流感病毒所致感染性慢阻肺急性加重期的临床特征及中医证候研究

Clinical features and TCM syndromes of infectious AECOPD caused by influenza virus

目的:观察流感病毒所致感染性慢阻肺急性加重期(AECOPD)的临床特征,并探讨其中医证候分布规律。方法:采用回顾性研究方法,收集2016年1月~2020年12月于望京医院呼吸科住院的感染性AECOPD患者66例,按是否感染流感病毒分为阳性组与阴性组,采集患者一般临床资料(性别、年龄、病程、本次是否发热)、炎症指标[降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数、中性粒细胞百分比、单核细胞百分比、淋巴细胞百分比(LYM%)]、肺功能(肺活量、用力肺活量、第1秒用力呼气容积、1秒率)、动脉血气分析[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压]等结果。利用Spearman相关分析分析流感病毒感染与各临床特征的相关性。总结两组患者中医证候分布规律。结果:阳性组与阴性组患者在年龄[77(69,80)岁vs 67(62,78)岁]、发热患者比例[14(38.89%)例vs 4(13.33%)例]、PCT[0.059(0.041,0.085)ng/mL vs 0.040(0.028,0.068)ng/mL]、CRP[20.42(2.61,60.99)mg/L vs 5.01(1.51,16.55)mg/L]、LYM%(17.10±6.81vs 20.96±8.68)、PaO_(2)[71.75(62.85,77.90)mmHg vs 75.15(68.18,80.23)mmHg]等指标方面,均存在显著差异,且差异具有统计学意义(P均<0.05)。Spearman相关分析显示,与阴性组相比,流感病毒所致感染性AECOPD患者年龄偏大,常出现发热症状,PCT、CRP水平偏高。感染性AECOPD患者中医证候分布均以痰热壅肺证为主,常兼阴虚证、气虚证、气阴两虚证及血瘀证;脏腑常涉及肺、脾、肾。结论:若AECOPD患者高龄,出现发热症状,且炎症指标PCT、CRP水平偏高,可考虑流感病毒感染。两组患者中医证候分布规律无显著差异,均以痰热壅肺证为主,常兼阴虚证、气虚证、气阴两虚证及血瘀证,脏腑常涉及肺、脾、肾。

Objective:To observe the clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)caused by influenza virus,and to explore the distribution of Chinese medical syndromes.Methods:Data of 66 patients with infectious AECOPD who were hospitalized in the Department of Respiratory Medicine of Wangjing Hospital from January 2016 to December 2020 were analyzed retrospectively.They were divided into the infected group and the negative group according to whether they were infected with influenza virus.General clinical data(gender,age,course of disease,fever status this time),inflammation indexes[procalcitonin(PCT),C-reactive protein(CRP),white blood cell count,neutrophil percentage,monocyte percentage,lymphocytes percent(LYM%)],lung function[vital capacity,forced vital capacity,forced expiratory volume in the first one second(FEV1),FEV1/FVC in the first one second second],arterial blood gas analysis[arterial blood oxygen partial pressure(PaO_(2)),arterial blood carbon dioxide partial pressure]and so on.Spearman correlation analysis was used to analyze the correlation between clinical characteristics and influenza virus infection. The distribution law of traditional Chinese medicine (TCM)syndromes was also analyzed. Results:Age of patients was 77(69,80)years vs 67(62,78)years in the infected group and the negative group,respectively. The proportion of patients with fever was 14(38.89%)vs 4(13.33%),PCT was 0.059 (0.041,0.085)ng/mL vs 0.040(0.028,0.068)ng/mL,CRP was 20.42(2.61,60.99)mg/L vs 5.01(1.51,16.55)mg/L, LYM% was 17.10±6.81 vs 20.96±8.68,PaO_(2) was 71.75(62.85,77.90)mmHg vs 75.15(68.18,80.23)mmHg in the infected group and the negative group,respectively. And the differences were statistically significant(P<0.05). Spearman correlation anal ysis showed that patients with infectious AECOPD caused by influenza virus were older,more likely to have fever,and had higher levels of PCT and CRP. Conclusion:If AECOPD patients are elderly,or have fever symptoms and higher levels of inflammation indicators such as PCT and CRP,influenza virus infection should be considered. TCM syndromes are mainly phlegm-heat stagna tion in the lung,often combined with yin deficiency,qi deficiency,qi and yin deficiency and blood stasis. The most involved vis cera are lung,spleen,and kidney.