本文關鍵詞：COPD合并CAP熱痰證與寒痰證患者病原學和炎癥特征探討　出處：《福建中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 慢性阻塞性肺疾病 社區(qū)獲得性肺炎 炎癥 痰證 證候特征

【摘要】：目的:觀察慢性阻塞性肺疾病合并社區(qū)獲得性肺炎熱痰證患者與寒痰證患者的病原學和炎癥特征,對比兩者的異同點。分別分析熱痰證證候積分、寒痰證證候積分與炎癥指標的關系,為臨床差異性治療方案提供新的思路。方法:收集2016年1月至2017年1月入住福建中醫(yī)藥大學附屬人民醫(yī)院肺病科的COPD合并CAP患者。按照熱痰證和寒痰證的中醫(yī)辨證標準分別納入熱痰證組和寒痰證組,采集兩組病例的性別、年齡、身高、體重、病程、吸煙指數等一般資料,并檢測血常規(guī)、Hs-CRP、PCT、呼吸道病原體譜(抗呼吸道合胞病毒IgM抗體、抗腺病毒IgM抗體、抗流感病毒A型IgM抗體、抗流感病毒B型IgM抗體、抗副流感病毒IgM抗體、抗肺炎支原體IgM抗體、抗肺炎衣原體IgM抗體、抗嗜肺軍團菌IgM抗體)、痰培養(yǎng)、肺功能(FEV1/FVC%、FEV1%pred)、FeNO等指標。對比熱痰證組和寒痰證組上述指標的差異,分別分析熱痰證組和寒痰證組上述指標與各自證候積分的相關性。結果:本研究共納入COPD合并CAP患者60例,其中熱痰證組30例,寒痰證組30例。①兩組患者的性別、年齡、病程、BMI、吸煙指數無統計學差異(P0.05),具有可比性。②熱痰證組痰培養(yǎng)陽性率高于寒痰證組,而呼吸道病原體譜陽性率低于寒痰證組,但差異無統計學意義(P0.05)。③熱痰證組NE%、Hs-CRP、PCT高于寒痰證組,LY%低于寒痰證組,差異均具有統計學意義(P0.05);兩組在FeNO改變上沒有顯著性差異(P0.05)。④熱痰證組FEV1%pred低于寒痰證組,差異有統計學意義(P0.05)。⑤熱痰證證候積分與Hs-CRP、PCT呈正相關;寒痰證證候積分與WBC、NE%呈負相關,差異均有統計學意義(P0.05)。結論:①COPD合并CAP熱痰證的炎癥水平高于寒痰證。②COPD合并CAP熱痰證的氣流受限程度較寒痰證明顯。③COPD合并CAP熱痰證和寒痰證患者的證候輕重均與炎癥程度存在相關性。Hs-CRP、PCT可協助判斷COPD合并CAP熱痰證的證候輕重,而WBC、NE%有助于COPD合并CAP寒痰證證候輕重的判斷。
[Abstract]:Objective: to observe the etiological and inflammatory characteristics of patients with chronic obstructive pulmonary disease (COPD) complicated with community acquired pneumonia with heat phlegm syndrome and cold phlegm syndrome. The relationship between syndrome integral of cold phlegm syndrome and inflammation index. To provide a new way of thinking for clinical differential treatment. Methods:. From January 2016 to January 2017, we collected COPD patients with CAP who were admitted to the Department of Pulmonary Diseases, people's Hospital affiliated to Fujian University of traditional Chinese Medicine. According to the TCM syndrome differentiation criteria of heat phlegm and cold phlegm respectively, we included heat phlegm. Syndrome group and cold phlegm syndrome group. The data of sex, age, height, weight, course of disease and smoking index were collected. Respiratory pathogen spectrum (anti-respiratory syncytial virus IgM antibody, anti-adenovirus IgM antibody, anti-influenza virus type A IgM antibody, anti-influenza virus type B IgM antibody, anti-parainfluenza virus IgM antibody). Anti mycoplasma IgM antibody, anti Chlamydia pneumoniae IgM antibody, anti Legionella pneumoniae IgM antibody, sputum culture, pulmonary function and FEV1 / FVC1pred. FeNO and other indicators. Compared the heat phlegm syndrome group and cold phlegm syndrome group of the above indicators. Results: 60 cases of COPD combined with CAP were included in this study, including 30 cases of heat phlegm syndrome group and 30 cases of heat phlegm syndrome group. There was no significant difference in sex, age, course of disease and smoking index between the two groups in 30 cases of cold phlegm syndrome group (P 0.05). The sputum culture positive rate in heat phlegm syndrome group was higher than that in cold phlegm syndrome group. But the positive rate of pathogen spectrum in respiratory tract was lower than that in cold phlegm syndrome group, but there was no significant difference between the two groups (P 0.05.3). The positive rate of Hs-CRP PCT in heat phlegm syndrome group was higher than that in cold phlegm syndrome group. LY% was lower than that of cold phlegm syndrome group, the difference was statistically significant (P 0.05). There was no significant difference in FeNO between the two groups. The FEV1%pred of the phlegm syndrome group was lower than that of the cold phlegm syndrome group. There was a positive correlation between the score of heat phlegm syndrome and Hs-CRP PCT. There was a negative correlation between the score of cold phlegm syndrome and WBCN%. The difference was statistically significant (P0.05). ... conclusion:. 1the inflammatory level of CAP with heat phlegm syndrome is higher than that of cold phlegm syndrome. 2 the airflow limitation degree of COPD with CAP hot phlegm syndrome is more obvious than that of cold phlegm syndrome. 3 COPD patients with CAP heat phlegm syndrome and cold phlegm syndrome. The severity of syndromes were correlated with the degree of inflammation. Hs-CRP. PCT can help to judge the severity of COPD combined with CAP hot phlegm syndrome, while WBCN% is helpful to judge the severity of COPD combined with CAP cold phlegm syndrome.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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