慢性阻塞性肺疾病营养不良中医证候的临床研究

Clinical Research on TCM Syndromes of Chronic Obstructive Pulmonary Disease Malnutrition

目的:探讨慢性阻塞性肺疾病(COPD)营养不良中医证候规律。方法:采用中医临床流行病学研究的科学方法,制定"慢性阻塞性肺疾病患者中医证候调查表",对符合纳入标准的病例进行分析、归纳,总结其中医证候规律。结果:COPD营养不良急性加重期(120例)单一证候共36例,占30%;复合证候共84例,占70%;单纯实证38例,占31.67%,单纯虚证23例,占19.17%,虚实夹杂证59例,占49.17%。COPD营养不良稳定期(105例)中单一证候共21例,占20.00%;复合证候共80例,占76.19%,常见复合证候为肺脾气虚证、肺肾亏虚证、脾肾阳虚证;单纯实证12例,占11.88%,单纯虚证60例,占59.41%,虚实夹杂证29例,占28.71%。无论急性加重期,还是稳定期,涉及脾虚、脾胃不和证候居多,达50%之多,常与它证相兼存住。结论:COPD营养不良急性加重期证候以复合证候为主,多表现为虚实夹杂证;稳定期以虚证为主,以两两兼证居多,多表现为肺脾气虚证、肺肾亏虚证、脾肾阳虚证。脾虚、脾胃不和在COPD营养不良发生、发展具有重要意义。

Objective： To observe the syndromes of chronic obstructive pulmonary disease （COPD） malnutrition. Methods ： The TCM syndromes questionnaire of chronic obstructive pulmonary disease was formulated by the TCM scientif- ic clinical epidemiology methods. The laws of TCM syndromes for the cases met the inclusion criteria were summarized and analyzed. Results： In the acute exacerbation of COPD malnutrition （120 cases）, the single syndromes were 36 cases, accounting for 30% ;the composite syndromes ~ere 84 cases, accounting for 70% ;the simple excess syndromes were 38 cases, accounting for 31.67% ;the simple deficiency syndromes were 23 cases, accounting for 19.17% ;the intermingled deficiency and excess syndromes were 59 cases, accounting for 49.17%. In the stable of COPD malnutrition （ 105 cases） , the single syndromes were 21 cases, accounting for 20.00% ; the composite syndromes were 80 cases, accounting for 76.19%, in which the lung qi deficiency accompanied by spleen qi deficiency syndromes, the lung qi deficiency accompa- nied by kidney qi deficiency syndromes and the spleen yang deficiency accompanied by kidney yang deficiency syndromes were the main syndromes. The simple excess syndromes were 12 cases, accounting for 11.88% ;the simple deficiency syndromes were 60 cases ,accounting for 59.41% ;the intermingled deficiency and excess syndromes were 29 cases, ac- counting for 28.71%. Both acute exacerbation and stable period,the spleen deficiency and incoordination between the spleen and the stomach syndromes were as much as 50%, usually accompanied by other syndromes. Conclusion： The composite syndromes and the intermingled deficiency and excess syndromes are main in the acute exacerbation of COPD malnutrition. The deficiency syndromes and two syndrome combinations are the main syndromes in the stable of COPD malnutrition. The common syndromes are lung - spleen qi deficiency syndrome,lung - kidney deficiency syndrome and spleen - kidney yang deficiency syndrome. The spleen deficiency and incoordination between the spleen and the stomach syndromes are very important to the occurrence and development in COPD malnutrition.