AECOPD热痰证与寒痰证患者病原学和炎症特征的对比分析
发布时间：2018-07-31 12:46
【摘要】：目的:观察慢性阻塞性肺疾病急性加重(AECOPD)热痰证与寒痰证患者的病原学特征及炎症指标的差异,分析两者证候与炎症指标的关系,为中西医结合治疗AECOPD提供一个新的思路。方法:①收集从2016年1月到2017年1月入住我科的AECOPD热痰证和寒痰证患者,记录两组的年龄、性别、吸烟史、病程、急性加重时间和FEV1%pred等基本情况,对比两组的异同。②检测痰涂片、痰培养和呼吸道病原体谱(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),比较热痰组与寒痰组患者病原学特征的差异。③检查痰液常规和血常规,比较热痰组与寒痰组患者痰中性粒细胞百分比、痰嗜酸性粒细胞百分比以及血中性粒细胞百分比的差异。④检测患者入院时的FeNO、hsCRP、PCT,比较两者之间的炎症标志物水平。⑤根据《2012慢性阻塞性肺疾病中医诊疗指南》和《中医量化诊断》,分别制定热痰证和寒痰证患者的证候积分量表并填写,分析AECOPD热痰组与寒痰组患者证候与炎症指标的关系。结果:①本研究共纳入AECOPD热痰证组和寒痰证组患者各30例,两组患者的年龄、性别、吸烟史、病程、急性加重时间和第一秒用力呼气容积占预计值的百分比(FEV1%pred)相比差异无统计学意义(P0.05)。②热痰组的细菌检出率高于寒痰组,差异有统计学意义(P0.05),热痰组细菌检出以革兰氏阴性菌为主;两组革兰氏阴性菌与革兰氏阳性菌的构成比无显著性差异(P0.05);热痰组的流感病毒B型血清学IgM抗体阳性率高于寒痰组,差异有统计学意义(P0.05),两组的呼吸道合胞病毒、腺病毒、流感病毒A型、副流感病毒、肺炎支原体、肺炎衣原体、嗜肺军团菌的血清学IgM抗体阳性率对比,差异无统计学意义(P0.05)。③AECOPD热痰组患者痰液以及血液的中性粒细胞百分比均显著高于寒痰组患者,差异有统计学意义(P0.05),两组的嗜酸性粒细胞百分比差异无统计学意义(P0.05)。④热痰组患者的FeNO、hsCRP、PCT值均高于寒痰组,差异有统计学意义(P0.05)。⑤AECOPD热痰组患者证候积分与hsCRP、PCT均呈正相关,差异有统计学意义(P0.05),但证候积分与FeNO无直线相关关系(P00.05);寒痰组患者证候积分与hsCRP、PCT、FeNO无直线相关关系(P0.05)。结论:①AECOPD热痰证患者的细菌检出率高,以革兰氏阴性菌为主,呼吸道病原体谱中流感病毒B型阳性率高;寒痰证患者的细菌和呼吸道病原体谱检出率低。②AECOPD热痰证患者炎症水平较寒痰证患者高,故AECOPD热痰证与寒痰证的辨证可选痰中性粒细胞、血中性粒细胞、超敏CRP、PCT、FeNO作为参考指标。③AECOPD热痰证患者的证候表现轻重与hsCRP和PCT存在一定的相关性,其可作为判断AECOPD热痰证患者证候轻重的客观依据。
[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.
【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】：R563.9
本文编号：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.
【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】：R563.9
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