慢性阻塞性肺疾病不同表型中医证型分布规律探讨

Study on the traditional Chinese medicine syndromes distribution regularity of COPD different phenotypes

目的:调查慢性阻塞性肺疾病(COPD)的哮喘-慢阻肺重叠综合征(ACOS)表型和肺气肿表型的中医证型分布规律。方法:按照前瞻性、病例对照的研究方法,选取2015年12月至2017年3月就诊福建中医药大学附属漳州中医院呼吸科门诊与病房的COPD稳定期患者为研究对象,选择符合纳入标准和排除标准的病例共140例,ACOS表型和肺气肿表型各70例。所有患者行肺功能、胸部CT检查,填写中医四诊信息采集表,根据临床特征及中医四诊信息进行表型判断和中医证型的辨证。运用数理统计方法探讨COPD不同表型的中医证型分布规律。结果:ACOS表型以肺脾气虚证为基础证型,多见肺脾气虚兼痰浊阻肺或兼外寒内饮,肺气肿表型证型则以肺肾气阴两虚证为基础证型,多见肺肾气阴两虚兼痰浊瘀肺或兼痰浊阻肺或兼痰热瘀肺。两者的中医证型特征存在明显的差异。结论:ACOS表型和肺气肿表型的中医证型特征存在明显的差异。

Objective： To study the TCM syndromes distribution regularities of asthma chronic obstructive pulmonary disease（COPD） overlap syndrome（ACOS） phenotype and emphysema phenotype. Methods： A prospective, cross-sectional and successional case analysis study was performed. A total of 140 patients with stable COPD who met the inclusion and exclusion criteria were enrolled in Zhangzhou Affiliated TCM Hospital of Fujian University of Traditional Chinese Medicine respiratory outpatient and inpatient from December 2015 to March 2017. There were 70 patients with ACOS phenotype and emphysema phenotype, respectively. All patients underwent lung function test and chest CT scan. The information form of TCM four diagnoses had been filled. The phenotypes and TCM syndromes were identified based on the clinical features and the information of TCM four diagnoses. Mathematical and statistical methods had been used to explore the TCM syndromes distribution regularities in different phenotypes. Results： Qi deficiency of lung and spleen was the basic TCM syndrome in ACOS phenotype. Qi deficiency of lung and spleen accompanied by turbid phlegm obstructing lung or qi deficiency of lung and spleen accompanied by exogenous cold and interior fluid-retention were common TCM syndromes. Deficiency of both qi and yin of lung and kidney was basic TCM syndrome in emphysema phenotype, which mainly manifested as deficiency of both qi and yin of lung and kidney accompanied by accumulation of turbid phlegm and blood stasis obstructing or turbid phlegm obstructing lung or phlegmatic heat and blood stasis obstructing lung. Conclusion： There are significant differences in TCM syndromes between ACOS phenotype and emphysema phenotype.