肺胀中医证型与患者气道重塑HRCT定量的相关性研究

发布时间：2018-01-14 05:04

本文关键词：肺胀中医证型与患者气道重塑HRCT定量的相关性研究　出处：《云南中医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:分析探讨肺气虚证和痰热壅肺证慢性阻塞性肺疾病患者段支气管及亚段支气管重塑的特点与差异,探讨肺胀两型中医证型与气道重塑HRCT定量的相关性,为肺胀的临床诊断、治疗及疗效评价提供客观理论依据。方法:选择2013年8月至2014年11月在云南省中医医院内科就诊的92例肺胀患者为研究对象,选择同期在体检中心体检的正常人群为对照组。其中,辨证属肺气虚证肺胀者45例,痰热壅肺证者47例,正常对照组40例。对受试者行胸部HRCT扫描,观察双肺病变,并利用胸部容积复合采集和重建软件(thoracic volume complex acquirement and reconstruction,Thoracic VCAR)的气道自动分析功能对双肺上叶尖(后)段、尖(后)亚段支气管进行测定,分别测量支气管的管壁厚度(wall thickness,WT)、管腔内径(inner diameter,Din)、管壁面积(wall area,WA)及管壁面积百分比(percentage of wall area,WA%),再对其结果进行对比分析,探讨两种证型肺胀患者气道重塑(airway remodeling,ARM)的特点及差别。结果:1.肺胀肺气虚证及痰热壅肺证患者的段和亚段支气管均存在气道重塑,HRCT上表现为不同程度的支气管壁增厚和管腔狭窄。2.肺气虚证患者的气道重塑主要发生在段支气管,亚段支气管的改变无痰热壅肺证患者明显,差异有统计学意义(P0.05),表现为WT增大、Din缩小、WA%增大,但WA无明显变化。3.痰热壅肺证患者的气道重塑在段、亚段支气管均有发生,表现为WT增大、Din缩小、WA%增大,同时WA也增大。4.痰热壅肺证患者支气管增厚程度较肺气虚证患者明显,肺气虚证患者肺气肿征象较痰热壅肺证患者明显,两种征象存在统计学差异(P0.05)。肺部渗出性病变在痰热壅肺证者较多见。结论:肺胀肺气虚证及肺胀痰热壅肺证患者的段和亚段支气管均存在气道重塑。肺气虚证患者的气道重塑主要发生在段支气管。痰热壅肺证患者的气道重塑主要在亚段支气管更明显。肺胀痰热壅肺证患者支气管增厚程度及肺部渗出性病灶较肺气虚证者明显。肺胀肺气虚证患者肺气肿征象较痰热壅肺证者明显。不同中医证型肺胀在肺实质、气道重塑等方面存在的差异和相关性可在不同程度上揭示肺胀病机特点的个体差异性,有助于揭示病变的实质和病机。HRCT能有效评价肺气虚证、痰热壅肺证肺胀患者的支气管改变和重塑情况。
[Abstract]:Objective: to study the characteristics and differences of bronchial remodeling in patients with chronic obstructive pulmonary disease (COPD) with deficiency of lung qi and obstruction of phlegm and heat. To explore the relationship between TCM syndromes of two types of lung distension and quantitative HRCT of airway remodeling, which is the clinical diagnosis of lung distension. Methods: from August 2013 to November 2014, 92 patients with lung distension were selected from the Department of Internal Medicine of Yunnan traditional Chinese Medicine Hospital as the research objects. In the control group, 45 patients with lung qi deficiency syndrome and 47 patients with phlegm heat syndrome were selected as control group. 40 cases of normal control group. Chest HRCT scan was performed to observe the bilateral lung lesions. And using the chest volume composite acquisition and reconstruction software (. Thoracic volume complex acquirement and reconstruction. The airway automatic analysis function of Thoracic VCAR was used to measure the apical (posterior) segment and the apical (posterior) subsegmental bronchus of the upper lobe in both lungs. The wall thickness of the bronchus and the diameter of the lumen were measured respectively. The wall area and the percentage of wall area of wall areaWAA were compared and analyzed. Objective: to investigate the airway remodeling of two types of pulmonary distension patients with airway remodeling. The characteristics and differences of ARM. Results 1. Airway remodeling existed in the segmental and subsegmental bronchi of patients with lung distension and lung qi deficiency syndrome and phlegm heat obstruction of lung syndrome. On HRCT, bronchial wall thickening and lumen stenosis. 2. The airway remodeling of patients with deficiency of lung qi mainly occurred in segmental bronchus, and the change of subsegmental bronchus was not obvious in patients with phlegm and heat obstruction of lung syndrome. The difference was statistically significant (P 0.05), showing that WT increased, Din decreased and WA% increased, but WA did not change significantly. 3. Airway remodeling in patients with phlegm-heat obstruction of lung. Subsegmental bronchi occurred, showing that WT increased Din decreased WA%, and WA also increased .4.The bronchial thickening degree in patients with phlegm heat and lung obstruction syndrome was more obvious than that in patients with lung qi deficiency syndrome. The pulmonary emphysema in patients with deficiency of lung qi is more obvious than that in patients with phlegm and heat obstructing the lung. There was a statistical difference between the two signs (P0.05). Pulmonary exudative lesions were more common in patients with phlegm and heat obstruction of the lung. Conclusion:. The airway remodeling occurred in the bronchi of the patients with lung distention of lung qi deficiency syndrome and the patients with lung distention and phlegm heat obstruction of lung syndrome. The airway remodeling of patients with lung qi deficiency syndrome mainly occurred in the segmental bronchus, and the airway remodeling of patients with phlegm heat blockage of lung syndrome mainly occurred in the subsegment. Bronchus is more obvious. The degree of bronchial thickening and pulmonary exudation in patients with pulmonary distention and phlegm heat blockage are more obvious than those with deficiency of lung qi. The signs of emphysema in patients with lung distention and lung qi deficiency are more obvious than those with phlegm and heat blocking lung syndrome. Distended in the lung parenchyma. The differences and correlations in airway remodeling and other aspects can reveal the individual differences in the characteristics of lung distention in different degrees, and help to reveal the essence of the disease and the pathogenesis. HRCT can effectively evaluate the lung qi deficiency syndrome. Changes and remodeling of bronchi in patients with phlegm and heat obstruction of lung.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.14

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