慢性阻塞性肺疾病稳定期脏虚与肺功能关系的临床观察

Relationship between zang-deficiency and lung function of chronic obstructive pulmonary disease at stable stage

目的探讨慢性阻塞性肺疾病(COPD)稳定期的中医脏虚证候与肺功能第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)、第1秒用力呼气容积实测值占预计值百分比(FEV1%)及严重程度分级的关系。方法将95例符合诊断标准的COPD稳定期患者按照证候表现分为单肺虚(25例)、两脏虚(肺脾两虚15例、肺肾两虚18例)、三脏虚(肺脾肾虚37例)3组,以中医证型为导向,同步检测肺功能,观察该证型与肺功能的相关关系。结果 3组FEV1/FVC及FEV1%之间的差别具有显著性的意义(P<0.001),单肺虚组指标高于两脏虚组和三脏虚组(均P<0.001),两脏虚组指标高于三脏虚组(均P<0.001)。3组在CODP严重程度分级中的分布差别亦具有显著性的意义(P<0.001),单肺虚组轻于两脏虚组、三脏虚组(P<0.01,P<0.001),两脏虚组轻于三脏虚组(P<0.01)。结论 COPD稳定期以肺脾肾虚为本,涉及脏腑从肺及脾,由脾及肾,且受累脏腑及病变程度亦随着FEV1/FVC及FEV1%预计值的下降、COPD分级降低而逐渐增多、加重,故应强调早期综合治疗。

Objective To discuss the relationship between TCM syndromes of zang-deficiency and lung function（FEV1/FVC and FEV1%） and severity grading of chronic obstructive pulmonary disease（COPD） at stable stage.Methods The patients of COPD at stable stage（n=95） were divided into the group of lung deficiency（n=25）,group of two-zang-deficiency（15 cases of lung-spleen deficiency and 18 of lung-kidney deficiency）,and group of three-zang-deficiency（37 cases of lung-spleen-kidney deficiency） according to patients＇ syndrome manifestations.The lung function oriented by TCM syndrome types was detected synchronously and the correlation between TCM syndrome types and lung function was observed.Results The differences in FEV1/FVC and FEV1% among three groups were significant（P0.001）.The indexes in the group of lung deficiency were higher than those in the group of two-zang-deficiency and group of three-zang-deficiency（all P0.001）.The indexes in the group of two-zang-deficiency were higher than those in the group three-zang-deficiency（all P0.001）.The distribution differences in COPD severity grading among three groups were significant（P0.001）.The severity in the group of lung deficiency was milder than that in the group of two-zang-deficiency or the group of three-zang deficiency（P0.01,P0.001）,and that in the group of two-zang-deficiency was milder than that in the group of three-zang-deficiency（P0.01）.Conclusion The syndromes in COPD at stable stage are mainly lung-spleen-kidney deficiency,and the involved zang-viscera are from lung to spleen,and then from spleen to kidney.The number of involved zang-viscera will increase along with the decreases of predicted value of FEV1/FVC,FEV1% COPD grading,and the pathological changes will become more serious.Early synthetical treatment should be paid more attention to.