急性肺栓塞中医证型与西医危险分层及首发症状的相关性研究

Study on the Correlation of Traditional Chinese Medicine Syndromes with Western Medical Risk Stratification and Initial Symptoms of Patients with Acute Pulmonary Embolism

【目的】探究急性肺栓塞患者中医证型与西医危险分层及首发症状的相关性。【方法】采用回顾性分析方法,选取2020年4月至2022年8月在广州中医药大学第一附属医院就诊并首次明确诊断为急性肺栓塞的患者共70例,将其分为痰浊阻肺证、痰瘀互结证、气虚血瘀证、阳气暴脱证4种证型,分析其中医证型的分布特点,探索与西医危险分层及不同首发症状之间的相关性。【结果】(1)中医证型分布方面,气虚血瘀证占比最多,为31.43%(22/70),阳气暴脱证占比最少,为18.57%(13/70),从高到低排序为:气虚血瘀证>痰瘀互结证>痰浊阻肺证>阳气暴脱证。(2)性别、年龄与中医证型分布关系方面,不同性别的中医证型分布比较,差异无统计学意义(P>0.05)。年龄分布比较,痰浊阻肺证患者平均年龄最小,阳气暴脱证患者平均年龄最大,各证型患者年龄分布由小到大依次为痰浊阻肺证<痰瘀互结证<气虚血瘀证<阳气暴脱证,差异有统计学意义(P<0.05)。(3)西医危险分层与中医证型分布关系方面,痰浊阻肺证主要分布在低危组与中低危组,阳气暴脱证主要分布在中高危组与高危组;各危险分层中占比最多的证型依次为低危组的痰浊阻肺证42.86%(9/21),中低危组的痰瘀互结证47.83%(11/23),中高危组的气虚血瘀证66.67%(10/15),高危组的阳气暴脱证90.91%(10/11),差异有统计学意义(P<0.01)。(4)首发症状与中医证型分布及西医危险分层的关系方面,不同首发症状的中医证型分布及西医危险分层分布不同,差异均有统计学意义(P<0.01)。其中,以呼吸困难、下肢水肿和晕厥的危险度最高,多分布在阳气暴脱证中,咳嗽咳痰的危险度最低,多分布在痰浊阻肺证中。【结论】急性肺栓塞患者中,气虚血瘀证与痰瘀互结证分布较多,年龄、西医危险分层和首发症状对其中医证型分布有一定影响。

Objective To investigate the correlation of traditional Chinese medicine(TCM)syndrome types with western medical risk stratification and initial symptoms in patients with acute pulmonary embolism(APE).Methods A retrospective analysis was conducted in the 70 patients who attended the First Affiliated Hospital of Guangzhou University of Chinese Medicine from April 2020 to August 2022 and were first definitively diagnosed as APE.The patients were classified into four syndrome types,namely turbid phlegm obstructing lung syndrome,phlegm blended with blood stasis syndrome,qi deficiency and blood stasis syndrome,and yang-qi sudden loss syndrome.After that,the distribution characteristics of the TCM syndrome types were analyzed,and the correlation of TCM syndrome types with western medical risk stratification the initial symptoms was explored.Results(1)In terms of the distribution of TCM syndrome types,qi deficiency and blood stasis syndrome accounted for the largest proportion,being 31.43%(22/70),and yang-qi sudden loss syndrome accounted for the least proportion,being 18.57%(13/70).The proportion of TCM syndrome types ranked from the highest to the lowest as the following:qi deficiency and blood stasis syndrome>phlegm blended with blood stasis syndrome>turbid phlegm obstructing lung syndrome>yang-qi sudden loss syndrome.(2)Regarding the relationship of gender,age with the distribution of TCM syndrome types,there was no statistically significant difference in the distribution of TCM syndrome types between the male and the female(P>0.05).The mean age of patients with turbid phlegm obstructing lung syndrome was the youngest,while the mean age of patients with yang-qi sudden loss syndrome was the oldest.The mean age in the patients with various syndromes in increasing sequence was as the following:turbid phlegm obstructing lung syndrome<phlegm blended with blood stasis syndrome<qi deficiency and blood stasis syndrome<yang-qi sudden loss syndrome.The difference of the mean age was statistically significant among various TCM syndrome types(P<0.05).(3)The analysis of the relationship between western medical risk stratification and TCM syndrome types showed that turbid phlegm obstructing lung syndrome was frequently seen in the low risk group and the medium-low risk group,and yang-qi sudden loss syndrome was frequently seen in the medium-high risk group and the high risk group.The predominated syndrome types in various risk stratification groups were as the following:turbid phlegm obstructing lung syndrome in the low risk group accounting for 42.86%(9/21),phlegm blended with blood stasis syndrome in the medium-low risk group accounting for 47.83%(11/23),qi deficiency and blood stasis syndrome in the medium-high risk group accounting for 66.67%(10/15),and yang-qi sudden loss syndrome in the high-risk group accounting for 90.91%(10/11).The difference of the distribution of TCM syndrome types was statistically significant among various risk stratification groups(P<0.01).(4)In terms of the relationship of the initial symptoms with the TCM syndrome types and western medical risk stratification,the distribution of TCM syndrome types and western medicine risk stratification varied in the initial symptoms,and the differences were statistically significant(P<0.01).Of the initial symptoms,dyspnea,lower limb edema and syncope had the highest risk and were frequently seen in the yang-qi sudden loss syndrome,and cough and sputum had the lowest risk and were frequently seen in the turbid phlegm obstructing lung syndrome.Conclusion In patients with APE,qi deficiency and blood stasis syndrome and phlegm blended with blood stasis syndrome are frequently seen,and the age,western medical risk stratification and initial symptoms have some influence on the distribution of the TCM syndrome types.