肺结节临床症状及中医证候分布特征

Clinical symptoms and distribution characteristics traditional Chinese medicine syndromes of pulmonary nodules

采用横断面研究综合2种辨证方式,采用χ2检验、系统聚类与Apriori算法关联分析,从肺结节数量、大小、性质、稳定性等角度研究肺结节患者临床症状及中医证候分布特征。结果显示,肺结节常见临床症状为乏力(77.35%)、烦躁(75.40%),将40个症状聚类可得3个症状组(消化系统症状、呼吸系统症状、情志及全身症状)、8个主要症状群。寒热辨证方面,寒热错杂证(63.43%)占比更高;病性辨证方面,证候分型前2位的是气虚证(88.03%)、气郁证(83.17%),阳虚证(60.52%)多于阴虚证(50.16%);肺结节数量方面,孤立性肺结节痰证(78.67%)、阳虚证(69.33%)占比更高;肺结节大小方面,随肺结节平均直径增大,痰证占比减少,而阳虚证、血瘀证占比增加,平均直径<10 mm者气郁证分布多(85.02%,P=0.044),平均直径≥10 mm者寒证分布多(16.67%,P=0.024);肺结节性质方面,伴随肺结节实性成分增多,气郁证与热证占比减少,阴虚证与寒热错杂证占比升高,血瘀证在含实性成分的结节中占比更高;肺结节稳定性方面,肺结节进展者湿证(72.97%)、血瘀证(37.84%)、寒热错杂证(70.27%)占比更高,新发结节者气逆证(52.00%,P=0.007)、寒热错杂证(66.00%,P=0.008)占比更高。同时,关联11个证候,得到4个常见复合证型(气虚气郁证、气郁痰凝证、气虚痰凝证、气虚湿阻证),其中气虚证、气郁证与其他证候均存在关联。结果表明,肺结节主要临床症状以乏力、烦躁为主,主要证候以气虚证、气郁证、阳虚证、寒热错杂证为主,证候分布特点与肺结节大小、有无新发结节具有显著相关性,常见复合证型为气虚气郁证、气郁痰凝证、气虚痰凝证、气虚湿阻证。

A cross-sectional study method combined with two types of traditional Chinese medicine(TCM)syndrome differentiation methods was adopted to investigate the clinical symptoms and distribution characteristics of TCM syndromes in patients with pulmonary nodules from the perspectives of number,size,nature,and stability of pulmonary nodules by using theχ~2 test,systematic clustering and Apriori algorithm correlation analysis.The common clinical symptoms of pulmonary nodules were fatigue(77.35%)and irritability(75.40%),and 40 symptoms were clustered into 3 groups(digestive system symptoms,respiratory system symptoms,and emotional and systemic symptoms)and 8 major symptom categories.The proportion of cold and heat in complexity syndrome(63.43%)was higher based on cold-heat syndrome differentiation.The top two syndromes were Qi deficiency syndrome(88.03%)and Qi depression syndrome(83.17%)based on disease syndrome differentiation.Yang deficiency syndrome(60.52%)was more than Yin deficiency syndrome(50.16%).There were higher proportions of phlegm syndrome(78.67%)and Yang deficiency syndrome(69.33%)of so-litary pulmonary nodules in terms of the number of pulmonary nodules.In terms of size,the proportion of phlegm syndrome decreased as the mean diameter of pulmonary nodules increased,while the proportions of Yang deficiency syndrome and blood stasis syndrome increased.The distribution of Qi depression syndrome was more in those with mean diameter<10 mm(85.02%,P=0.044)and cold syndrome was more in those with mean diameter≥10 mm(16.67%,P=0.024).In terms of the nature of pulmonary nodules,the proportions of Qi depression syndrome and heat syndrome decreased with the increase in solid components of pulmonary nodules,while the proportions of Yin deficiency syndrome and cold and heat in complexity syndrome increased.The blood stasis syndrome accounted for a higher proportion of pulmonary nodules with solid components.In terms of the stability of pulmonary nodules,dampness syndrome(72.97%),blood stasis syndrome(37.84%),and cold and heat in complexity syndrome(70.27%)accounted for higher proportions.In addition,patients with new nodules presented higher proportions in Qi inversion syndrome(52.00%,P=0.007)and cold and heat in complexity syndrome(66.00%,P=0.008).Meanwhile,11 syndromes were associated and 4 common compound syndromes were obtained(Qi deficiency and depression syndrome,Qi depression and phlegm coagulation syndrome,Qi deficiency and phlegm coagulation syndrome,and Qi deficiency and dampness obstruction syndrome).Qi deficiency syndrome and Qi depression syndrome could be associated with other syndromes.The results show that the main clinical symptoms of pulmonary nodules are fatigue and irritability.The main TCM syndromes of pulmonary nodules are Qi deficiency syndrome,Qi depression syndrome,Yang deficiency syndrome,and cold and heat in complexity syndrome.The distribution of TCM syndromes is significantly correlated with the size of pulmonary nodules and the presence or absence of new nodules.The common compound syndromes are Qi deficiency and depression syndrome,Qi depression and phlegm coagulation syndrome,Qi deficiency and phlegm coagulation syndrome,and Qi deficiency and dampness obstruction syndrome.