本文選題：慢性阻塞性肺疾病　切入點(diǎn)：臨床表型　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:通過(guò)收集慢性阻塞性肺病(COPD)患者的的臨床基本資料、病史、體征、輔助檢查及中醫(yī)體質(zhì)情況,歸納慢阻肺患者的臨床表型與中醫(yī)體質(zhì)情況,以研究不同臨床表型患者中醫(yī)體質(zhì)的分布規(guī)律及二者的相關(guān)性,為慢性阻塞性肺疾病的診斷和個(gè)體化治療提供依據(jù)。方法:對(duì)2015年1月至2015年12月間于山東省中醫(yī)院呼吸科住院診斷為COPD的患者進(jìn)行病歷查閱及問(wèn)卷調(diào)查,獲取患者的基本情況(性別、年齡、個(gè)人史、既往史、等),臨床表型要素(COPD病史、吸煙指數(shù)、每年急性加重次數(shù)、呼吸困難指數(shù)(mMRC)、癥狀體征、影像特征、合并癥)、中醫(yī)體質(zhì)要素等,將COPD患者進(jìn)行臨床表型及中醫(yī)體質(zhì)的分類(lèi),應(yīng)用SPSS 21進(jìn)行數(shù)據(jù)統(tǒng)計(jì),分析COPD患者的臨床癥候特點(diǎn)并通過(guò)對(duì)應(yīng)分析法探究不同表型與中醫(yī)體質(zhì)之間的相關(guān)性。結(jié)果:1.納入本研究的241例病例中,COPD表型與中醫(yī)體質(zhì)之間的卡方值為82.878,P=0.0000.05,說(shuō)明COPD表型與中醫(yī)體質(zhì)之間有顯著的相關(guān)性。2.不同臨床表型患者中醫(yī)體質(zhì)的分布規(guī)律:非頻繁急性加重表型患者以濕熱質(zhì)為最多,其次分別為陰虛質(zhì)、氣虛質(zhì)、痰濕質(zhì),哮喘慢阻肺重疊表型患者中特稟質(zhì)占大多數(shù),其次為陽(yáng)虛質(zhì)及痰濕質(zhì),以肺氣腫為主的頻繁急性加重表型患者以氣虛質(zhì)為最多,其余幾種主要體質(zhì)的分布無(wú)明顯差異,以慢支為主的頻繁急性加重表型患者以濕熱質(zhì)最多,其次為痰濕質(zhì)、陰虛質(zhì)。3.不同臨床表型與中醫(yī)體質(zhì)之間在散點(diǎn)圖上的距離:非頻繁急性加重表型與陰虛質(zhì)距離最近,哮喘慢阻肺重疊表型與特稟質(zhì)距離最近,以肺氣腫為主的頻繁急性加重表型與氣虛質(zhì)距離最近,以慢支為主的頻繁急性加重表型距離與濕熱質(zhì)距離最近。結(jié)論:COPD臨床表型與中醫(yī)體質(zhì)之間有密切的聯(lián)系,非頻繁急性加重表型與陰虛質(zhì)關(guān)系最密切,哮喘慢阻肺重疊表型與特稟質(zhì)關(guān)系最密切,以肺氣腫為主的頻繁急性加重表型與氣虛質(zhì)關(guān)系最密切,以慢支為主的頻繁急性加重表型與濕熱質(zhì)關(guān)系最密切。
[Abstract]:Objective: to summarize the phenotype and physique of chronic obstructive pulmonary disease (COPD) patients by collecting the basic clinical data, medical history, physical signs, auxiliary examination and physique of TCM. In order to study the distribution law of TCM constitution and the correlation between them in different clinical phenotypes, Methods: from January 2015 to December 2015, the patients diagnosed as COPD in Department of Respiratory, Shandong traditional Chinese Medicine Hospital were investigated by medical records and questionnaires. To obtain the basic conditions of the patients (sex, age, personal history, past history, et al., clinical phenotypic factors such as COPD history, smoking index, acute exacerbation times per year, dyspnea index mMRC, symptoms and signs, imaging features, etc.). The clinical phenotype and TCM constitution of COPD patients were classified, and SPSS 21 was used to carry out data statistics. The clinical symptom characteristics of COPD patients were analyzed and the correlation between different phenotypes and TCM physique was explored by correspondence analysis. Results: 1. The chi-square value between phenotype of COPD and TCM constitution was 82.878P0.0000.05, which indicated that the correlation between phenotype of COPD and TCM constitution was 82.878p 0.0000.05. There was significant correlation between COPD phenotype and TCM physique. 2. The distribution of TCM constitution in different clinical phenotypes: the most frequent acute exacerbation phenotypes were dampness and heat. The second was yin deficiency, qi deficiency, phlegm and dampness. The most of the patients with superposition phenotype of asthmatic slow obstructive lung, the second were yang deficiency and phlegm dampness, and the most frequent acute exacerbation phenotypes were emphysema, and the most frequent acute exacerbation phenotypes were emphysema. There was no significant difference in the distribution of other major physiques. The most frequent acute exacerbation phenotypes were slow bronchitis, followed by phlegm, heat and heat, followed by phlegm and dampness. The distance between different clinical phenotypes and TCM physique on scatter plot: the distance between infrequent acute exacerbation phenotype and yin deficiency type, the overlap phenotype of asthmatic slow obstructive lung and the intrinsic character, The frequent acute exacerbation phenotype with emphysema is the closest to the deficiency of qi, and the frequent acute exacerbation with slow bronchitis is the closest to the moist heat and heat. Conclusion there is a close relationship between the clinical phenotype of COPD and the constitution of TCM. The phenotype of infrequent acute aggravation was most closely related to deficiency of yin, the overlap phenotype of chronic obstructive lung of asthma was most closely related to intrinsic quality, and the phenotype of frequent acute exacerbation of emphysema was most closely related to deficiency of qi. The frequent acute exacerbation phenotypes, mainly of slow bronchioles, are most closely related to heat and humidity.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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