慢性阻塞性肺疾病合并肺动脉高压中医证素分布特点的研究

发布时间：2018-06-19 16:05

本文选题：慢性阻塞性肺疾病 + 肺动脉高压　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的本研究以慢性阻塞性肺疾病合并肺动脉高压为切入点,借鉴询证医学理念和数理统计方法,对其中医证素进行相关统计分析。并尝试探讨本病中医证素分布规律,深化中医对本病的认识,使中医辨证更加规范化、客观化、标准化,同时为该病辨证标准的创建提供客观依据,为临床防治提供参考。研究方法1.文献研究计算机检索相关期刊论文(CNKI)、万方学术期刊数据库、中文科技期刊数据库(VIP)以及中国生物医学文献数据库(CBM)收集近15年有关慢性阻塞性肺疾病合并肺动脉高压中医证型研究的相关文献,从中进行证素提取,并利用统计学方法进行频次、聚类和关联分析,以探索其特征及规律。2.临床研究对52例慢性阻塞性肺疾病合并肺动脉高压患者进行临床调查问卷填写,在四诊信息的基础上进行中医积分辨证,并利用方差分析、非参数检验等统计方法,对其中医证素分布特点进行探索性分析。结果1.文献研究结果共检出符合标准文献25篇,病例总数共2098例,提取病位证素2个,分别是肺(64.45%)和肾(35.55%)。病性证素5个,其中实性证素2个,为血瘀(38.78%)和痰浊(28.67%);虚性证素3个,分别为气虚(26.75%)、阳虚(1.29%)和阴虚(4.52%)。证素组合类型可归纳为三种,包括单证素形式(15.92%)、双证素形式(46.66%)、三证素形式(37.42%),其中双证素出现频率最高,尤以血瘀+痰浊最为多见。从病性虚实角度而言,以虚实兼夹组合居多,占52.76%。聚类分析可分为4大类,C1:肺、肾、阳虚;C2:气虚;C3:痰浊、血瘀;C4:阴虚。关联分析共挖掘支持度≥10%、置信度≥80%的证素组合27组,其中血瘀→痰浊的支持度为63.49%,置信度达100.00%;血瘀→气虚、痰浊的支持度为37.42%,置信度为100.00%;痰浊→肺、血瘀的支持度34.60%,置信度100.00%;血瘀→气虚的支持度为59.25%,置信度为81.01%。2.临床研究结果共提取证素25个,其中病位证素8个,病性证素17个。病位证素主要为肺(100.00%)、心(21.15%)、脾(21.15%)、肾(17.31%);病性证素中虚性证素主要为气虚(51.92%)、阳虚(38.46%)、血虚(15.38%)、阴虚(13.46%),实性证素主要为痰(59.62%)、血瘀(30.77%)、湿(21.15%)、饮(17.31%)、气滞(15.38%)。病性证素组合形式共7种,其中双证素组合形式构成比最大,占36.54%,以气虚+阳虚组合和痰+血瘀组合多见。单证素组合形式构成比仅次于双证素,为19.23%,其中气虚出现频数最多。三证素组合形式构成比为13.46%,以痰+血瘀+气滞组合多见。结论本研究运用综合的数理统计方法以及四诊信息资料的提取,可以得出的结论有:1.文献挖掘的病位证素为肺肾两脏,提示该病首伤于肺,渐累及肾,最终可致肺肾两脏同病。病性虚性证素中气虚所占比例最大,可见气虚是发病之本,阴虚和阳虚均可在气虚的基础上演变而来。归属于病性实性证素的痰瘀形成后,反可因壅而致气滞亦甚,阻塞胸肺,加重病情。此数据结果与慢性阻塞性肺疾病合并肺动脉高压的病程特征相符合,其具有慢性、进行性、不可逆性、复杂性的特点。本病病性组合以虚实兼夹组合多见,虚、痰、瘀是本病迁延缠绵,反复发作的重要原因。2.调查问卷可总结出本病发展的大致顺序:肺→心脾→肾→五脏。此过程恰巧是一个病邪深入的过程,也是一个由单一病位向复合病位发展的过程,体现了本病复杂繁多,呈进行性发展的特点。从病性证素可以看出,气损及阳,阳虚不能化气行水,使得痰浊、气滞、瘀血互结,使得本病虚实夹杂,病情反复,病程缠绵,经久难愈。
[Abstract]:Objective to study the TCM Syndromes of chronic obstructive pulmonary disease (COPD) with pulmonary hypertension, and to explore the distribution of TCM syndromes, deepen the understanding of TCM, and make the TCM syndrome differentiation more standardized, objective and standardized, and at the same time, at the same time It provides an objective basis for the establishment of the syndrome differentiation criteria for the disease, and provides a reference for clinical prevention and control. Research methods 1. literature search of Chinese journal full text database (CNKI), Wanfang academic journal database, Chinese sci-tech journal database (VIP) and Chinese biomedical literature database (CBM) for the collection of chronic obstructive pulmonary disease in the last 15 years The related literature of the TCM syndrome type of the disease combined with pulmonary hypertension was extracted, and the statistical methods were used to carry out frequency, cluster and correlation analysis to explore the characteristics and regularity of.2. clinical study on 52 cases of chronic obstructive pulmonary disease with pulmonary hypertension. On the basis of traditional Chinese medicine integral syndrome differentiation, and using variance analysis, non parametric test and other statistical methods, the distribution characteristics of TCM syndromes were explored. Results the results of 1. literature study found 25 standard literature, total number of cases were 2098 cases, and 2 cases were extracted from the lung (64.45%) and kidney (35.55%). Among them, the disease syndrome factor was 5. There are 2 sex syndrome elements, blood stasis (38.78%) and phlegm (28.67%), 3 deficiency syndrome elements, Qi deficiency (26.75%), Yang deficiency (1.29%) and yin deficiency (4.52%). The combination of syndrome elements can be classified into three types, including the form of syndrome element (15.92%), double syndrome (46.66%), and three syndrome (37.42%), among which the frequency of bisyndrome is the highest, especially blood stasis + phlegm turbidity From the point of view of disease and deficiency, 52.76%. cluster analysis can be divided into 4 categories: C1: lung, kidney, Yang deficiency, C2: Qi deficiency, C3: phlegm, blood stasis and C4: Yin deficiency. Association analysis is a combination of 27 groups of syndromes that support the degree of support more than 80%, and the support of blood stasis to phlegm is 63.49%, confidence is 100%, blood stasis and blood stasis. Qi deficiency, phlegm turbidity of 37.42%, confidence of 100%; phlegm to lung, lung, blood stasis of 34.60%, confidence 100%; blood stasis to Qi deficiency of 59.25%, the confidence of the 81.01%.2. clinical research results of a total of 25 of the total, including 8 of the disease position syndrome, 17 of the disease, heart (21.15%), the heart (21.15%), spleen (2), spleen (2 (21.15%), spleen (2) (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2) (spleen) (spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2), spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2), spleen (21.15%), spleen (2) (spleen (21.15%), spleen (2). 1.15%), kidney (17.31%); the deficiency syndrome elements in the disease syndrome are mainly Qi deficiency (51.92%), Yang deficiency (38.46%), blood deficiency (15.38%) and yin deficiency (13.46%). The real syndrome elements are mainly phlegm (59.62%), blood stasis (30.77%), wet (21.15%), drink (17.31%), Qi Stagnation (15.38%). The combination of syndrome elements is the largest, accounting for 36.54% and Qi deficiency. The combination of Yang deficiency and phlegm + blood stasis is more common. The constituent ratio of the combination form of the syndrome element is only second to the double syndrome element, which is 19.23%, among which the frequency of qi deficiency is the most. The composition ratio of the three syndromes is 13.46%, and the combination of phlegm + blood stasis + qi stagnation is common. Conclusion this study can be obtained by using the comprehensive mathematical statistics method and the extraction of four diagnosis information data. The conclusions are as follows: 1. the disease location in the literature is the two dirty of the lung and kidney, suggesting that the disease first wound in the lungs, gradually accumulate the kidney, and eventually lead to the same disease of the two organs of the lung and kidney. The result of this data is consistent with the course characteristics of chronic obstructive pulmonary disease combined with pulmonary hypertension. It has the characteristics of chronic, progressive, irreversible, complex characteristics. The combination of the disease and the combination of deficiency and solid, deficiency, phlegm, and blood stasis is the prolonged and repeated onset of this disease. The.2. survey questionnaire can summarize the general sequence of the development of the disease: lung, heart, spleen, kidney, and five zang organs. This process happens to be a process of disease and evil. It is also a process of developing from single disease to complex position, which embodies the characteristics of complicated and progressive development of the disease. Deficiency can not transform Qi into running water, making phlegm, qi stagnation and blood stasis intermingled. This makes the deficiency and excess of the disease mixed, and the condition is repeated.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】