以病机证素为纲探讨特发性肺纤维化诊疗新思路

Discussion of TCM Syndrome Elements Based Novel Diagnosis and Treatment Method of Idiopathic Pulmonary Fibrosis

目的:以病机证素为纲,探讨特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的病机演变规律,为临床治疗提供新思路。方法:通过文献分析、专家咨询等确立IPF的病机证素辨识标准,收集40例IPF患者的病机证素,利用SPSS 19.0软件进行统计分析。结果:在IPF发生发展过程中,各病机证素错综复杂,胶结合和为患。在疾病的急性加重期痰、瘀、湿的比例出现最高,慢性持续期则为气虚、瘀、湿,而到了临床缓解期则变为瘀、气虚、阳虚。急性加重期,痰和中医证候总积分呈正相关,瘀和mMRC呼吸困难分级呈正相关,痰、瘀、气虚和胸部高分辨CT结果呈正相关;慢性持续期,风、寒、阳虚和中医证候总积分呈正相关;临床缓解期,寒、气虚和中医证候总积分呈正相关,瘀、阳虚和mMRC呼吸困难分级呈正相关。结论:IPF患者在不同疾病阶段病机类型亦不相同,瘀贯穿疾病发展过程始终,治疗应将病机证素和临证发展转归相统一,组方配伍中应注重化瘀通络药物的使用。

Objective:To discuss the pathogenesis of idiopathic pulmonary fibrosis(IPF)based on the TCM syndrome elements,and provide new methods in clinical treatment.Methods:Through literature analysis and expert consultation,the identification criteria of IPF pathogenic syndromes were established,according to which,40 IPF patients′syndromes elements were collected and statistically analyzed by SPSS19.0 software.Results:In the process of the occurrence and development of IPF,the various pathogenesis and syndrome factors are intricate,the main illness is Phlegm and Blood stasis.,the highest syndrome proportion was Phlegm,Blood stasis,and dampness in the acute exacerbation of IPF,Qi deficiency,Blood stasis,and dampness in the chronic duration,and Blood stasis,Qi deficiency,and Yang deficiency in the clinical catabasis.During the acute exacerbation,Phlegm is positively correlated with the total score of syndrome elements,Blood stasis is positively correlated with mMRC dyspnea grade.Phlegm,Blood stasis,Qi deficiency and are positively correlated with chest HRCT results;During the chronic duration,Wind,Cold,Yang deficiency are positively correlated with and the total score of syndrome elements;During clinical catabasis,Cold,Qi deficiency,and syndrome elements were positively correlated,and Blood stasis,Yang deficiency,and mMRC dyspnea grade were positively correlated.Conclusion:Different pathogenesis types exist in different stages of IPF patients;however,Blood stasis exists consistently.The treatment should integrate the syndrome elements and clinical disease courses,and pay more attention to Blood stasis-eliminating circulation-invigorating drugs in formula combination.