基于象思维的“天龙竭”方案对IPF分期辨治的临床研究

发布时间：2018-06-17 16:48

本文选题：特发性肺间质纤维化 + 阳虚　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:本研究旨在通过基于象思维的“天龙竭”分期辨治方案观察特发性肺间质纤维化患者的综合疗效。为“天龙竭”方案的运用提供临床证据;发掘云南民族医药资源中防治IPF行之有效的方法和手段。方法:运用“天龙竭”分期辨治方案,将收集的34例病例进行分期分组治疗,由同组高年资中医医师执行,根据中医四诊合参收集证候,结合病程、实验室指标、肺功能及影像学检查分为早期肺痹组、晚期肺痿组,两组患者均采用“天龙竭”分期辨治方案干预,予门诊中药口服,对全体患者治疗前后的高分辨CT(HRCT)、肺功能(通气和弥散功能),IPF中医证侯积分表,圣乔治呼吸问卷(SGRQ)及呼吸困难评分表(m MRC)进行疗效综合评估。结果:本研究最终纳入34例患者,肺痹组17例,男性12例,女性5例,平均年龄为62.76±11.22岁,病程1.71±1.07年;肺痿组17例,男性10例,女性7例,平均年龄为68.88±9.59岁,病程2.59±1.62年,基本情况无统计学差异(P0.05)。治疗前后总体患者肺功能(TLC、VC、DLco)指标无统计学差异;肺痹组患者治疗后TLC及VC较前改善,DLco无统计学差异;肺痿组患者治疗前后TLC、VC、DLco无统计学差异。治疗后患者高分辨率CT总体检查结果有效2例,稳定26例,无效6例。肺痹组治疗后有效2例,稳定15例,肺痿组治疗后稳定11例,无效6例,两组间比较差异有统计学意义(P0.05)。治疗后两组患者中医证候评分中主症、次症、或见症及总分均较治疗前有明显降低,差异有统计学意义(P0.05)。治疗后两组患者圣乔治评分较治疗前有显著改善,差异有统计学意义(P0.001)。两组患者治疗后的m MRC评分较治疗前有显著缓解,差异有统计学意义(P0.001)。肺痹组患者治疗前后肝肾功无统计学差异,肺痿组患者治疗前后AST、尿素氮无统计学差异,ALT较治疗前升高,肌酐较治疗前降低,上述指标均在正常值范围。结论:综合所有资料得出,基于象思维的“天龙竭”分期辨治方案治疗特发性肺间质纤维化能明显改善患者的症状、体征,提高其生活质量,对其肺功能及高分辨率CT有稳定性作用,治疗无肝肾功能损伤。
[Abstract]:Objective: This study aims to observe the comprehensive curative effect of the patients with idiopathic pulmonary fibrosis based on the "tiandragon" staging based on image thinking. To provide clinical evidence for the application of the "Tianlong exhaustion" scheme, and to explore the effective methods and means for the prevention and treatment of IPF in the national medical resources of Yunnan. The plan, 34 cases of the collected cases were divided into groups, which were carried out by the same group of high year traditional Chinese medicine doctors. According to the four diagnosis of Chinese medicine, according to the four diagnosis of TCM syndrome, combined with the course of disease, laboratory index, lung function and imaging examination, it was divided into early lung arthralgia group and advanced lung flaccid group. The two groups were treated with "Tianlong exhaustion" stage differentiation and treatment plan intervention, to outpatient medicine Oral high resolution CT (HRCT), pulmonary function (ventilation and diffusion function), IPF syndrome score table, St Georges Respiratory Questionnaire (SGRQ) and dyspnea score (m MRC) were evaluated. Results: the results were included in 34 patients, 17 cases in the pulmonary arthralgia group, 12 male and 5 female, with an average age of 62.76 11.. 22 years old, the course of disease was 1.71 + 1.07 years, lung flaccid group 17 cases, male 10 cases, 7 cases of female, the average age was 68.88 + 9.59 years, the course of disease was 2.59 + 1.62 years, the basic situation was not statistically different (P0.05). The pulmonary function (TLC, VC, DLco) before and after treatment was not statistically different; the TLC and VC in the pulmonary arthralgia group were improved after treatment, and there was no statistical difference in DLco; the lung flaccid had no statistical difference. There was no statistical difference between TLC, VC and DLco before and after treatment. The total results of high resolution CT after treatment were effective in 2 cases, stable in 26 cases and ineffective in 6 cases. 2 cases were effective after treatment in the pulmonary arthralgia group, 15 cases were stable, 11 cases were stable after the treatment of the lung flaccid group and 6 cases were invalid (P0.05). The TCM syndrome of two groups after treatment was evaluated after treatment. The main symptoms, secondary symptoms, or symptoms and total scores were significantly lower than before the treatment (P0.05). After treatment, the two groups of patients in the two groups were significantly improved than before treatment, the difference was statistically significant (P0.001). The two groups of patients after the treatment of M MRC scores were significantly relieved before treatment, the difference was statistically significant (P0.001). There was no statistical difference between the liver and kidney work before and after treatment in the arthralgia group. There was no statistical difference between the AST and the urea nitrogen in the patients before and after the treatment. The ALT was higher than that before the treatment, and the creatinine was lower than that before the treatment. All the above indexes were in the normal range. Conclusion: the comprehensive data obtained, based on the "tiandragon" stage differentiation and treatment scheme based on the image thinking to treat the idiopathic pulmonary interstitial Fibrosis can significantly improve the symptoms and signs of patients, improve their quality of life, and have a stabilizing effect on lung function and high-resolution CT.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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