慢性阻塞性肺疾病稳定期证候及证候要素分布特点的临床研究

Distribution characteristics of TCM syndromes and syndrome factors of COPD in stable stage

目的探索慢性阻塞性肺疾病(COPD)稳定期常见中医证候、证候要素的分布特点。方法通过多中心临床流行病学调查,采集COPD稳定期患者四诊信息及经验辨证的相关数据,对数据进行描述性统计分析。结果共收集病例774例,经验辨证证候类型有269个,证候类型经名称规范后为155个,其中常见(出现率>1%,下同)的证候有20个;在证候规范基础上,提取病位类证候要素10个,常见病位类证候要素是肺、肾、脾,病性类证候要素16个,常见病性类证候要素是痰、气虚、火(热)、血瘀、阴虚、阳虚。结论 COPD稳定期患者经验辨证名称表述存在不规范问题;其证候表现类型可概括为以肺肾脾的气虚、阴虚为主的虚证;以肺中痰、湿(浊)、热、瘀相互搏结为主的实证;以肺肾气虚+痰热壅肺为主的虚实夹杂证。从证候要素角度来研究COPD稳定期证候具有执简驭繁的优势。

Objective To investigate the distribution characteristics of common TCM syndromes and syndrome factors of chronic obstructive pulmonary disease（COPD） in stable stage.Methods The data related to the information of four examinations and syndrome differentiation based on experiences were collected from the patients with COPD in stable stage through multicenter,clinical and epidemiological survey.The data were analysed with descriptive statistics.Results There were 774 cases collected,among them there were 269 pattern types of syndrome differentiation based on experiences.After standardization of names,there were 155 pattern types,of them,there were 20 common syndromes（with the occurrence rate over 1%,similarly hereinafter）.On the basis of syndrome standardization,there were 10 syndrome factors of disease location extracted and common ones were lung,kidney and spleen.There were 16 syndrome factors of disease nature extracted and common ones were phlegm,qi deficiency,fire（heat）,blood stasis,yin deficiency and yang deficiency.Conclusion There are nonstandard descriptions in the names of syndrome differentiation based on experiences in the patients with COPD in stable stage.The pattern types can be summed up as qi deficiency taking deficiency of lung-qi,kidney-qi and spleen-qi as principal ones,deficiency syndrome taking yin deficiency as principal one,excess syndrome taking phlegm,dampness（turbidity）,heat and stasis intertwined with each other in lung as principal ones,and mixture syndrome of deficiency and excess taking deficiency of lung-qi and kidney-qi combined with phlegm-heat obstructing lung as principal ones.It is advantageous to study the syndromes of COPD in stable stage from the angle of syndrome factors.