慢性阻塞性肺疾病合并肺癌的中医证候要素分布规律研究

Distribution rule of TCM syndrome elements in chronic obstructive pulmonary disease with lung cancer

目的研究慢性阻塞性肺疾病(COPD)合并肺癌的中医证候要素分布规律。方法参考相关文献内容结合临床实践经验,筛选出能够反映COPD和肺癌临床特征性变化的中医症状及体征并制定调查量表,在此基础上收集COPD(无肺癌)、肺癌(无COPD)、COPD合并肺癌患者(分别设为COPD组、肺癌组、COPD合并肺癌组)的基线资料及中医四诊信息,并录入“肺i中医”健康管理软件系统,结合证候要素辨证体系分析比较各组患者中医证候要素的分布情况。借助系统聚类分析方法探讨中医证候要素的组合规律。结果①共收集有效病例527例,其中COPD组166例、肺癌组182例、COPD合并肺癌组179例。②179例COPD合并肺癌患者的病性类中医证候要素中,超过1/3的患者有痰(134例)、气虚(123例)、血瘀(75例)。与COPD组相比,COPD合并肺癌组患者痰和血瘀出现比例增加,气滞出现比例减少(P<0.05);与肺癌组相比,COPD合并肺癌组患者痰出现比例增加,阴虚出现比例减少(P<0.05)。③179例COPD合并肺癌患者的病位类中医证候要素中,超过半数患者的病位涉及肺(179例)、肾(121例)、脾(94例)。与肺癌组相比,COPD合并肺癌组患者病位涉及肾的比例增加(P<0.05)。④与COPD组、肺癌组比较,COPD合并肺癌组出现≥3个中医证候要素的患者比例增加(P<0.05)。⑤COPD合并肺癌的病性类中医证候要素可聚为3大类:第一类为痰和血瘀,第二类为气虚和阳虚,第三类为阴虚、湿、热、血虚、气滞和寒。结论COPD合并肺癌的病位主要在肺、肾、脾,痰、血瘀、气虚、阳虚是最为常见的中医证候要素,具有正气不足、痰瘀互结、虚实夹杂的病机特点。

Objective To explore the distribution rule of traditional Chinese medicine(TCM)syndrome elements in chronic obstructive pulmonary disease(COPD)with lung cancer.Methods Referring to relevant literature and clinical experience,the TCM symptoms and signs that can reflect the clinical characteristics of COPD and lung cancer were selected and a survey scale was developed.On this basis,baseline data and TCM four diagnosis information of COPD(without lung cancer),lung cancer(without COPD),and COPD with lung cancer(respectively set as COPD group,lung cancer group,and COPD with lung cancer group)were collected and entered into“iLUNG TCM”health management software system.The TCM syndrome elements distribution in each group of patients were analyzed and compared based on the syndrome elements differentiation system.The TCM syndrome elements combination rule was explored using hierarchical cluster analysis method.Results①A total of 527 subjects were collected,including 166 patients in the COPD group,182 patients in the lung cancer group,and 179 patients in the COPD with lung cancer group.②Among 179 patients in the COPD with lung cancer group,more than one-third had phlegm(134 cases),qi deficiency(123 cases),and blood stasis(75 cases)in terms of TCM syndrome elements of the disease nature category.The COPD with lung cancer group had higher proportion of patients with phlegm and blood stasis and lower proportion of patients with qi stagnation than the COPD group(P<0.05);Meanwhile,the COPD with lung cancer group had higher proportion of patients with phlegm and lower proportion of patients with yin deficiency than the lung cancer group(P<0.05).③Among 179 patients in the COPD with lung cancer group,more than half of the patients had their disease locations involving the lung(179 cases),kidney(121 cases),and spleen(94 cases)in terms of the TCM syndrome elements of disease location category.The COPD with lung cancer group had higher proportion of kidney involvement in patients than the lung cancer group(P<0.05).④The COPD with lung cancer group had higher proportion of patients with more than 3 syndrome elements than the COPD group and the lung cancer group(P<0.05).⑤The result of cluster analysis showed that the syndrome elements of the disease nature category in COPD with lung cancer could be divided into three categories:the first category included phlegm and blood stasis,the second category included qi deficiency and yang deficiency,and the third category included yin deficiency,dampness,heat,blood deficiency,qi stagnation and cold.Conclusions The disease location of COPD with lung cancer is mainly in lung,kidney and spleen.The phlegm,blood stasis,qi deficiency and yang deficiency are the most common TCM syndrome elements in patients with COPD and lung cancer,with the pathogenic characteristics of vital qi deficiency,intermingled phlegm and blood stasis,and intermingled deficiency and excess.