COPD合并CAP热痰证与寒痰证患者病原学和炎症特征探讨

发布时间：2017-12-31 02:16

本文关键词：COPD合并CAP热痰证与寒痰证患者病原学和炎症特征探讨　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察慢性阻塞性肺疾病合并社区获得性肺炎热痰证患者与寒痰证患者的病原学和炎症特征,对比两者的异同点。分别分析热痰证证候积分、寒痰证证候积分与炎症指标的关系,为临床差异性治疗方案提供新的思路。方法:收集2016年1月至2017年1月入住福建中医药大学附属人民医院肺病科的COPD合并CAP患者。按照热痰证和寒痰证的中医辨证标准分别纳入热痰证组和寒痰证组,采集两组病例的性别、年龄、身高、体重、病程、吸烟指数等一般资料,并检测血常规、Hs-CRP、PCT、呼吸道病原体谱(抗呼吸道合胞病毒IgM抗体、抗腺病毒IgM抗体、抗流感病毒A型IgM抗体、抗流感病毒B型IgM抗体、抗副流感病毒IgM抗体、抗肺炎支原体IgM抗体、抗肺炎衣原体IgM抗体、抗嗜肺军团菌IgM抗体)、痰培养、肺功能(FEV1/FVC%、FEV1%pred)、FeNO等指标。对比热痰证组和寒痰证组上述指标的差异,分别分析热痰证组和寒痰证组上述指标与各自证候积分的相关性。结果:本研究共纳入COPD合并CAP患者60例,其中热痰证组30例,寒痰证组30例。①两组患者的性别、年龄、病程、BMI、吸烟指数无统计学差异(P0.05),具有可比性。②热痰证组痰培养阳性率高于寒痰证组,而呼吸道病原体谱阳性率低于寒痰证组,但差异无统计学意义(P0.05)。③热痰证组NE%、Hs-CRP、PCT高于寒痰证组,LY%低于寒痰证组,差异均具有统计学意义(P0.05);两组在FeNO改变上没有显著性差异(P0.05)。④热痰证组FEV1%pred低于寒痰证组,差异有统计学意义(P0.05)。⑤热痰证证候积分与Hs-CRP、PCT呈正相关;寒痰证证候积分与WBC、NE%呈负相关,差异均有统计学意义(P0.05)。结论:①COPD合并CAP热痰证的炎症水平高于寒痰证。②COPD合并CAP热痰证的气流受限程度较寒痰证明显。③COPD合并CAP热痰证和寒痰证患者的证候轻重均与炎症程度存在相关性。Hs-CRP、PCT可协助判断COPD合并CAP热痰证的证候轻重,而WBC、NE%有助于COPD合并CAP寒痰证证候轻重的判断。
[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.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】