慢性阻塞性肺疾病稳定期中医证候与理化检测指标的相关性研究

摘要

目的 探讨5个慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期常见的证候(肺气虚、肺肾气虚、肺脾气虚、痰湿蕴肺、痰瘀阻肺)与相关检测指标的关系.方法 在中日友好医院中医肺病科和呼吸科门诊和病房经过筛选共收69例符合条件的COPD患者,将患者分为5组(肺气虚组、肺肾气虚组、肺脾气虚组、痰湿蕴肺组、痰瘀阻肺组)采用呼吸困难分级评分(modified british medical research Council,mMRC)调查表和COPD患者生活质量评估问卷(COPD assessment test,CAT)对患者健康状况调查,血常规、血生化、血气分析、肺功能,将5组的资料进行统计学分析.结果 (1)痰湿蕴肺组患者白细胞比痰瘀阻肺组、肺气虚组、肺脾气虚组、肺肾气虚组高,经统计学分析结果均有差异(P<0.05);痰湿蕴肺组患者中性粒细胞百分率比肺脾气虚组高,经统计学分析结果均有差异(P<0.05).(2)肺肾气虚组的总胆固醇(total cholesterol,TC)比肺气虚组、肺脾气虚组、痰湿蕴肺组高,差异有统计学意义(P<0.05);痰瘀阻肺组的总胆固醇比肺气虚组、肺脾气虚组、痰湿蕴肺组高,经统计学分析结果有差异(P<0.05);痰瘀阻肺组的低密度脂蛋白(low density lipoprotein,LDL)比肺气虚组、肺肾气虚组、肺脾气虚组、痰湿蕴肺组高,经统计学分析结果均有差异(P<0.05).(3)肺肾气虚组患者的用力肺活量(forced vital capacity,FVC)和一秒用力呼气容积(forced expiratory volume in one second,FEV1)比肺气虚组、肺脾气虚组、痰湿蕴肺组低,差异有统计学意义(P<0.05);痰瘀阻肺组患者肺功能FVC、FEV1比肺气虚组、肺脾气虚组低,经统计学分析结果有差异(P<0.05);痰湿蕴肺组的肺功能FEV1比肺气虚组低,经统计学分析结果均有差异(P<0.05);肺肾气虚组的肺功能FEV1/FVC比肺气虚组、肺脾气虚组低,经统计学分析结果均有差异(P<0.05).(4)肺肾气虚组的血氧分压比肺气虚组、肺脾气虚组、痰湿蕴肺组、痰瘀阻肺组低,经统计学分析结果有差异(P<0.05).肺肾气虚组的血二氧化碳分压比肺气虚组、肺脾气虚组、痰湿蕴肺组,痰瘀阻肺组高,经统计学分析结果均有差异(P<0.05).(5)痰瘀阻肺组的mMRC比肺气虚组、肺脾气虚组、痰湿蕴肺组高;肺肾气虚组的mMRC比肺气虚组高,经统计学分析结果均有差异(P<0.05).肺气虚组的CAT比肺肾气虚组、痰瘀阻肺组、痰湿蕴肺组低,经统计学分析结果有差异(P<0.05).结论 研究说明随着COPD患者病情的进展和复杂化,中医证候的理化检测指标亦可出现不同程度的变化.%Objective To study the relationship of common syndromes(Feiqixu, Feishenqixu, Feipiqixu, Tanshiyunfei, Tanyuzufei) of chronic obstructive pulmonary disease (COPD) in stable phase with the related indicators.Methods 69 cases of eligible patients with COPD in pneumology department and lung disease of China-Japan friendship hospital were filtered, the patients were divided into 5 groups (Feiqixu group, Feishenqixu group, Feipiqixu group, Tanshiyunfei group, Tanyuzufei group), breathing difficulties classification score (mMRC) questionnaire and COPD patients quality of life assessment questionnaire (CAT) was used to investigate patients' health, blood routine, blood biochemistry, blood gas analysis, pulmonary function.The data of 5 groups were analysed statistically.Results (1) WBC of Tanshiyunfei group was higher than Tanyuzufei group, Feiqixu group, Feipiqixu group and Feishenqixu group, results had significant difference (P<0.05).NEUT % of Tanshiyunfei group was higher than Feipiqixu group, results have significant difference (P<0.05).(2) Total cholesterol of Feishenqixu group was higher than Feiqixu group, Feipiqixu group and Tanshiyunfei group.total cholesterol of Tanyuzufei group was higher than Feiqixu group, Feipiqixu group and Tanshiyunfei group, results had significant difference (P<0.05).LDL-C of Tanyuzufei group blood was higher than Feiqixu group, Feishenqixu group and Feipiqixu group, results had significant difference (P<0.05).(3) Forced vital capacity and forced expiratory volume in one second of Feishenqixu group was lower than Feiqixu group, Feipiqixu group, Tanshiyunfei group is low and Tanyuzufei group, results had significant difference (P<0.05).FVC and FEV1 of Feishenqixu group was lower than Feiqixu group, Feipiqixu group and Tanshiyunfei group;FEV1 of Tanyuzufei group was lower than Feiqixu group,results had significant difference (P<0.05).FEV1 / FVC of Feishenqixu group was lower than Feiqixu group and Feipiqixu group, results had significant difference (P<0.05).(4) Blood PaO2 of Feishenqixu group was higher than Feiqixu group, Feipiqixu group, Tanshiyunfei group and Tanyuzufei group, results had significant difference (P<0.05).PaCO2 of Feishenqixu group was higher than Feiqixu group, Feipiqixu group, Tanshiyunfei group and Tanyuzufei group, results had significant difference (P<0.05).(5) mMRC of Tanyuzufei group was higher than Feiqixu group, Feipiqixu group and Tanshiyunfei group.mMRC of Feishenqixu group was higer than Feiqixu group, results had significant differences (P<0.05).CAT of Feiqixu group was lower than Feishenqixu group, Tanyuzufei group and Tanshiyunfei group, the results had significant difference (P<0.05).Conclusion The results show that the physical and chemical indexes of TCM syndrome can be changed to varying degrees with the development and complication of COPD.