摘要
目的:分析稳定期慢性阻塞性肺疾病(COPD)患者中医辨证分型与肺功能、炎症指标的关系。方法:选取我院于2020年2月~2022年1月收治的180例稳定期COPD患者为研究对象,根据《慢性阻塞性肺疾病中医诊疗指南》将其按照中医证型进行归类,分析不同中医分型患者肺功能、炎症指标、改良版英国医学研究会呼吸困难问卷(mMRC)评分、COPD患者生存状况评估(BODE)指数变化,评估过去1年急性加重次数。结果:收集180例稳定期COPD患者,发现肺脾气虚证52例、痰湿蕴肺证的45例、肺脾肾虚证的44例和痰瘀阻肺证的39例。肺脾气虚证和肺脾肾虚证的病程以>20年为主,痰瘀阻肺证的病程则集中在5~10年,而痰湿蕴肺证的病程大多<5年。肺脾气虚证肺功能分级集中在Ⅳ级,痰湿蕴肺证和痰瘀阻肺证则集中在Ⅱ级,肺脾肾虚证集中在Ⅲ级。四组患者第1秒用力呼气容积占预计值百分比(FEV1%Pred)、FEV1/用力肺活量(FVC)、mMRC评分、BODE指数、炎症指标及过去1年内急性加急次数组间比较,有统计学意义(P<0.05)。其中FEV1%Pred、FVC按照肺脾肾虚证、肺脾气虚证、痰瘀阻肺证、痰湿蕴肺证逐渐上升,而mMRC评分、BODE指数、过去1年内急性加急次数及白细胞介素-2(IL-2)、白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)水平则按照肺脾肾虚证、肺脾气虚证、痰瘀阻肺证、痰湿蕴肺证逐渐下降,白细胞介素-10(IL-10)水平则是肺脾肾虚证高于其他证型,有统计学意义(P<0.05)。结论:随着痰湿蕴肺证、痰瘀阻肺证、肺脾气虚证到肺脾肾虚证的变化,患者病程越长,肺功能越差,炎症程度越重,更易急性发作。
Objective:To analyze the relationship between TCM dialectical classification and pulmonary function and inflammatory indexes in patients with stable chronic obstructive pulmonary disease(COPD).Methods:Selected 180 stable COPD patients treated in our hospital from February 2020 to January 2022 as the research objects,classified them according to TCM syndrome types according to the Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease,and analyzed different TCM syndromes.Changes in lung function,inflammatory indexes,Modified British Medical Research Association dyspnea questionnaire(mMRC)score,COPD patient survival evaluation(BODE)index,and the number of acute exacerbations in the past 1 year were evaluated.Results:Collected 180 COPD patients in stable stage,and found 52 cases of lung-spleen deficiency syndrome,45 cases of phlegm-dampness accumulation in the lung syndrome,44 cases of lung-spleen-kidney deficiency syndrome,and 39 cases of phlegm stasis and lung syndrome.The disease course of lung-spleen-Qi deficiency syndrome and lung-spleen-kidney-deficiency syndrome is mainly>20 years,the disease course of phlegm stasis lung syndrome was concentrated in 5~10 years,and the disease course of phlegm-dampness accumulation lung syndrome was mostly<5 years.The lung function grading of deficiency of lung and spleen was concentrated in gradeⅣ,the syndrome of phlegm-dampness in the lung and the syndrome of phlegm stasis in the lung were concentrated in gradeⅡ,and the syndrome of deficiency of lung,spleen and kidney was concentrated in gradeⅢ.The percentage of forced expiratory volume in 1 second to the predicted value(FEV1%Pred),FEV1/forced vital capacity(FVC),mMRC score,BODE index,inflammatory index and the number of acute exacerbations in the past 1 year were compared among the four groups and had academic significance(P<0.05).Among them,the FEV1%Pred and the FVC gradually increased according to the syndrome of lung-spleen-kidney deficiency,lung-spleen deficiency,phlegm blood stasis and phlegm dampness accumulation in the lung,while the mMRC score,the BODE index,the number of acute emergencies in the past 1 year,interleukin-2(IL-2),interleukin-4(IL-4)and tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)gradually decreased according to the syndrome of lung-spleen-kidney deficiency,lung-spleen deficiency,phlegm blood stasis and phlegm dampness accumulation in the lung.The level of interleukin-10(IL-10)in lung-spleen-kidney deficiency syndrome was higher than that in other syndrome types,with statistical significance(P<0.05).Conclusion:With the changes of phlegm-dampness in the lung,phlegm-stasis in the lung,lung-spleen-Qi deficiency syndrome to lung-spleen-kidney deficiency syndrome,the longer the course of the disease,the worse the lung function,the more severe the inflammation,and the more prone to acute attacks.
作者
康馨匀
付建梅
高娜
白洁
董闯
KANG Xinyun;FU Jianmei;GAO Na(Department of Respiratory,CNPC Central Hospital,Langfang Hebei 065000,China;Department of Endocrinology,CNPC Central Hospital,Langfang Hebei 065000,China)
出处
《四川中医》
2022年第12期48-52,共5页
Journal of Sichuan of Traditional Chinese Medicine
基金
廊坊市科技支撑计划项目(项目编号:2021013047,课题名称:COPD患者的运动干预方案构建及实践有效性研究,负责人:康馨匀)
关键词
稳定期
慢性阻塞性肺疾病
肺功能
炎症因子
Stable period
Chronic obstructive pulmonary disease
Lung function
Inflammatory factors
作者简介
第一作者及通讯作者:康馨匀,本科,研究方向:COPD相关,E-mail:candy_future@126.com。
