140例支气管结核纤维支气管镜镜下中医辨证分型初探

Differentiation by TCM of bronchoscopic findings of 140 cases with Endobronchial tuberculosis

目的:针对用传统的中医辨证分型方法治疗肺痨难以收到满意疗效的现状,首次通过纤维支气管镜镜下观察以希冀探索中医辨证分型的新方法。方法通过对140例确诊的支气管结核的镜下观察,从现代医学和祖国医学理论两方面分析其表现,找出病变的规律。结果140例发病男女比例为1.26:1,20～59岁病例占86.43%,首次纤支镜检查病变同时累及双侧支气管90例(64.29%),病变位于气管5例(3.57%),右主支气管11例(7.86%),右上叶支气管50例(35.71%),右中间支气管51例(36.43%),右中叶支气管105例(75%),右下叶支气管42例(30%),左主支气管88例(62.86%),左上叶支气管42例(30%),左舌叶支气管26例(18.57%),左下叶支气管56例(40%)。140例的镜下表现按发生率依次为支气管黏膜充血者132例(94.29%),黏膜水肿56例(40%),浅表溃疡(多为1～2个)37例(26.43%),黄色或白色被膜状物72例(51.43%),苍白色瘢痕形成15例(10.71%),浅表毛细血管单根或呈网状曲张41例(29.29%),出血17例(12.14%),支气管狭窄15例(10.71%),支气管分嵴部增宽20例(14.29%),隆凸增宽1例(0.71%),肉芽肿5例(3.57%),瘘管形成1例(0.71%)。结论肺痨的发病是迁延不愈的长期过程,其早期和中期是以邪实占主导地位的,正虚尤其是肺阴不足表现并不明显;只有久病正气虚弱才得以显现而表现为正虚邪实的特点。病人可以根据纤维支气管镜镜下表现重新进行中医辨证分型,可以分为痨热毒郁肺血败肉腐型、气滞血瘀痰凝湿阻型和气血不足气阴亏虚型。根据中医理法可以制定相应的治疗方法,可能走出肺痨治疗方法的老圈子,提高中医药的疗效。

Objective Through the bronchoscopic findings of endobronchial tuberculosis(EBTB),to explore the new differentiation method of Traditional Chinese Medicine for the first time. Methods 140 cases of EBTB admitted from 2000 to 2005 were analyzed according to western medicine and basic theory of TCM based on fiberoptic bronchoscopic findings. Results Male patients occupied 55.71%(78/140) of the total and were more than female ones.Patients aged from 20 to 59 years old occupied 86.43%(121/140).In 64.29% of patients the left and right bronchi were involved at the same time. The initial endobronchial lesions were found in trachea(3.57%), right main bronchus (7.86%), right upper bronchus(35.71%), right midian bronchus(36.43%), right middle bronchus(75%), right lower bronchus(30%), left main bronchus(62.86%), left upper bronchus(30%), left lingular bronchus(18.57%) and left lower bronchus(40%). Most lesions looked inflamed(94.29%), followed by swollen(40%), ulcerative(26.43%), caseous(51. 43%), cicatricial(10.71%), mucosal vascular varicose(29.29%), bleedy(12.14%), stenosed(10.71%), the secondary carina widened(14.29%),granulomatous(3.57%) and fistulous(0.71%) appearance. Conclusions Based on the bronchoscopic features,clinical manifestations of excess of Evil were much more than that of deficiency of vital Qi especially the lack of Lung-Yin type at the early and middle stage.So we may divided the EBTB patients into three types of TCM such as toxic Heat stagnation in the lungs type,Qi stagnation and Blood stasis and blockage of Phlegm type,deficiency of Qi and Blood and Yin type.