3408例老年慢性阻塞性肺疾病患者中医体质与共患病相关性分析

Correlation Between Traditional Chinese Medicine Constitution and the Comorbidities in Elderly Patients with Chronic Obstructive Pulmonary Disease:An Analysis of 3 408 Cases

【目的】观察老年慢性阻塞性肺疾病(COPD)稳定期患者中医体质类型与共患病相关性。【方法】采用横断面研究方法,调查2017年1月~2019年12月在青岛市中医医院、青岛市第五人民医院门诊就诊,年龄≥65岁的COPD稳定期患者3 408例,对所有患者进行中医体质判定,同时完成衰弱、疲劳、蒙特利尔认知评估量表(MoCA)的评估,测量肌肉质量、步行速度、握力,检测老年营养风险指数(GNRI);分析不同中医体质患者衰弱、认知障碍、营养不良等并发症的发生情况。【结果】(1)衰弱情况:与非衰弱组比较,衰弱组患者的平和质比例较低,气虚质、阳虚质比例较高(P<0.05);(2)疲劳情况:与无疲劳组比较,疲劳组患者的平和质比例较低,气虚质、阳虚质比例较高(P<0.05);(3)认知功能情况:与认知功能正常组比较,认知功能障碍组患者的平和质比例较低,气虚质、血瘀质比例较高(P<0.05);(4)肌肉情况:与肌肉正常组比较,肌肉衰减组患者的平和质比例较低,气虚质、阳虚质、痰湿质比例较高(P<0.05);(5)营养情况:与营养正常组比较,营养不良组患者的平和质比例较低,气虚质、阳虚质、痰湿质比例较高(P<0.05)。【结论】平和质老年COPD稳定期患者出现共患病的几率较低,气虚质、阳虚质出现共患病的几率较高,故临床应重点关注气虚质、阳虚质患者的共患病情况。

Objective To observe the correlation between the types of traditional Chinese medicine(TCM) constitution and the comorbidity in elderly patients with chronic obstructive pulmonary disease(COPD)at stable phase. Methods A cross-sectional study was conducted to investigate 3 408 COPD patients at stable phase and aged ≥65 years who visited the outpatient department of Qingdao Hospital of TCM and Qingdao Fifth People’s Hospital from January 2017 to December 2019. The classification of TCM constitution was performed on all patients. Meanwhile,we completed the frailty scoring with FRAIL scale,fatigue scoring with fatigue severity scale(FSS)and cognition scoring with Montreal Cognitive Assessment Scale(MoCA), measured the muscle mass,walking speed, grip strength and geriatric nutritional risk index(GNRI), and analyzed the occurrence of complications such as frailty,cognitive impairment and malnutrition in patients with different TCM constitutions.Results(1)Correlation of TCM constitution with frailty:compared with the non-frailty group,the frailty group had a lower proportion of balanced constitution and a higher proportion of qi deficiency constitution and yang deficiency constitution(P<0.05).(2)Correlation of TCM constitution with fatigue:compared with the non-fatigue group,the patients in the fatigue group had a lower proportion of balanced constitution and a higher proportion of qi deficiency constitution and yang deficiency constitution(P<0.05).(3)Correlation of TCM constitution with cognitive function:compared with the normal cognitive function group,the patients in cognitive dysfunction group had a lower proportion of balanced constitution and a higher proportion of qi deficiency constitution and blood stasis constitution(P<0.05).(4)Correlation of TCM constitution with muscles: compared with the normal muscle group,patients with sarcopenia group had a lower proportion of balanced constitution and a higher proportion of qi deficiency constitution,yang deficiency constitution and phlegm-damp constitution(P<0.05).(5)Correlation of TCM constitution with nutrition status:compared with the normal nutrition group,the malnutrition group had a lower proportion of balanced constitution and a higher proportion of qi deficiency constitution, yang deficiency constitution, and phlegm-damp constitution(P<0.05). Conclusion The incidence of comorbidities in elderly COPD patients at stable phase with balanced constitution is relatively low,while the incidence of comorbidities in the patients with qi deficiency constitution and yang deficiency constitution is relatively high. Therefore, more attention should be paid to the comorbidities in patients with qi deficiency constitution and yang deficiency constitution.