弥漫性肺间质疾病急性加重期61例中医特征分析
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摘要
目的分析总结61例弥漫性肺间质疾病急性加重期(AE-DPLD)患者的中医证候特征。方法对2013年1月—2017年5月笔者所在医院住院的AE-DPLD患者61例的中医证候特征进行分析,同时分析中医证候与西医临床特征的关系。结果 61例AE-DPLD患者所占比例较高的前5位证候类型包括:脾肺气虚证、痰湿内阻证、气阴两虚证、湿热内阻证、中气下陷证,寒证、虚证所占比例较高,病位在肺、脾者所占比例较高。接受中药内服治疗者60例,共涉及38个方剂,以益气养阴、温阳化湿为主要功效者所占比例最高。临床表现为发热的患者,气阴两虚证所占比例最高。影像学表现为普通型间质性肺炎(UIP)患者,气阴两虚证所占比例最高;影像学表现为机化性肺炎(OP)患者,热证、表证所占比例高于UIP及非特异性间质性肺炎(NSIP)患者。低氧血症患者中脾肺气虚证所占比例最高。应用机械通气的患者,病位累及肾者所占比例高于未应用机械通气者。转归差者以虚证为主。结论气虚、痰湿是AE-DPLD患者的主要证型表现,肺、脾是主要病位,治法以益气养阴、温阳化湿为主。
Objective To analyze TCM syndrome characteristics of 61 patients with acute exacerbation of diffuse parenchymal lung diseases(AE-DPLD).Methods From January 2013 to May 2017,the characteristics of TCM syndromes and the correlation between TCM syndromes and the clinical features of western medicine in 61 hospitalized patients with AE-DPLD in our hospital were analyzed. Results The first five types of TCM syndromes with higher proportion were: spleen-lung qi deficiency syndrome,interior obstruction of phlegm-damp syndrome,Qi-Yin deficiency syndrome,interior obstruction of dampness-heat syndrome,middle Qi collapse syndrome,cold syndrome and deficiency syndrome occupied the highest proportion,the disease location in lung and spleen were higher. 60 cases were treated with internally taking Chinese herbal medicine with a total of 38 prescriptions involved. Tonifying Qi and nourishing Yin,warming yang and drying dampness were mostly used. Among those with fever,deficiency of qi and yin were seen most. Heat syndrome and exterior syndrome were most found in OP patient in image more than that in UIP an NSIP patient. Among the patients with hypoxemia,spleen-lung qi deficiency syndrome were most found. Kidney was most involved among the patients with use of mechanical ventilation more than without use of mechanical ventilation. Prognosis was poorer in deficiency syndrome. Conclusion Qi deficiency and phlegm-damp syndrome are dominant pathogenic manifestation among 61 cases of AE-DPLD.Lung and spleen are major disease locations.The mainly therapeutic methods are tonifying Qi nourishing Yin,and warming yang and dry dampness.
Objective To analyze TCM syndrome characteristics of 61 patients with acute exacerbation of diffuse parenchymal lung diseases(AE-DPLD).Methods From January 2013 to May 2017,the characteristics of TCM syndromes and the correlation between TCM syndromes and the clinical features of western medicine in 61 hospitalized patients with AE-DPLD in our hospital were analyzed. Results The first five types of TCM syndromes with higher proportion were: spleen-lung qi deficiency syndrome,interior obstruction of phlegm-damp syndrome,Qi-Yin deficiency syndrome,interior obstruction of dampness-heat syndrome,middle Qi collapse syndrome,cold syndrome and deficiency syndrome occupied the highest proportion,the disease location in lung and spleen were higher. 60 cases were treated with internally taking Chinese herbal medicine with a total of 38 prescriptions involved. Tonifying Qi and nourishing Yin,warming yang and drying dampness were mostly used. Among those with fever,deficiency of qi and yin were seen most. Heat syndrome and exterior syndrome were most found in OP patient in image more than that in UIP an NSIP patient. Among the patients with hypoxemia,spleen-lung qi deficiency syndrome were most found. Kidney was most involved among the patients with use of mechanical ventilation more than without use of mechanical ventilation. Prognosis was poorer in deficiency syndrome. Conclusion Qi deficiency and phlegm-damp syndrome are dominant pathogenic manifestation among 61 cases of AE-DPLD.Lung and spleen are major disease locations.The mainly therapeutic methods are tonifying Qi nourishing Yin,and warming yang and dry dampness.
引文
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[9] 景海卿, 付义.从“宗气亏虚”探讨间质性肺疾病的中医辨治[J].光明中医, 2015, 30(11):2275-2276.
[10] 章九红, 李文泉, 张镭, 等.间质性肺疾病中医证候与影像学特征临床观察[J].辽宁中医药大学学报,2014, 16(12):78-80.
[2] Natsuizaka M, Chiba H, Kuronuma K,et al.Epidemiologic survey of Japanese patients with idiopathic pulmonary fibrosis and investigation of ethnic differences[J].Am J Respir Crit Care Med, 2014,190(7):773-779.
[3] Kishaba T, Tamaki H, Shimaoka Y, et al.Staging of acute exacerbation in patients with idiopathic pulmonary fibrosis[J].Lung, 2014,192(1):141-149.
[4] 程绍恩.中医证候诊断治疗学[M].北京科学技术出版社,1993.
[5] 国家技术监督局.GB/T 16751.2-1997.中医临床诊疗术语:证候部分[S].北京:中国标准出版社, 1997.
[6] 中华医学会呼吸病学分会间质性肺疾病学组.特发性肺纤维化诊断和治疗中国专家共识[J].中华结核和呼吸杂志, 2016,30(6):427-432.
[7] 唐玲华, 王冰.肺间质纤维化急性发作期的中医辨治[J].中国中医急症, 2010, 19(3):440,442.
[8] 马桂琴.运用“象”思维辨治结缔组织病继发肺间质纤维化[J].中医杂志, 2013, 54(10):884-885.
[9] 景海卿, 付义.从“宗气亏虚”探讨间质性肺疾病的中医辨治[J].光明中医, 2015, 30(11):2275-2276.
[10] 章九红, 李文泉, 张镭, 等.间质性肺疾病中医证候与影像学特征临床观察[J].辽宁中医药大学学报,2014, 16(12):78-80.