侵袭性肺部真菌感染的中医证候学特征与转归

Chinese medicine syndrome characteristics and prognosis of invasive pulmonary fungal infections

目的探讨侵袭性肺部真菌感染(IPFI)的中医证候学特征与转归,为进一步中西医结合治疗IPFI提供可靠的依据。方法对详细采集的104例IPFI患者中医四诊资料进行分析总结,判断其确诊时的中医证候,并用SPSS 20.0软件包进行统计学分析。结果 (1)IPFI多发于75岁以上的老年人,常患有多种基础疾病,长期反复使用广谱抗菌药物,常使用糖皮质激素及免疫抑制剂等。(2)中医症状表现为咳嗽,痰色白,痰液黏稠或呈拉丝状,咯痰不易,喘息,胸闷,咽干,口渴,气短懒言,神疲乏力,纳呆,寐差,便秘,小便短赤等。舌象以舌红,舌苔黄腻、少苔或无苔为主。脉象以弦、滑、细、数为主。(3)IPFI的证候分布以痰热壅肺证和气阴两虚证为主。证候分布与患者的年龄及性别无相关性。(4)IPFI的转归与证候分布具有相关性,热陷心包证的预后最差。结论 IPFI具有其独特的证候学特征,其转归与确诊时的中医证型相关;在病原学证据尚不足阶段通过详辨其证候特征,综合施治IPFI,有望提高疗效。

Objective To explore the Chinese medicine syndrome characteristics and prognosis of invasive pulmonary fungal infections（ IPFI）,thus to provide reliable basis for further treatment of intergrated Chinese and western medicine.Methods The four diagnosis data of 104 patients with IPFI were analysed and the Chinese medicine syndrome were judged.SPSS 20.0 were used to conduct statistical analysis.Results（1）IPFI always happened in the elderly over the age of 75,who often suffered from a variety of basic diseases and used of broad spectrum antibiotics repeatedly for a long time,as well as glucocorticoids or immunosuppressants.（2） The main symptoms of IPFI were cough,white,thick or filamentous sputum,difficult to cough up,wheezing,chest tightness,dry throat,thirst,short breath and disinclination to talk,spiritlessness and weakness,poor appetite,insomnia,constipation,scanty dark urine,et al.The color of tongue was red,and the coating was yellow greasy,less or no moss.The pulse was taut,slippery,stringer and rapid.（3）The common syndromes of IPFI were syndrome of phlegm-heat obstructing in lung and syndrome of deficient of both qi and yin,and the syndrome distributions had no relationship with age and gender.（4）The prognosis of IPFI had great relationship with syndrome,and the prognosis of heat invading pericardium syndrome was the worst.Conclusion IPFI has unique characteristics of syndromes,its prognosis have relationship with TCM syndrome types.Based on the syndrome characteristics,and integrated Chinese and western medicine could improve the curative effect.