稳定期慢性阻塞性肺病患者不同俞穴体表温度变化及相关因素分析

Analysis of Body Surface Temperature Changes in Different Acupoints of Chronic Obstructive Pulmonary Disease Patients at Stable Stage and Related Factors

目的:通过测定不同脏腑虚损COPD患者及健康正常对照组不同俞穴(肺俞、脾俞、肾俞)及督脉的体表温度,发现COPD患者俞穴体表温度的变化规律及可能的影响因素,为COPD的中医药治疗提供依据。方法:纳入COPD稳定期患者148例,其中肺气虚证患者39例,肺脾两虚证者46例,肺肾(肺脾肾)虚证者63例,健康对照组患者49例,采用DT-9875红外热像仪测定各组患者的肺、脾、肾俞及督脉的体表温度,比较各组之间不同俞穴及督脉体表温度差异,并通过相关性分析,找出COPD患者各俞穴体表温度变化的影响因素。结果:(1)将COPD患者肺、脾、肾俞穴体表温度及督脉平均温度与健康对照组比较发现COPD组肺、脾、肾俞及督脉平均温度均显著低于健康对照组。(2)将COPD组患者按照中医脏腑虚损分组后比较不同脏腑虚损COPD患者与健康对照组肺、脾、肾俞及督脉体表温度差异,结果发现肺气虚组、肺脾两虚组、肺肾(肺脾肾)虚组肺、脾、肾俞及督脉平均温度均显著低于健康正常组,而各脏腑虚损组之间未发现显著差异性,但肺俞及督脉皮肤温度有随着脏腑虚损程度加重而逐渐降低的趋势。(3)肺俞部位皮肤温度与患者的吸烟指数、近1年急性加重次数、m MRC评分、CAT评分、中医症状评分呈显著负相关性;与肺功能中FEV1%、FVC%、FEV1/FVC呈正相关性;脾俞部位皮肤温度与患者的吸烟指数、m MRC评分、中医症状评分呈负相关性,与肺功能中FEV1%、FVC%、FEV1/FVC呈正相关性;肾俞部位皮肤温度与m MRC评分、中医症状评分呈负相关性,与肺功能中FEV1%、FVC%、FEV1/FVC呈正相关性;督脉平均温度与吸烟指数、m MRC评分、中医症状评分呈负相关性,与肺功能FEV1%、FVC%、FEV1/FVC呈正相关性。结论:COPD患者肺、脾、肾俞穴及督脉体表温度较健康正常人均显著降低,且温度变化与肺功能、吸烟、症状评分具有相关性,能够从一定程度上反映出疾病的严重程度,同时为中医治疗(外治法)稳定期COPD提供了依据。

Objective： By measuring different surface temperature of different acupoints（lung shu, spleen shu, kidney shu） and du meridian in different viscera deficiency patients with chronic obstructive pulmonary disease（COPD） and healthy control groups, to found the changing laws in surface temperature of acupoint and the possible influencing factors,so as to provide a basis for the TCM treatment of COPD. Methods： 148 patients were included in stable COPD patients,including 39 patients with lung deficiency syndrome, 46 cases with lung and spleen deficiency, 63 cases with（lung,spleen, kidney） deficiency, 49 healthy people as control group. The DT-9875 infrared thermal imager was used to determine the body surface temperature. The difference of different acupoints and the meridian surface temperature in different groups was compared. Through correlation analysis, the various influencing factors of acupoint surface temperature in COPD patients were found out. Results：（1） Comparing the surface temperature of lung shu points, spleen shu points, kidney shu points, and the du meridian between COPD patients and healthy controls, it was found that the surface temperature of lung shu points, spleen shu points, kidney shu points, and the du meridian were significantly lower than that of healthy controls.（2） In accordance with the viscera deficiency, the patients were divided. Comparing the surface temperature of lung shu points, spleen shu points, kidney shu points, and the du meridian in different groups, the results showed that the temperature of lung shu points, spleen shu points, kidney shu points, and the du meridian in lung deficiency group, lung and spleen deficiency group, lung and kidney deficiency group were all significantly lower than that of normal healthy group, and found no significant difference between each viscera deficiency group, but the surface temperature of lung shu points and the du meridian had a trend of reducing by viscera deficiency degree aggravating gradually. There was a significant negative correlation between the skin temperature and the patients＇ smoking index, the incidence of acute exacerbation, m MRC score, CAT score, and TCM symptom score in the lung shu points, and a positive correlation with FEV1%, FVC%, FEV1/FVC in lung function; The skin temperature of the spleen shu points was negatively correlated with the patients′ smoking index, m MRC score and TCM symptom score, and was positively correlated with FEV1%, FVC%, FEV1/FVC in lung function. The skin temperature of kidney shu points was negatively correlated with m MRC score and TCM symptom score, and was positively correlated with FEV1%, FVC%, FEV1/FVC in lung function. The average skin temperature of du meridian was negatively correlated with the smoking index, m MRC score and TCM symptom score, and was positively correlated with FEV1%, FVC%, FEV1/FVC in lung function.Conclusion： The surface temperature of lung shu points, spleen shu points, kidney shu points, and the du meridian were significantly lower than that of healthy control group. The temperature changes were associated with lung function,smoking, symptom scores, which reflects the severity of the disease to certain extent. It also provide a basis for the treatment of traditional Chinese medicine especially external treatment for stabilization of COPD.