摘要
目的探讨间质性肺疾病(ILD)患者中医证型特点及与呼吸困难程度、肺功能之间的关系。方法采用横断面研究,采集2022年1月—2023年3月就诊于中日友好医院中医肺病一部门诊及病房、呼吸与危重症医学科三部病房诊断为ILD的患者资料,收集患者的一般资料、中医四诊信息、呼吸困难问卷(mMRC)分级、近期肺功能检查数据[用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、第1秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)、肺一氧化碳弥散量占预计值百分比(DLCO SB%pred)]、西医最终诊断,统计限制性通气功能、阻塞性通气功能、弥散功能分级情况,分析不同西医诊断类别的ILD患者中医证型分布特点,比较不同中医证型患者mMRC分级、肺功能及肺功能分级。结果纳入ILD患者203例,西医最终诊断为结缔组织病相关ILD 66例(32.5%),特发性肺纤维化22例(10.8%),其他已知原因及特发性ILD 43例(21.2%),不便分类的ILD 72例(35.5%),不同西医诊断患者的性别分布差异有统计学意义(P<0.05)。中医证型主证中肺气虚证占比最高,然后依次为阴虚肺燥证、肺肾气虚证、肺肾气阴两虚证;兼证中血瘀证占比最高,然后依次为痰湿证、痰热证。不同西医诊断类别患者中医主证和痰湿证分布情况差异均无统计学意义(P均>0.05),不同西医诊断类别患者痰热证、血瘀证分布情况差异均有统计意义(P均<0.05)。不同中医主证患者和是否兼有血瘀证患者的mMRC分级分布情况差异均有统计学意义(P均<0.05);中医主证中肺气虚证与肺肾气虚证、肺肾气阴两虚证患者mMRC分级分布情况比较和阴虚肺燥证与肺肾气虚证患者mMRC分级分布情况比较差异均有统计学意义(P均<0.05)。不同中医主证患者和有无血瘀证患者的FVC%pred、FEV_(1)%pred、DLCO SB%pred比较差异均有统计学意义(P均<0.05);中医主证中肺气虚证和阴虚肺燥证患者的FVC%pred与肺肾气虚证、肺肾气阴两虚证患者比较差异均有统计学意义(P均<0.05);肺气虚证患者的FEV_(1)%pred与肺肾气虚证、肺肾气阴两虚证患者比较差异均有统计学意义(P均<0.05),阴虚肺燥证患者的FEV_(1)%pred与肺肾气虚证患者比较差异有统计学意义(P<0.05);肺气虚证患者的DLCO SB%pred与阴虚肺燥证、肺肾气虚证、肺肾气阴两虚证患者比较差异均有统计学意义(P均<0.05)。结论ILD在疾病初始以肺气虚证为主,肺气虚证、阴虚肺燥证属ILD轻症,肺肾气虚证、肺肾气阴两虚证属ILD重症,随疾病进展,患者mMRC分级升高,肺功能降低;ILD患者多兼有血瘀证,兼有血瘀证的患者较无血瘀证的患者mMRC分级更高、肺功能更低。中医证型、mMRC分级、肺功能在评估患者呼吸困难程度上具有较好的同质性,能够相互参考、相互反映。
Objective It is to investigate the characteristics of traditional Chinese medicine(TCM)syndromes and their relationship with degree of dyspnea and lung function in patients with interstitial lung disease(ILD).Methods A cross-sectional study was used to collect data from patients diagnosed with ILD who visited the outpatient clinic and ward of the Department of TCM Lung Diseases Division I and the ward of the Department of Respiratory and Critical Care Medicine Division III of China-Japan Friendship Hospital from January 2022 to March 2023,and to collect the patients'general information,four diagnosis information of TCM,mMRC classification,and the data from the recent pulmonary function tests(FVC%pred,FEV_(1)%pred,FEV_(1)/FVC,and DLCO SB%pred),the final diagnosis of the western medicine,and the restrictive ventilation function,obstructive ventilation function,diffusion function classification were calculated,the distribution characteristics of TCM syndrome in ILD patients with different western medicine diagnostic types were analyzed,and the mMRC classification,lung function and pulmonary function classification in patients with different TCM syndromes were compared.Results Two hundreds and three patients with ILD were collected,their finally western medical diagnosis were as follows:66 cases(32.5%)with connective tissue disease-related ILD,22 cases(10.8%)with idiopathic pulmonary fibrosis,43 cases(21.2%)with other known causes and idiopathic ILD,and 72 cases(35.5%)with non-classified ILD,and the differences in the gender distribution among the patients with different western medical diagnosis were significant(all P<0.05).The proportion of lung Qi deficiency was the highest in the main TCM syndromes,followed by Yin deficiency with lung dryness,lung-kidney Qi deficiency,and lung-kidneyQi-Yin deficiency;the proportion of blood stasis was the highest in the accompanied syndromes,followed by phlegm-dampness and phlegm-heat.The differences in the distribution of TCM main syndromes and phlegm-dampness syndrome among patients with different western medical diagnostic types were not significant(all P>0.05),while the differences in phlegm-heat syndrome and blood stasis syndromes were significant(all P<0.05).The differences in the distribution of mMRC classification among patients with different main TCM syndromes and between patients with or without blood stasis were statistically significant(all P<0.05),the differences were also significant among patients with lung Qi deficiency and lung-kidney Qi deficiency,lung-kidney Qi-Yin deficiency,and between Yin deficiency and lung dryness and lung-kidney Qi deficiency(all P<0.05).The differences in FVC%pred,FEV_(1)%pred,and DLCO SB%pred among patients with different TCM main syndromes and between patients with or without blood stasis were statistically significant(all P<0.05);the differences in FVC%pred among patients with lung Qi deficiency syndrome and Yin deficiency with lung dryness in TCM main syndromes were statistically significant when compared with patients with lung-kidney Qi deficiency syndrome and lung-kidney Qi-Yin deficiency syndrome(all P<0.05);the differences in FEV_(1)%pred among patients with lung Qi deficiency syndrome,lung-kidney Qi deficiency syndrome and lung-kidney Qi-Yin syndrome were significant(all P<0.05),and the difference in FEV_(1)%pred was also significant between Yin deficiency with lung dryness syndrome and lung-kidney Qi deficiency syndrome(P<0.05);the differences in DLCO SB%pred of patients with lung Qi deficiency syndrome were significant when compared with those with Yin deficiency with lung dryness syndrome,lung-kidney Qi deficiency syndrome and lung-kidney Qi Yin deficiency syndrome(all P<0.05).Conclusion At the beginning of ILD,lung Qi deficiency is the main syndrome,lung Qi deficiency syndrome and Yin deficiency with lung dryness syndrome were mild ILD,and lung-kidney Qi deficiency syndrome,lung-kidney Qi-Yin deficiency were severe ILD.With the progression of the disease,the patients’mMRC classification increases and their lung function decreases;most patients with ILD accompanied with blood stasis syndrome,and their mMRC classification is higher while their lung function is worse compared with those without blood stasis.The TCM syndrome,mMRC classification and lung function have good homogeneity in evaluating the degree of dyspnea of patients,and can refer to and reflect each other.
作者
罗雪
孙放
张美怡
肖锶瑶
于洋
樊佳佳
闫家馨
张纾难
韩桂玲
LUO Xue;SUN Fang;ZHANG Meiyi;XIAO Siyao;YU Yang;FAN Jiajia;YAN Jiaxin;ZHANG Shunan;HAN Guiling(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;National Center for Respiratory Medicine/National Key Laboratory of Respiratory and Comorbidity/National Clinical Research Center for Respiratory Diseases/Research Institute of Respiratory Diseases,Chinese Academy of Medical Sciences/Department of TCM Lung Diseases Division I of Respiratory Center of China-Japan Friendship Hospital,Beijing 100029,China;Shanghai Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,Shanghai 201203,China;Shaanxi Provincial Hospital of Chinese Medicine,Xi’an 710003,Shaanxi,China)
出处
《现代中西医结合杂志》
CAS
2024年第4期444-451,共8页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
中央高水平医院临床科研业务费资助项目(2022-NHLHCRF-LX-01-0308)
中华中医药学会求实项目(2022-QNQSDEP-10)。
