中医治疗老年社区获得性肺炎的研究策略与实践

Research strategies and practice for the TCM treatment of elderly people with community-acquired pneumonia

文章基于近年中医药治疗老年社区获得性肺炎(CAP)主要研究进展结合作者的研究实践,就有关工作进行总结并对相关问题展开讨论。主要包括病机研究的"衰老积损、热毒损肺"理论的提出,证候分类与诊断标准的制定,疗效评价中的文献评价和疗效的实证研究,诊疗指南的研究,疗效评价指标体系的建立与测评工具的研制,模型的建立与机制探讨包括内毒素损伤模型与应用和细菌性肺炎模型与应用及痰热壅肺CAP的病证结合模型建立与应用等。有关中医治疗老年CAP研究应着重4点:病机研究、证候学研究是突出个体化辨证治疗的理论基础,应着眼于基于疾病变化规律而完善证候学内容的规范/标准并达到共识,注重老年患者的特点;疗效评价及评价方法研究为获取高质量证据的保障,既要遵循国际公认的方法又要注重突出中医治疗优势评价方法的研究与应用;诊疗指南制定与应用为临床研究成果转化提供了指导,应结合不同实际因素(地域、气候等)而不断完善或基于指南而制定适宜的临床诊疗路径;有关模型的建立与应用及有关药理学研究等应用基础研究将为探讨作用机制、研究开发新药、优化治疗方法/方案提供依据,应结合中医药的疗效特点和临床应用的实际而注重有关方法学研究。

Based on the research progress of TCM for elderly people with community-acquired pneumonia（CAP） and the author’s study practice,the paper made a summary and discussion on the work-related issues of CAP,included the proposal of the ＂accumulation of aging damage and pyretic toxicity damage on the lung＂ pathogenesis hypothesis,the establishment of the syndrome classification and diagnostic criteria,the study of curative effect evaluation,the research of the diagnosis and treatment guidelines,the development of the curative effect evaluation index system and the assessment tools,the build of the animal model and the discussion of mechanism.There were four key points that should be pay attention for the treatment of elderly people with CAP by TCM： The studies of pathogenesis and syndrome were the theoretical basis for individual syndrome differentiation and treatment,it should be focus on change regular pattern of the disease to improve the standard of the contents of syndrome,it also should pay attention to the characteristics of the elderly patients;the study of curative effect evaluation and its methods should not only follow the internationally recognized method but also highlight the advantages of TCM evaluation method and application,which were the guarantee of getting high quality evidence;the study of the formulation and application of the diagnosis and treatment guidelines should combine different actual factors（regional,climate,etc.） for continuous improvement,or formulate appropriate clinical diagnosis path by using the guidelines,which provided guidance for the transformation of clinical research achievements;the build and application of the animal model should combine characters of TCM evaluation with practical and useful methodology,which provided the basis for exploring the action mechanism,developing new drugs,optimizing treatment methods or study protocol.