基于微观辨证理论的结核相关阻塞性肺疾病临床特征及中医证型判别分析

Clinical Features and Discriminant Analysis of TCM Syndromes of Tuberculosis Associated Obstructive Pulmonary Disease Based on the Micro Syndrome Differentiation Theory

目的分析结核相关阻塞性肺疾病(Tuberculosis associated obstructive pulmonary disease,TOPD)中西医临床特征,探索该病中医症候的微观辨证体系,试为TOPD的临床诊治和该病中医临床辨证提供客观依据。方法本项研究对2018年1月-2020年11月新疆维吾尔自治区中医医院收治的387例TOPD患者的临床数据进行回顾性分析。分析不同性别患者年龄、吸烟情况、发病年龄、住院天数等差异及统计描述肺功能指标、影像学特征、中医证型分布,最后构建中医辨证分型的判别模型。结果387例TOPD患者中男性218(56.3%),女性169(43.7%)。与女性患者相比,男性患者年龄和发病年龄更大,吸烟占比更高,住院时间更长,差异具有统计学意义(P<0.05)。纳入患者中民族以汉族、文化水平以小学学历、职业以离退休占比最高。肺功能提示TOPD患者存在混合性通气功能障碍;影像学显示肺结核瘢痕发病部位主要见于右肺上叶215(67.8%)、右肺下叶168(52.9%)和左肺上叶176(55.5%);此外患者存在不同程度的肺气肿、支气管扩张征象和胸腔积液现象。以中医证型为因变量,实验室客观指标为自变量进行中医辨证分型的判别分析的总体符合率为63.7%,最后构建各个中医证型判别方程。结论本项研究对387例TOPD患者一般资料、肺功能特点、影像学特征及中医证型分布情况进行统计描述,并在微观辨证理论指导下进行中医证型与实验室指标的判别分析,为该病中医症候辨证客观化、标准化及规范化进行了初步尝试和有益探索。

Objective To analyze the clinical characteristics of Tuberculosis associated Obstructive Pulmonary Disease(TOPD) in Chinese and Western medicine,and to explore the microscopic syndrome differentiation system of TCM symptoms.To provide objective basis for clinical diagnosis and treatment and TCM clinical syndrome differentiation of TOPD.Methods This study retrospectively analyzed the clinical data of 387 patients with TOPD admitted to the Hospital of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region from January 2018 to November 2020.The differences of age,smoking status,age of onset and length of stay of patients of different genders were analyzed,and the lung function indexes,imaging characteristics and distribution of TCM syndrome types were described statistically.Finally,the discriminant model of TCM syndrome differentiation was constructed.Results Among the 387 TOPD patients,218(56.3%) were males and 169(43.7%) were females.Compared with female patients,male patients were older in age and onset age,had a higher proportion of smoking,and had a longer hospital stay,with statistical significance(P0.05).Among the included patients,han nationality,primary school education,occupation and retired accounted for the highest proportion.Lung function suggested mixed ventilation dysfunction in PATIENTS with TOPD.Imaging showed that pulmonary tuberculosis scar mainly occurred in the upper lobe of right lung 215(67.8%),the lower lobe of right lung 168(52.9%) and the upper lobe of left lung 176(55.5%).In addition,there were different degrees of emphysema,bronchiectasis and pleural effusion.The overall accuracy of discriminant analysis of TCM syndrome types was 63.7% with TCM syndrome types as dependent variables and objective laboratory indicators as independent variables,and the typical functional classification graph of TCM syndrome types was constructed.Conclusion In this study,the general information,lung function characteristics,imaging characteristics and TCM syndrome type distribution of 387 PATIENTS with TOPD were statistically described.The discriminant analysis of TCM syndrome types and laboratory indicators was conducted under the guidance of microscopic syndrome differentiation theory,which made a preliminary attempt and beneficial exploration for objectification,standardization and standardization of TCM syndrome differentiation of this disease.