慢性阻塞性肺疾病稳定期中医证候分布规律与GOLD2017综合评估的相关性探讨

Correlation Between Distribution of TCM Syndromes and Gold2017 Comprehensive Assessment in Stable Period of Chronic Obstructive Pulmonary Disease

目的:探讨慢性阻塞性肺疾病(COPD)稳定期GOLD2017综合评估与证候分布规律的关系。方法:收集2017年6月—2018年1月期间COPD稳定期患者共189例,调查其一般资料并进行GOLD2017分级,统计分析COPD稳定期GOLD2017分级与证候分布之间的关系。结果:189例患者13种证候,以虚证居多。虚证类证候以肺肾气虚(17. 96%)和肺脾肾气虚(15. 87%)最多,实证类证候以痰瘀阻肺(15. 87%)、血瘀证(13. 47%)和痰湿阻肺(12. 57%)最多。肺气虚证患者CAT较低、m MRC较低,急性发作次数少,综合评估分布于各组;肺脾气虚证患者CAT增高、m MRC增高,急性发作次数相对增多,综合评估主要分布于B组和D组;肺肾气虚、肺脾肾气虚、阳虚水泛证患者CAT高、m MRC高,急性发作次数多,综合评估主要分布于D组;肺肾气阴两虚患者CAT高、急性发作次数多,虽然m MRC相对肺脾气虚稍低,但综合评估主要分布于D组。5组实证类患者虽然CAT、m MRC,急性发作次数,各有不同,总体以痰湿阻肺、痰热壅肺证较低,痰瘀阻肺、血瘀证、痰热瘀肺证较高,但综合评估都主要集中在D组;兼夹血瘀的患者明显在各类评估中高于兼夹痰湿、痰热的患者;痰热壅肺证患者综合评估差异不明显。结论:肺气虚贯穿于COPD稳定期的始终,症状相对较少,风险小,预后相对较好,但亦会出现明显加重趋势;肺脾气虚证患者症状较多,急性加重次数相对较多,提示风险相对较高,如不积极控制预后不佳;肺肾气虚、肺脾肾气虚、阳虚水泛、肺肾气阴两虚证患者患者病情重,风险高,预后不佳;脾气虚、肾气虚是影响病情严重程度的关键因素。兼夹痰湿、血瘀、热邪各类实邪的患者,都有临床症状加重、呼吸困难程度加重、急性发作增多的趋势,患者病情重,风险高,预后不佳;血瘀是影响病情严重程度的主要兼夹因素;痰热壅肺证病情严重程度不明显,有可能是患者病情加重的始动因素。

Objective: To investigate the relationship between the comprehensive evaluation of GOLD2017 and the distribution of syndrome in the stable period of chronic obstructive pulmonary disease( COPD). Methods: A total of 189 COPD stable patients from June 2017 to January 2018 were collected,and their general data and GOLD2017 grading were investigated. The relationship between GOLD2017 classification and syndrome distribution in COPD stable phase was statistically analyzed. Results: There were13 syndromes in 189 cases,most of which were deficiency syndrome. Syndrome of deficiency syndrome was mainly lung and kidney Qi deficiency( 17. 96%) and lung spleen kidney Qi deficiency( 15. 87%). Syndrome type was mainly phlegm stasis and lung obstruction( 15. 87%),blood stasis syndrome( 13. 47%) and phlegm dampness obstructing lung( 12. 57%). The CAT and m MRC of patients with Qi deficiency were lower. The number of acute attack was less. CAT of patients with lung spleen deficiency syndrome was relatively higher,m MRC increased relatively. The relative increase in comprehensive evaluation mainly distributed in B group and D group. Lung and kidney Qi deficiency,lung Qi deficiency of spleen and kidney,Yangpang water syndrome CAT and m MRC were the highest. The highest frequency of acute attack of the most comprehensive assessment was mainly distributed in the D group. Although the relative m MRC of lung and spleen deficiency syndrome was slightly lower,the comprehensive evaluation was mainly distributed in the D group. Among 5 groups,though CAT and m MRC also had different times of acute attack,generally characterized by phlegm dampness,phlegm heat obstructing lung syndrome and phlegm and stasis blocking lung,blood stasis syndrome,phlegm heat stasis syndrome. However,the comprehensive evaluation was mainly concentrated in D group. The patients with blood stasis were obviously higher than those with phlegm dampness and phlegm fever in all kinds of evaluation. Conclusion:The lung Qi throughout the stable phase of COPD has relatively few symptoms and the risk is small. It has relatively good prognosis,but appearing obvious increasing trend. The patients with lung and spleen deficiency syndrome have more symptoms and more acute aggravation times,suggesting that the risk is relatively high,such as not actively controlling the poor prognosis. The patients with lung kidney Qi deficiency,lung and spleen and kidney Qi deficiency,Yang deficiency and water flooding,lung-kidney Qi-Yin deficiency syndrome are serious,with high risk and poor prognosis. Both patients with phlegm dampness,blood stasis,heat evil and all kinds of solid pathogens have the trend of exacerbation of clinical symptoms,exacerbation of dyspnea and increased incidence of acute exacerbations. Blood stasis is the key factor to affecting the severity of the disease. Phlegm heat in the lung disease severity is not obvious,there may be an initiating factor of exacerbations. There is no significant difference in the comprehensive assessment of phlegm heat syndrome.