Study On The Correlation Between The Severity Of Bronchiectasis And TCM Syndromes And Clinical Features In Hospitalized Patients With Bronchiectasis

ObjectiveThrough the cross-sectional observation of the hospitalized patients with bronchiectasis,we discuss the relationship between the severity of the disease and the syndrome types and clinical features of the patients with bronchiectasis.Methods:All patients with bronchiectasis were collected from March 201 7 to December 201 8 in Respiratory Ward of Jiangsu Provincial Hospital of traditional Chinese Medicine.We collected general data,clinical symptoms,pulmonary function,sputum culture,chest CT,and the past history.According to the relevant data,we calculated the FACED score of the patients,evaluated the severity of the patients undefined condition,and classified them according to the syndrome differentiation of traditional Chinese medicine(TCM),Finally,we analyzed and summarized the relationship between the severity of bronchiectasis and its clinical features,as well as the evolution of TCM syndrome type.Results1.There were 70 males(38%)and 114 females(62%);BMI 22.88±4.45 kg/m2,mean age 62.1±12.5 years.Among them,38 cases(20.7%)had chronic obstructive pulmonary disease,15 cases(8.2%)had a history of tuberculosis,11 cases(6.0%)had a history of asthma.Cough,expectoration,hemoptysis and asthma were the most common symptoms in patients with bronchiectasis.Gram-negative bacilli accounted for the majority of sputum culture positive in patients with bronchiectasis,of which Pseudomonas aeruginosa infection was the most common.FEV1%pred was 68.23±24.2%,FVC%was 74.62±21.2%,FEV1/FVC%was 73.98±12.8%.2.In 184 cases of bronchiectasis,the TCM syndrome types were divided into two categories:excess syndrome and syndrome of intermingled deficiency and excess,98 cases(53.3%),including 47 cases of phlegm-heat accumulation of lung,34 cases of liver fire invading lung,and 17 cases of wind-dryness lung injury.There were 86 cases(46.7%)of syndrome of intermingled deficiency and excess,including 38 cases of deficiency of lung and spleen,along with phlegm-turbid obstruction,32 cases of qi-yin deficiency along with phlegm-heat stagnation of lung,16 cases of deficiency of lung and kidney along with phlegm-heat depression.There were statistical differences in age,lung function,lung lobe cumulation,mMRC respiratory distress score and FACED score between the patients with excess syndrome and syndrome of intermingled deficiency and excess.3.According to the FACED score,125 cases(67.9%)were mild,41 cases(22.3%)were moderate and 18 cases(9.8%)were severe.There was no statistical difference in the sex and BMI of the patients with the bronchiectasis between the grades of the severity of the disease.4.In patients with mild bronchiectasis,FEV1%pred,FEV1/FVC%and FVC%pred were respectively(79.28±17.2)%,(78.21±10.2)%and(83.88±15.3)%.In patients with moderate bronchiectasis,FEV1%pred,FEV1/FVC%and FVC%pred were respectively(49.93±21.3)%,(66.44±12.6)%and(59.91±19.4)%.In severe patients,FEV1%pred,FEV1/FVC%and FVC%pred were respectively(33.13±8.6)%,(61.86±14.1)%and(43.78±9.3)%.There was statistical difference in FEV1%pred,FEV1/FVC%,FVC%pred among patients with bronchiectasis in different severity grades.5.There were statistical differences in the distribution of TCM syndrome types in patients with bronchiectasis of different severity,in patients with mild bronchiectasis,there were 87 cases(69.6%)with excess syndrome,38 cases(30.4%)with syndrome of intermingled deficiency and excess,in patients with moderate bronchiectasis,9 cases(22%)with excess syndrome,32 cases(78%)with syndrome of intermingled deficiency and excess,and in severe patients,2 cases(11.1%)with excess syndrome,there were 16 cases(88.9%)of intermingled deficiency and excess,which indicated that the excess syndrome was more common in mild patients,the syndrome of intermingled deficiency and excess was more common in moderate and severe patients.Among them,phlegm-heat stagnation lung syndrome and liver-fire invading lung syndrome are more common in mild patients.In moderate and severe patients,the qi-yin deficiency and phlegm-heat depression lung,lung-kidney deficiency and Phlegm-heat stagnation of lung are more common,asthenia of pulmonosplenic qi and phlegm-turbid lung obstruction in the distribution of mild,moderate and serious patients did not see significant statistical differences.6.There were 126 cases with airflow limitation,among which 71 cases were mild,37 cases were moderate,8 cases were severe,and there was statistical difference between mild,moderate and severe groups.Conclusion:1.The majority of 184 patients with bronchiectasis are female.2.In the 184 patients with bronchiectasis,the rate of excess syndrome patients is higher,the most common was Phlegm-heat depression lung.Compared with the patients with excess syndrome,the patients with syndrome of intermingled deficiency and excess had older age,more severe damage to lung function,more lung lobes cumulation,and higher scores of mMRC and FACED.3.The value of FEV1%pred,FVC%pred,FEV1/FVC%in moderate and severe patients was lower than that in mild ones,indicating that the lung function damage in moderate and severe patients was more severe than that in mild ones.4.There are differences in the distribution of TCM syndrome types with different severity.With the aggravation of the disease,there are fewer patients with excess syndrome,and there is an upward trend in the patients with syndrome of intermingled deficiency and excess.The excess syndrome is more common in mild patients.Deficiency and excess intermingled syndrome is more common in moderate and severe patients.Among them,phlegm-heat stagnation of lung and liver-fire invading lung mostly distributed in mild patients,qi-yin deficiency,phlegm-heat depression of lung and lung-kidney deficiency,phlegm-heat depression of lung mostly distributed in moderate and severe patients.5.The proportion of bronchiectasis patients with airflow limitation in moderate and severe group was higher than that in mild group.