AECOPD熱痰證與寒痰證患者病原學(xué)和炎癥特征的對比分析
發(fā)布時間：2018-07-31 12:46
【摘要】：目的:觀察慢性阻塞性肺疾病急性加重(AECOPD)熱痰證與寒痰證患者的病原學(xué)特征及炎癥指標(biāo)的差異,分析兩者證候與炎癥指標(biāo)的關(guān)系,為中西醫(yī)結(jié)合治療AECOPD提供一個新的思路。方法:①收集從2016年1月到2017年1月入住我科的AECOPD熱痰證和寒痰證患者,記錄兩組的年齡、性別、吸煙史、病程、急性加重時間和FEV1%pred等基本情況,對比兩組的異同。②檢測痰涂片、痰培養(yǎng)和呼吸道病原體譜(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(tuán)菌IgM抗體),比較熱痰組與寒痰組患者病原學(xué)特征的差異。③檢查痰液常規(guī)和血常規(guī),比較熱痰組與寒痰組患者痰中性粒細(xì)胞百分比、痰嗜酸性粒細(xì)胞百分比以及血中性粒細(xì)胞百分比的差異。④檢測患者入院時的FeNO、hsCRP、PCT,比較兩者之間的炎癥標(biāo)志物水平。⑤根據(jù)《2012慢性阻塞性肺疾病中醫(yī)診療指南》和《中醫(yī)量化診斷》,分別制定熱痰證和寒痰證患者的證候積分量表并填寫,分析AECOPD熱痰組與寒痰組患者證候與炎癥指標(biāo)的關(guān)系。結(jié)果:①本研究共納入AECOPD熱痰證組和寒痰證組患者各30例,兩組患者的年齡、性別、吸煙史、病程、急性加重時間和第一秒用力呼氣容積占預(yù)計值的百分比(FEV1%pred)相比差異無統(tǒng)計學(xué)意義(P0.05)。②熱痰組的細(xì)菌檢出率高于寒痰組,差異有統(tǒng)計學(xué)意義(P0.05),熱痰組細(xì)菌檢出以革蘭氏陰性菌為主;兩組革蘭氏陰性菌與革蘭氏陽性菌的構(gòu)成比無顯著性差異(P0.05);熱痰組的流感病毒B型血清學(xué)IgM抗體陽性率高于寒痰組,差異有統(tǒng)計學(xué)意義(P0.05),兩組的呼吸道合胞病毒、腺病毒、流感病毒A型、副流感病毒、肺炎支原體、肺炎衣原體、嗜肺軍團(tuán)菌的血清學(xué)IgM抗體陽性率對比,差異無統(tǒng)計學(xué)意義(P0.05)。③AECOPD熱痰組患者痰液以及血液的中性粒細(xì)胞百分比均顯著高于寒痰組患者,差異有統(tǒng)計學(xué)意義(P0.05),兩組的嗜酸性粒細(xì)胞百分比差異無統(tǒng)計學(xué)意義(P0.05)。④熱痰組患者的FeNO、hsCRP、PCT值均高于寒痰組,差異有統(tǒng)計學(xué)意義(P0.05)。⑤AECOPD熱痰組患者證候積分與hsCRP、PCT均呈正相關(guān),差異有統(tǒng)計學(xué)意義(P0.05),但證候積分與FeNO無直線相關(guān)關(guān)系(P00.05);寒痰組患者證候積分與hsCRP、PCT、FeNO無直線相關(guān)關(guān)系(P0.05)。結(jié)論:①AECOPD熱痰證患者的細(xì)菌檢出率高,以革蘭氏陰性菌為主,呼吸道病原體譜中流感病毒B型陽性率高;寒痰證患者的細(xì)菌和呼吸道病原體譜檢出率低。②AECOPD熱痰證患者炎癥水平較寒痰證患者高,故AECOPD熱痰證與寒痰證的辨證可選痰中性粒細(xì)胞、血中性粒細(xì)胞、超敏CRP、PCT、FeNO作為參考指標(biāo)。③AECOPD熱痰證患者的證候表現(xiàn)輕重與hsCRP和PCT存在一定的相關(guān)性,其可作為判斷AECOPD熱痰證患者證候輕重的客觀依據(jù)。
[Abstract]:Objective: to observe the etiological characteristics and inflammatory indexes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with heat phlegm syndrome and cold phlegm syndrome, analyze the relationship between the syndromes and inflammatory indexes, and provide a new idea for the treatment of AECOPD with combination of traditional Chinese and western medicine. Methods from January 2016 to January 2017, we collected AECOPD patients with hot phlegm syndrome and cold phlegm syndrome, and recorded their age, sex, smoking history, course of disease, acute exacerbation time and FEV1%pred. The sputum smear, sputum culture and 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) were compared between the two groups. Anti parainfluenza virus IgM antibody, anti mycoplasma pneumoniae IgM antibody, anti chlamydia pneumoniae IgM antibody and anti Legionella pneumophila IgM antibody). To compare the percentage of neutrophil in phlegm group and cold phlegm group, Percentage of eosinophil in sputum and percentage of neutrophil in blood "Quantification diagnosis of TCM", the syndrome integral scale of patients with heat phlegm syndrome and cold phlegm syndrome was developed and filled in, To analyze the relationship between syndromes and inflammatory indexes in AECOPD hot phlegm group and cold phlegm group. Results the study included 30 cases of AECOPD heat phlegm syndrome group and 30 cold phlegm syndrome group each. The age, sex, smoking history, course of disease of the two groups were analyzed. There was no significant difference in the acute exacerbation time and the percentage of forced expiratory volume in the first second (FEV1%pred) between the two groups (P0.05). The positive rate of bacteria in the hot sputum group was higher than that in the cold sputum group. The difference was statistically significant (P0.05), the bacteria in the hot sputum group were mainly Gram-negative bacteria, the composition ratio of Gram-negative bacteria and Gram-positive bacteria in the two groups had no significant difference (P0.05); the positive rate of influenza B serological IgM antibody in the hot phlegm group was higher than that in the cold phlegm group, the positive rate of influenza B serological IgM antibody in the hot phlegm group was higher than that in the cold phlegm group. The difference was statistically significant (P0.05). The serological IgM antibody positive rates of respiratory syncytial virus, adenovirus, influenza virus A, parainfluenza virus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila were compared between the two groups. The percentage of neutrophil in sputum and blood was significantly higher in AECOPD group than in cold sputum group. There was no significant difference in eosinophil percentage between the two groups (P0.05). The PCT values of FeNO-hsCRPnc-PCT in febrile phlegm group were significantly higher than those in cold phlegm group (P0.05). There was a positive correlation between the syndrome score and hsCRPnPCT in AECOPD febrile phlegm group (P0.05), and there was no significant difference in eosinophilic granulocyte percentage between the two groups (P0.05). The difference was statistically significant (P0.05), but there was no linear correlation between syndromes score and FeNO (P0. 05), and there was no linear correlation between syndromes score and hsCRP- PCT- FeNO in cold phlegm group (P0.05). Conclusion the detection rate of bacteria in the patients with W1 AECOPD fever and phlegm syndrome is high, mainly Gram-negative bacteria, and the positive rate of influenza virus B in respiratory pathogen spectrum is high. The detection rate of bacteria and respiratory tract pathogens in patients with cold phlegm syndrome is low. 2. 2AECOPD patients with heat phlegm syndrome have higher inflammatory level than those with cold phlegm syndrome, so the differentiation of AECOPD heat phlegm syndrome and cold phlegm syndrome can choose phlegm neutrophil and blood neutrophil. The syndromes of patients with hyper-sensitive CRP- PCT- FeNO as a reference index. 3AECOPD patients with phlegm syndrome have a certain correlation with hsCRP and PCT, which can be used as an objective basis to judge the severity of syndrome of AECOPD patients with hot phlegm syndrome.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.9
本文編號：2155625
[Abstract]:Objective: to observe the etiological characteristics and inflammatory indexes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with heat phlegm syndrome and cold phlegm syndrome, analyze the relationship between the syndromes and inflammatory indexes, and provide a new idea for the treatment of AECOPD with combination of traditional Chinese and western medicine. Methods from January 2016 to January 2017, we collected AECOPD patients with hot phlegm syndrome and cold phlegm syndrome, and recorded their age, sex, smoking history, course of disease, acute exacerbation time and FEV1%pred. The sputum smear, sputum culture and 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) were compared between the two groups. Anti parainfluenza virus IgM antibody, anti mycoplasma pneumoniae IgM antibody, anti chlamydia pneumoniae IgM antibody and anti Legionella pneumophila IgM antibody). To compare the percentage of neutrophil in phlegm group and cold phlegm group, Percentage of eosinophil in sputum and percentage of neutrophil in blood "Quantification diagnosis of TCM", the syndrome integral scale of patients with heat phlegm syndrome and cold phlegm syndrome was developed and filled in, To analyze the relationship between syndromes and inflammatory indexes in AECOPD hot phlegm group and cold phlegm group. Results the study included 30 cases of AECOPD heat phlegm syndrome group and 30 cold phlegm syndrome group each. The age, sex, smoking history, course of disease of the two groups were analyzed. There was no significant difference in the acute exacerbation time and the percentage of forced expiratory volume in the first second (FEV1%pred) between the two groups (P0.05). The positive rate of bacteria in the hot sputum group was higher than that in the cold sputum group. The difference was statistically significant (P0.05), the bacteria in the hot sputum group were mainly Gram-negative bacteria, the composition ratio of Gram-negative bacteria and Gram-positive bacteria in the two groups had no significant difference (P0.05); the positive rate of influenza B serological IgM antibody in the hot phlegm group was higher than that in the cold phlegm group, the positive rate of influenza B serological IgM antibody in the hot phlegm group was higher than that in the cold phlegm group. The difference was statistically significant (P0.05). The serological IgM antibody positive rates of respiratory syncytial virus, adenovirus, influenza virus A, parainfluenza virus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila were compared between the two groups. The percentage of neutrophil in sputum and blood was significantly higher in AECOPD group than in cold sputum group. There was no significant difference in eosinophil percentage between the two groups (P0.05). The PCT values of FeNO-hsCRPnc-PCT in febrile phlegm group were significantly higher than those in cold phlegm group (P0.05). There was a positive correlation between the syndrome score and hsCRPnPCT in AECOPD febrile phlegm group (P0.05), and there was no significant difference in eosinophilic granulocyte percentage between the two groups (P0.05). The difference was statistically significant (P0.05), but there was no linear correlation between syndromes score and FeNO (P0. 05), and there was no linear correlation between syndromes score and hsCRP- PCT- FeNO in cold phlegm group (P0.05). Conclusion the detection rate of bacteria in the patients with W1 AECOPD fever and phlegm syndrome is high, mainly Gram-negative bacteria, and the positive rate of influenza virus B in respiratory pathogen spectrum is high. The detection rate of bacteria and respiratory tract pathogens in patients with cold phlegm syndrome is low. 2. 2AECOPD patients with heat phlegm syndrome have higher inflammatory level than those with cold phlegm syndrome, so the differentiation of AECOPD heat phlegm syndrome and cold phlegm syndrome can choose phlegm neutrophil and blood neutrophil. The syndromes of patients with hyper-sensitive CRP- PCT- FeNO as a reference index. 3AECOPD patients with phlegm syndrome have a certain correlation with hsCRP and PCT, which can be used as an objective basis to judge the severity of syndrome of AECOPD patients with hot phlegm syndrome.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.9
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