支气管哮喘不同分期证素演变规律研究

Evolution Rule of Syndrome Elements on Different Stages of Bronchial Asthma

目的探讨支气管哮喘不同分期证素的分布情况及演变规律。方法以16家中医院支气管哮喘患者为研究对象,制定支气管哮喘中医临床调查表,采用现场问卷形式,收集患者人口学资料及中医证型情况,从辨证结果中提取证素并建立数据库,分别统计患者急性发作期、慢性持续期、临床缓解期病性及病位证素分布情况,并对不同分期各证素构成比进行比较。结果发放调查表2500份,回收2481份,有效2428份。1273例急性发作期患者共提取病性证素11个,总频次为2902,出现频率前3位依次为痰(54.12%)、寒(42.11%)、饮(42.11%);病位证素6个,总频次为1304,出现频率前3位依次为肺(71.09%)、脾(14.06%)、肾(8.09%)。586例慢性持续期患者共提取病性证素11个,总频次为1407,出现频率前3位依次为气虚(59.73%)、痰(42.32%)、寒(42.32%);病位证素6个,总频次为998,出现频率前3位依次为肺(89.08%)、脾(41.98%)、肾(30.72%)。569例临床缓解期患者共提取病性证素10个,总频次为843,出现频率前3位依次为气虚(72.58%)、阳虚(16.70%)、阴虚(13.88%);病位证素5个,总频次为833,出现频率前3位依次为肺(70.65%)、脾(40.42%)、肾(29.53%)。与急性发作期比较,慢性持续期病性证素中热的构成比显著降低,气虚构成比显著升高;病位证素中脾、肾构成比升高(P<0.05或P<0.01)。与急性发作期比较,临床缓解期病性证素中痰、寒、饮、热的构成比显著降低,气虚、阳虚的构成比显著升高;病位证素中脾、肾构成比升高(P<0.05或P<0.01)。与慢性持续期比较,临床缓解期病性证素中痰、寒构成比均降低,气虚构成比升高(P<0.05或P<0.01)。结论支气管哮喘急性发作期病性证素以痰、寒、饮、热为主,病位以肺为主;慢性持续期病性证素以痰、寒、气虚为主,病位以肺、脾、肾为主;临床缓解期病性证素以气虚、阳虚为主,病位以肺、脾、肾为主;血瘀贯穿始终。

Objective To explore the distribution and evolution rule of syndrome elements on different stages of bronchial asthma. Methods Bronchial asthma patients in 16 TCM hospitals were included. Make clinical questionnaire of bronchial asthma,and collect demographic data and Traditonal Chinese medicine（ TCM） syndrome of patients. Extract syndrome elements from syndrome differentiation results and establish data base. Make statistics of patients＇ syndrome elements distribution of nature and location of disease on acute attack,chronic persistent stage and clinical remission respectively. Compare constituent ratio of all syndrome elements on different stages. Results There were 2500 questionnaires given out,2481 taken back and 2428 valid. Extract 11 syndrome elements of disease nature from 1273 patients on acute attack. Total frequency was 2902. Top three syndrome elements were phlegm（ 54. 12%）,cold（ 42. 11%） and fluid（ 42. 11%）. Extract 6 syndrome elements of disease location. Total frequency was 1304. Top three location were lung（ 71. 09%）,spleen（ 14. 06%） and kidney（ 8. 09%）. Extract 11 syndrome elements of disease nature from 586 patients on chronic persistent stage. Total frequency was 1407. Top three were Qi deficiency（ 59. 73%）,phlegm（ 42. 32%） and cold（ 42. 32%）. Extract 6 syndrome elements of disease location.Total frequency was 998. Top three were lung（ 89. 08%）,spleen（ 41. 98%） and kidney（ 30. 72%）. Extract 10 syndrome elements of disease nature from 569 patients on clinical remission. Total frequency was 843. Top three were Qi deficiency（ 72. 58%）,Yang deficiency（ 16. 70%） and Yin deficiency（ 13. 88%）. Extract 5 syndrome elements of disease location. Total frequency was 833. The top three were lung（ 70. 65%）,spleen（ 40. 42%） and kidney（ 29. 53%）. Compared to acute attack,about syndrome elements of disease nature,constituent ratio of heat decreased and that of Qi deficiency increased on chronic persistent stage; about syndrome elements of disease location,constituent ratio of spleen and kidney increased（ P〈0. 05 or P〈0. 01）. Compared to acute attack,about syndrome elements of disease nature,constituent ratio of phlegm,cold,fluid and heat decreased and that of Qi and Yang deficiency increased on clinical remission; about syndrome elements of disease location,constituent ratio of spleen and kidney increased（ P〈0. 05 or P〈0. 01）. Compared to chronic persistent stage,about syndrome elements of disease nature,constituent ratio of phlegm and cold decreased and that of Qi deficiency increased on clinical remission（ P〈0. 05 or P〈0. 01）. Conclusion Syndrome elements of disease nature on acute attack of bronchial asthma were mainly phlegm,cold,fluid and heat; disease location was mainly lung. On chronic persistent stage,syndrome elements of disease nature were mainly phlegm,cold and Qi deficiency; disease locations were mainly lung,spleen and kidney. On clinical remission,syndrome elements of disease nature were mainly Qi and Yang deficiency;disease locations were mainly lung,spleen and kidney. Blood stasis ran through the whole course.