慢性阻塞性肺疾病稳定期痰瘀证候特点及血液流变学、血浆D-二聚体变化研究

Research of Chronic Obstructive Pulmonary Disease Characteristics of Such Syndromes and Changes in Blood Rheology,Plasma D-dimer

目的：分析COPD稳定期痰瘀证候的特点,初步探索＂肺络微型症瘕＂辨证依据,以及COPD＂肺络微型症瘕＂形成的理化指标。方法：收集COPDⅠ-Ⅲ级稳定期患者各30例,收集四诊信息,测定相关指标。分析COPD痰瘀证候特点、血浆D-二聚体、血液流变学（血沉、全血黏度）分别与COPD严重程度、肺功能、血气分析的相关性,血浆D-二聚体与血液流变学的相关性。结果：（1）88例中,痰瘀证诊断病例66例（67.04%）;（2）痰瘀症状发生频数由大到小的顺序为舌下络脉粗张（88.6%、）、咯痰（87.5%）、舌质紫黯（82.9%、）、胸闷如窒（67.05%）等,并随着COPDⅠ-Ⅲ级,出现频次逐渐增加;（3）COPDⅠ-Ⅲ级之间全血黏度（1-150 s）,D-二聚体差异有统计学意义（P〈0.05）;（4）全血黏度（1-150 s）与FEV1、Pa O2呈负相关（P〈0.05）,与Pa CO2呈正相关（P〈0.05）;（5）血浆D-二聚体与FEV1、Pa O2呈负相关（P〈0.05）,与Pa CO2呈正相关（P〈0.05）,与全血黏度（1、10、150 s）呈正相关（P〈0.05）。结论：（1）舌下络脉粗张、咯痰、舌质紫黯、胸闷如窒可初步作为肺络微型症瘕形成的辨证依据;（2）D-二聚体、全血黏度可初步作为＂肺络微型症瘕＂形成的参考理化指标。

Objective：Preliminary explore＂pulmonary collaterals mini Zheng jia＂dialectical basis and COPD＂pulmonary collaterals mini Zheng jia＂physical and chemical indicators of the formation,by analyzing the syndromes characterized of stable COPD. Methods：Collect 30 cases of patients with stable of COPDⅠ-Ⅲ and collect their four diagnostic information related indicators measured. Analyze the syndromes characterized of stable COPD,and the correlation among plasma D-dimer,blood rheology（erythrocyte sedimentation rate,blood viscosity）the severity of COPD,pulmonary function,blood gas analysis,and the correlation between plasma D-dimer and blood rheology. Results：（1）There are 88 cases Selected,which 59 cases of diagnosed cases of phlegm and blood stasis,accounting for 67.04%.（2）The crude sublingual,expectoration,dark purple tongue,chest tightness total incidence are as high as 88.6%,87.5%,82.9%,67.05%.（3）There are different index among D-dimer,whole blood viscosity（1-150 s）.And the difference was statistically significant（P〈0.05）.（4）Whole blood viscosity（1-150 s）and FEV1,Pa O2 was negatively correlated（P〈0.05）,the wheezing extent,Pa CO2 was positively correlated（P〈0.05）.（5）D-dimer and FEV1,Pa O2 was negatively correlated（P〈0.05）. And wheezing extent,Pa CO2 was positive correlation（P〈0.05）. And whole blood viscosity（1 s,10 s,150 s）was positive correlation（P〈0.05）. Conclusion：（1）Crude Sublingual,expectoration,dark-purple tongue used as the objective indications of COPD phlegm and blood stasis syndrome differentiation may also be as the pulmonary collaterals micro Zheng Jia formed.（2）D-dimer,whole blood viscosity can be initially the physical and chemical indicators of the＂pulmonary collaterals mini Zheng Jia＂.