慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征重叠综合征中医证候研究

Study on TCM syndrome of chronic obstructive pulmonary disease complicated with obstructive sleep apnea hypopnea syndrome overlap syndrome

目的探索慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)重叠综合征的中医证候特点和规律。方法回顾性分析2017年8月—2020年6月诊治的385例COPD-OSAHS重叠综合征患者(广州中医药大学东莞医院179例,广州中医药大学第一附属医院142例,东莞市中西医结合医院64例)资料,提取患者的一般资料、中医症状体征信息以制订该综合征的中医证候采集表,采用证候因子频数统计结合因子分析及聚类分析的方式进行整理分析,结合临床对结果作出证候分类。结果385例患者中,排除出现频率小于5%的中医证候因子,共出现了66个中医证候因子,最为常见的症状为咳嗽、咳痰、打鼾、夜间憋醒,出现频率均在60%以上;因子分析以特征值>1取公因子,共提取14个公因子,共覆盖65%的中医证候因子,结合聚类分析结果,COPD-OSAHS重叠综合征的常见证型有痰热壅肺、痰湿蕴肺、痰瘀互结、肺肾气虚4种,占比分别为25.7%,23.3%,26.7%,24.1%。与痰有关的证候占75.84%,以痰瘀互结证为最常见证候,病性以实证为主,虚实夹杂,病位在肺,涉及脾肾。结论COPD-OSAHS重叠综合征同时兼有COPD、OSAHS的证候规律特征,以痰浊为主要病理因素,可见虚实夹杂证;治疗过程中应以燥湿祛痰为主,随证兼用活血化瘀、清热化痰、补益肺脾肾之法。

Objective It is to explore the traditional Chinese medicine(TCM)syndrome characteristics and regularity of chronic obstructive pulmonary disease(COPD)combined with obstructive sleep apnea hypopnea syndrome(OSAHS)overlap syndrome.Methods The data of 385 patients with COPD-OSAHS overlap syndrome diagnosed and treated from August 2017 to June 2020(179 cases in Dongguan Hospital of Guangzhou University of Chinese Medicine,142 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine,and 64 cases in Dongguan Hospital of Integrated Traditional Chinese and Western Medicine)were retrospectively analyzed,the general information and TCM symptoms and signs information of these patients were extracted to formulate the TCM syndrome collection table of the syndrome,the frequency statistics of syndrome factors combined with factor analysis and cluster analysis were used for sorting and analysis,and the results were classified into syndromes in combination with clinical practice.Results A total of 66 TCM syndrome factors for COPD-OSAHS Overlap Syndrome were present in 385 cases,excluding some factors that were present at a frequency of less than 5%.Frequency statistics show that the most common symptoms whose frequency was generally more than 60%were:cough,expectoration,snoring and oppressive wake at night.In Factor analysis,common factors were select based on eigenvalue>1 and 14 common factors were extracted,covering 65%of TCM syndromes.Reference to the result of cluster analysis,there were 4 common syndromes of COPD-OSAHS overlap syndrome,which were respectively phlegm heat obstructing lung,phlegm-damp amassing in lung,intermingled phlegm and stasis,Qi deficiency of lung and kidney,the distribution proportion was 25.7%,23.3%,26.7%and 24.1%respectively.According to the outcome,the TCM syndrome which related to the phlegm was up to 75.84%,the most familiar common syndromes was intermingled phlegm and stasis,the nature of the disease was mainly reflected in excess syndrome while sometimes would manifests itself in syndrome of intermingled deficiency and excess,disease located in the lung,involving the spleen and kidney.Conclusion The TCM syndromes of COPD-OSAHS overlap syndrome have common characteristics of both COPD and OSAHS.The main TCM pathological factor of COPD-OSAHS overlap syndrome is phlegm-turbidity,and this disease may manifest itself in the syndrome of intermingled deficiency and excess during the course of disease.In the treatment process,the way of eliminating phlegm should be dominant,while use the way of promoting blood circulation for removing blood stasis,clearing heat and drying dampness,invigorating lung spleen and kidney flexibly.