The Distribution Of COPD Syndrome In TCM And The Correlation Between The Deficiency Of Lung And Kidney Qi And The SNP Polymorphism Of ACE Gene (I/D) In COPD

Objective: To standardize and summarize the distribution pattern of COPD syndrome and syndrome elements,we will explore the main TCM Syndrome Types and syndrome elements in COPD stable stage,and prove that the lung kidney qi deficiency syndrome is the main syndrome type of COPD stable phase.Based on this,we discuss the correlation between COPD lung kidney qi deficiency syndrome and ACE gene SNP polymorphism(I/D).Method: 1.Theoretical exploration: literature review and systematic review of the understanding of COPD lung and kidney qi deficiency syndrome by the physicians and modern scholars in the past dynasties and the discussion of the lung kidney qi deficiency syndrome is the main syndrome type of COPD stable phase and the feasibility of the correlation study between the lung kidney qi deficiency syndrome and the ACE gene polymorphism.2.Literature research: search nearly 10 years related COPD TCM syndrome differentiation literature and syndromes and syndrome factors and summarized analysis and descriptive analysis,SPSS19.0 statistical software Pearson to study the correlation between COPD syndrome,syndrome distribution and refinement of COPD syndrome and syndrome elements that makes it more systematic and standardized;3.Clinical research: using cross-sectional survey method,we collected the outpatient department and inpatient department of Department of respiration,Chengdu University of Traditional Chinese Medicine Affiliated Hospital and first people’s Hospital of Chengdu from June 2017 to January 2018.And Chengdu city simaqiao community hospital 189 cases of patients with stable COPD and questionnaire survey.Collect patients’ general information,clinical symptoms,signs,pulmonary function grading,GOLD2017 grading and comprehensive evaluation of TCM four diagnostic information,analysis,descriptive analysis in SPSS19.0 statistical software Pearson correlation analysis,cluster analysis,principal component analysis and Logistic regression.The distribution of symptoms and main symptoms,the distribution pattern of syndrome elements,the classification of lung function and the distribution of syndromes in COPD stable patients were statistically analyzed,and the correlation between GOLD2017 comprehensive evaluation and grading and the distribution of syndromes were also analyzed.Cluster analysis and principal component analysis were used to explore the main TCM Syndrome Types and syndrome elements in COPD stable phase.Logistic regression analysis was used to screen symptoms with syndrome differentiation in the main syndromes of COPD in stable phase.4.Experimental study: selected patients with stable COPD into standard 95 cases as the case group,and select the same period in Chengdu City,simaqiao community hospital,82 cases of healthy people as control group.A case-control study was used in the control group and the control group and the case group were 1: 1 matched by sex and age.5m L venous blood samples were collected and DNA was extracted.The genotype and allele frequencies of ACE were detected by PCR and agarose gel electrophoresis.The correlation between COPD lung and kidney qi deficiency syndrome and ACE gene SNP polymorphism insertion / deletion(I/D)was analyzed.Result: 1.Theoretical exploration: most of the past doctors and modern scholars believe that the etiology and pathogenesis of COPD in stable phase is most closely related to the two organs of lung and kidney.The essential connotation of syndrome of COPD lung and kidney qi deficiency is consistent with the essence of ACE gene polymorphism.2.Literature research: a total of 501 articles were included.There were 1214 items of syndromes,297 syndromes(before specification),and 219 after finishing.There were 10 syndromes of disease,16 of the disease type,and 26 syndrome factors.In the stable phase,the top 10 were the spleen and lung qi deficiency,lung qi deficiency,lung and kidney qi deficiency,lung and kidney deficiency,phlegm dampness blocking lung,lung spleen two deficiency,phlegm stasis,lung,lung,spleen and kidney qi deficiency,lung,spleen and kidney deficiency,spleen and kidney yang deficiency,among which deficiency syndrome was the majority,accounting for 8.The analysis results of the eight classes showed that in the period of COPD stability,there was a majority of Li + Ping + deficiency(54.81%).Pearson correlation analysis showed that COPD was significantly associated with deficiency of stability during the flat card,certificate(sig=0.000<0.01).There are 14 kinds of syndromes that constitute COPD stable phase,which are mainly Qi deficiency,phlegm,blood stasis and yin deficiency.There are 8 targets in disease location,mainly in lung,kidney and spleen.In the combination of syndrome factors,the combination of single syndrome elements was mainly(57.45%),and the four syndrome elements and multiple syndromes were least(0.55%).In the combination of single syndrome,Qi deficiency mainly(83.23%),the target of the target in the lung,kidney,spleen.The results of Pearson correlation analysis: Qi deficiency was significantly associated with lung,kidney and spleen(sig=0.000<0.01).In the acute phase,the top 10 are the phlegm heat obstructing the lung,the phlegm dampness obstructing the lung,the phlegm stasis obstructing the lung,the lung and kidney qi deficiency,the exterior cold heart drinking,Yang deficiency and water flooding,the lung qi deficiency,the phlegm heat stasis lung,the spleen lung qi deficiency and blood stasis syndrome,among which the majority is 6.The analysis of syndrome differentiation of the eight classes showed that in the acute phase of COPD,the majority of the patients were Li + heat +(29.03%),Li + flat +(25.31%).Pearson correlation analysis showed that significant correlation with empirical heat syndrome,flat card,certificate(sig=0.000<0.01).There are 15 essential syndromes that constitute AECOPD,which are mainly phlegm,heat,Qi deficiency and blood stasis.There are 9 targets in disease position,mainly in lung,kidney and spleen.The combination of two syndromes was mainly(62.94%).In the combination of single syndrome,Qi deficiency is the main factor(47.78%),and its target is in the lung,lung,lung,spleen and spleen.In the combination of two syndromes,phlegm + heat was the main(38.31%),and its target was in the lung.Pearson correlation analysis results: sputum and lung were significantly correlated(sig=0.000<0.01),heat was significantly correlated with lung(sig=0.000<0.01),and Qi deficiency was significantly correlated with spleen and kidney(sig=0.000<0.01).3.Clinical research: 189 cases of COPD patients in the stable period of cough,expectoration,wheezing,wheezing after aggravating the highest frequency of four symptoms in all clinical symptoms in.The syndromes of patients with deficiency and solid inclusion were the most,accounting for 75.66%,followed by deficiency syndrome(15.87%).The proportion of lung,spleen and kidney qi deficiency,phlegm stasis and lung obstruction,lung kidney qi deficiency and blood stasis syndrome,lung and kidney qi deficiency accounted for more than 8%,which were 14.81%,14.29% and 8.99%,respectively,the most important type of syndrome in stable stage.The analysis of the eight classes showed that the "Li + Ping + deficiency and real inclusion"(64.02%)in the COPD stable period were most.Pearson correlation analysis showed that with the actual card and flat card,interior correlation(sig=0.000<0.01).The disease type syndrome is mainly lung(29.55%),kidney(12.72%),spleen(8.1%),and the disease syndrome is mainly Qi deficiency(17.67%),phlegm(11.67%)and stasis(11.04%).The disease syndrome factor combination in the form of a total of 6 species,in combination with three(46.56%).Single syndrome factors and syndrome targets in combination,with Qi deficiency(93.33%),the targets in lung and kidney(60.71%),two syndrome factors and syndrome targets combination,Qi + blood stasis(70.18%),the targets in lung and kidney(50%),three factors and syndrome when target combinations,Qi + phlegm + blood stasis(54.55%),the targets in the spleen and kidney(32.18%).Pearson correlation analysis: Qi deficiency was significantly associated with lung,spleen and kidney(sig=0.000<0.01).After "dimension reduction",the distribution of TCM syndromes in TCM was mostly(52.4%).Asthenia syndrome was mostly lung and kidney qi deficiency(17.96%)and lung spleen kidney qi deficiency(15.87%).The pulmonary function of the asthenia of lung and kidney qi and the deficiency of lung and spleen and kidney qi deficiency syndrome is low,mainly in grade III and IV.The patients with asthenia of lung and kidney qi,lung spleen and kidney qi deficiency and yang deficiency syndrome were high in CAT,high in m MRC,and with more acute episodes.The comprehensive evaluation was mainly distributed in group D.The results of cluster analysis and principal component analysis belong to 3 types of syndromes: spleen and kidney qi deficiency,phlegm stasis obstructing the lung,Qi and yin deficiency,phlegm heat obstructing the lung,wind cold invading the lung,lung and kidney qi deficiency,phlegm dampness obstructing the lung.Logistic regression analysis results of the main syndrome lung qi deficiency syndrome factor Yaoxisuanruan,nocturia,white fur;main syndrome of lung qi deficiency of spleen syndrome factor for Yaoxisuanruan,anorexia,abdominal distension,tinnitus.4.Experimental study: SNP sequence query results showed that the mutation frequency of the ACE gene rs4646994 loci was lower than 1%.The distribution and frequency distribution of COPD,ID,II group of patients with DD genotype were44(46.32%),38(40%),13(13.68%),lung and kidney qi deficiency group was16(43.24%),17(45.95%),4(10.81%),non lung qi deficiency group was28(48.28%),21(36.21%),9(15.52%),the control group was33(40.24%),40(48.78%),9(10.98%).The correlation analysis showed that: COPD group,lung and kidney qi deficiency group and non lung and kidney qi deficiency group respectively compared with the control group,in addition to lung and kidney deficiency group and non lung qi deficiency group,ACE gene SNP polymorphism(I/D)genotype frequency distribution showed no significant difference(P > 0.05).Conclusion: 1.Lung and kidney qi deficiency syndrome is the main TCM syndrome type in COPD stable stage.The ACE gene SNP polymorphism(I/D)is a feasible and credible method to study the microscopic syndrome connotation of COPD lung kidney qi deficiency syndrome.2.In the stable phase of COPD,the two main organs of lung and kidney were the main syndromes.Qi deficiency was the main syndrome factor.Lung and kidney qi deficiency were the main syndromes of COPD stable stage and the main deficiency syndrome type of COPD.3.The COPD of lung qi deficiency and lung function mainly in III and IV grade,comprehensive evaluation is mainly distributed in the D group,the main syndrome factors for Yaoxisuanruan,nocturia,moss white,can provide the clinical basis for the clinical treatment of the direct evidence.4.The evidence for the correlation between the rs4646994 loci of ACE gene and the pathogenesis of COPD is not sufficient.The second generation sequencing and Taq Man probe technology need further introduction.The SNP polymorphism of ACE gene(I/D)is not sufficient for the microscopic markers of lung kidney qi deficiency syndrome.It needs a multi center,large sample and repeated clinical investigation to verify it.