慢性阻塞性肺疾病急性加重期中医证型与急性胃肠损伤的相关性研究

Study on the correlation between TCM syndromes of acute exacerbation of chronic obstructive pulmonary disease and acute gastrointestinal injury

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者中医证型与急性胃肠损伤(AGI)的相关性,评估AGI对不同证型AECOPD患者发生呼吸衰竭的影响。方法将2017年12月—2019年5月在东莞市中医院住院治疗的240例重度和极重度AECOPD患者辨证分为痰热郁肺组、痰浊蕴肺组、肺肾气虚组、阳虚水泛组,同时以20例健康体检者作为对照组,比较各组呼吸衰竭发生率、AGI发生率、动脉血氧分压[p(O_(2))]、AGI症状评分、每分钟肠鸣音次数、腹腔内压、血清瓜氨酸及肠型脂肪酸结合蛋白(IFABP)水平;Spearman相关性分析各证型AECOPD患者与p(O_(2))、AGI症状评分、每分钟肠鸣音次数、腹腔内压、血清瓜氨酸及IFABP的相关性;采用二元Logstic回归分析方法对不同证型患者呼吸衰竭的危险因素进行分析。结果240例患者分为痰热郁肺组80例,痰浊蕴肺组60例,肺肾气虚组56例,阳虚水泛组44例,痰热郁肺为主要证型。各不同证型组p(O_(2))、每分钟肠鸣音次数、血清瓜氨酸水平均明显低于对照组(P均<0.05),腹腔内压、血清IFABP水平均明显高于对照组(P均<0.05);痰热郁肺组p(O_(2))、每分钟肠鸣音次数、血清瓜氨酸水平均明显低于其他证型组(P均<0.05),AGI症状评分、腹腔内压、血清IFABP水平均明显高于其他证型组(P均<0.05);阳虚水泛组AGI症状评分、腹腔内压、血清IFABP水平均明显高于肺肾气虚组、痰浊蕴肺组(P均<0.05),血清瓜氨酸水平明显低于肺肾气虚组、痰浊蕴肺组(P均<0.05)。痰热郁肺证与AGI症状评分、腹腔内压、血清IFABP水平呈正相关(P均<0.05),与p(O_(2))、每分钟肠鸣音次数、血清瓜氨酸水平呈负相关(P均<0.05);二元Logstic回归分析显示,AGI症状评分、每分钟肠鸣音次数、腹腔内压、血清瓜氨酸水平、血清IFABP水平均为AECOPD患者发生呼吸衰竭的危险因素(P均<0.05),各个危险因素的回归系数以痰热证型最大,其次为阳虚水泛型。结论AECOPD患者痰热郁肺型占主要比例,且较其他证型与AGI相关性最强;其次为阳虚水泛型。AGI相关指标可以一定程度上作为辅助AECOPD分型的依据并作为判断不同证型AECOPD病情的指标。AGI为各证型AECOPD尤其是痰热郁肺、阳虚水泛者发生呼吸衰竭的危险因素,临床上应重视对AECOPD尤其是痰热郁肺型、阳虚水泛型患者合并AGI的处理。

Objective It is to investigate the correlation between TCM syndromes and acute gastrointestinal injury(AGI)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to evaluate the influence of AGI on the occurrence of respiratory failure in patients with different syndromes of AECOPD.Methods 240 patients with severe or extremely severe AECOPD who were hospitalized in Dongguan Hospital of Traditional Chinese Medicine from December 2017 to May 2019 were divided into group of phlegm-heat stagnating lung,group of phlegm-turbid accumulating lung,group of lung-kidney Qi-deficiency,and group of Yang deficiency with water flooding,20 healthy subjects were used as the control group.The incidence of respiratory failure,the incidence of AGI,the partial pressure of arterial oxygen p(O_(2)),the AGI symptom score,the number of bowel sounds per minute,intra-abdominal pressure,serum level of citrulline and intestinal fatty acid binding protein(IFABP)were compared among every group;Spearman correlation analysis was used to analyzed the correlation of syndrome with with p(O_(2)),AGI symptom score,bowel sounds per minute,intra-abdominal pressure,serum citrulline and IFABP in patients with AECOPD;Binary Logstic regression analysis method was used to analyze the risk factors of respiratory failure in patients with different syndromes.Results In the 240 patients selected,there were 80 cases in group of phlegm-heat stagnating lung,60 cases in group of phlegm-turbid accumulating lung,56 cases in group of lung-kidney Qi-deficiency,and 44 cases in group of Yang deficiency with water flooding,the syndrome of phlegm-heat stagnating lung was the main syndrome type.The p(O_(2)),bowel sounds per minute,and serum citrulline level of the different syndrome groups were significantly lower than those of the control group(all P<0.05),and the intra-abdominal pressure and serum IFABP level were significantly higher than those of the control group(all P<0.05);p(O_(2)),bowel sounds per minute,and serum citrulline level in the group of phlegm-heat stagnating lung were significantly lower than those in other syndrome groups(all P<0.05),AGI symptom score,intra-abdominal pressure,serum IFABP were significantly higher than those of other syndrome groups(P<0.05);AGI symptom scores,intra-abdominal pressure,and serum IFABP level in the group of Yang-deficiency with water flooding were significantly higher while the serum citrulline level was significantly lower than those in the group of phlegm-turbid accumulating lung,group of lung-kidney Qi-deficiency(all P<0.05).The syndrome of phlegm-heat stagnating lung was positively correlated with AGI symptom score,intra-abdominal pressure,and serum IFABP level(all P<0.05),and negatively correlated with p(O_(2)),the number of bowel sounds per minute,and serum citrulline level(all P<0.05);Binary Logstic regression analysis showed that AGI symptom score,number of bowel sounds per minute,intra-abdominal pressure,serum citrulline level,and serum IFABP level were all risk factors for respiratory failure in patients with AECOPD(all P<0.05),the regression coefficient of each risk factor of the phlegm-heat syndrome type was the largest,followed by the Yang-deficiency with water flooding.Conclusion The syndrome of phlegm-heat stagnating lung accounts for the main proportion of AECOPD patients,and it has the strongest correlation with AGI compared with other syndrome types;the second is the type of Yang deficiency with water flooding.AGI-related indicators can be used to a certain extent as a basis for assisting AECOPD classification and as an indicator for judging the condition of different syndromes of AECOPD.AGI is a risk factor for respiratory failure in various types of AECOPD,especially those with syndrome of phlegm-heat stagnating lung,and Yang deficiency with water flooding.More attention should be paid to the treatment of AECOPD,especially in patients with phlegm-heat stagnating lung and Yang-deficiency with water flooding with AGI.