the X-ray image was small range multiplication or effusion focus. Yin deficiency fire burnt type in 204（29.6 % ）, the X-ray image that tubercle focus was more extensive than the last type, the cheesy focus （80.6%） and cavity focus （60.2%） were more than the other types. Both Qi Yin deficiency type in 67 （9.7 % ）, the frequency of extensive fibrosis focus was high （47.3 % ）. Both Yin Yang deficiency type in 13 （1.8 % ）, that was appeared disease late, damage of the lung tissue was very serious. Four types sputum smearpositive rate were 19.3 %, 63.1%, 13.6 % and 3.9 % in order. The difference was statistically significant （ P 〈 0.01 ）. Conclusion TCM syndrome differentiation typing is related to X-ray image with sputum examination in pulmonary tuberculosis. X-ray diagnosis and sputum examination was benefit for objective diagnosis of TCM syndrome differentiation typing in pulmonary tuberculosis.