Study On The Distribution Of Syndromes Of Chronic Obstructive Pulmonary Disease Complicated With Pneumonia And Its Pathogenic Correlation

Obj ective:Through collecting and analyzing the clinical profile and Traditional Medicine(TCM)diagnostic information of chronic obstructive pulmonary disease,induct the TCM syndrome types of complicated with pneumonia and explore the relationship between different syndrome and clinical basic information,certain risk factors,physical and chemical indexes,pathogen.finally,provide the basis for clinical dialectical treatment.Method:The COPD patients with pneumonia in the respiratory department of Dongzhimen Hospital from January 2018 to January 2019 were investigated by questionnaire.The four diagnostic information,the clinical basic data and the results of physical and chemical examination were collected,and the results of physical and chemical examination were carried out.The collected information is set up in the database and analyzed and described by using SPSS 20.0 statistical soft.ware,including chi-square test,non-parametric rank sum test,cluster analysis,factor analysis and other data analysis methods.By Cluster Analysis to analysis patients’symptoms,to get the type of syndrome of traditional Chinese medicine in patients with complicated with pneumonia.and by factor analysis to get different syndrome types of main symptoms and minor symptoms.By analyzing the syndrome of collecting case,get the syndromes that each patient,finally,summarized the relationship between the various types of syndromes and clinical basic information,certain risk factors,physical,chemical parameters,pathogen.Results:The clinical study included 164 cases of COPD complicated by pneumonia.The proportion of males(55.5%)was higher than that of females(44.5%),and most patients were more than 80 years old(55.5%).The overall mean age was about 77 years old;On the seasonal distribution,the number of chronic obstructive pulmonary disease complicated by pneumonia occurs in winter mainly,to 60 cases,accounting for 36.6%,followed by spring,to 43 cases,accounting for 26.2%;On the clinical symptoms,there were 102 cases,whose temperature is normal,accounting for more than 62.2%,47 cases of low heat,accounting for 28.7%,14 cases of moderate heat,accounting for 8.5%,1 case of high fever,accounting for 0.6%,0 case of Ultra-high ht,accounting for 0%.The mean temperature of the whole body was about 37.0℃.The number of smokers was more than non-smokers,accounting for 67.1%and 32.9%separately.Contact factors included the history of exposure to dust and the history of PET.There were 87 cases who had the history of exposure to dust,accounting for 53%of the total,and 38 cases who had the history of PET.On the group of disease,the group of A was 24 cases,representing14.6%,the group of B was 59 cases,representing 36%,the group of C was 10 cases,representing 6.1%,the group of D was 71 cases,representing 43.3%.The composition ratio of age in each of group is different(P<0.05).Group B,Group C and Group D had a larger proportion of patients over 75 years of age.In symptom score,there was a significant difference in mMRC score between male and female in grade 0 and grade 4:the proportion of male was highest in grade 0 and lowest in grade 4,the proportion of female was highest in grade 4 and lowest in grade 0.The CAT score of women was also higher than that of men(P<0.05).The four diagnostic information of 164 patients of COPD with pneumoniawere analyzed and described firstly,and the symptoms with frequency more than 20%were analyzed by cluster analysis.Finally,there are five major TCM syndromes of chronicobstructive pulmonary disease with pneumonia:dampness-stagnation intestinal syndrome,turbid phlegm obstructing lung,spleen andkidney deficiency(with the syndrome deficiency of heart-QI and blood stasis),lung and spleen-QI deficiency syndrome,(with blood stasissyndrome or outsidein the cold fluid retention syndrome),evil attack outside lung(with phlegm-heat syndrome of lung or lung dryness due to yin deficiency).Determined everyone’s syndrome,and analyzed the correlation between the types ofsyndromes and clinical basic materials,physical and chemical index,etiological distribution.The results were as the follows:on the age distribution,The 18 patients withspleen-kidney deficiency syndrome were all over 75 years old,mainly≥80 years old(83.3%).The composition ratio of disease group was different among different syndrome groups,and there was a correlation between syndrome and disease group(correlation coefficient=0.465,P<0.01):Phlegm turbidity obstructs lung syndrome,spleen and kidney deficiency syndrome,and external evil attack lung syndrome are mainly group D,lung and spleen deficiency syndrome is mainly B group.The percentage of mMRC grade 1(0%)was significantly lower than that in grade 4(42.9%)in spleen-kidney deficiency syndrome group;In physical and chemical index,the NE%levels of spleen-kidney deficiency was significantly higher than lung and spleen-QI deficiency(P<0.05)and the CRP level of evil attack outside was higher than the lungand spleen-QI deficiency(P<0.05);The D-dimer level of turbid phlegm obstructing was higher than lung and spleen-QI deficiency syndrome(P<0.05).The study detected a total of 14 kind of pathogenic bacteria that caused pneumonia,representing the first two digits was candida albicans,mycoplasma,.The most common syndrome type of Candida albicans infection was turbid phlegm obstructing lung,spleen-kidney deficiency and evil attack outside lung,and the syndrome type of mycoplasma pneumoniae was turbid phlegm obstructing lung.The clinical characteristics of pathogenic bacteria infection were obtained by analyzing the syndrome types of pathogenic bacteria:The syndrome elements of Candida albicans infection were ’phlegm’,’qi stagnation’,followed by ’wind’,’qi deficiency’,’heat’,and the syndrome elements of mycoplasma were ’phlegm’,’qi stagnation’,followed by ’qi deficiency’Conclusion:1.The majority of COPD patients are the elderly.Aging can lead to increased symptoms or an increased risk of acute exacerbation in patients with COPD and the symptoms of COPD in women are more severe than those in men.The incidence of COPD complicated with pneumonia was the highest in winter and spring.After the onset of the disease,the body temperature was normal or slight fever,and the clinical symptoms could be atypical.2.The syndrome of patients with COPD combined with pneumonia is generally divided into 5 categories:dampness-stagnation intestinal syndrome,turbid phlegm obstructing lung,spleen and kidney deficiency,lung and spleen-QI deficiency syndrome,evil attack outside lung.The disease is mainly related to the lung,spleen and kidney.The main pathological factors are sputum,drink,and blood stasis.The study appears evil attack outside lung can be accompanied by phlegm-heat syndrome of lung or lung dryness due to yin deficiency,lung and spleen-QI deficiency syndrome can be accompanied by outside in the cold fluid retention syndrome or blood stasis syndrome,spleen and kidney deficiency can be accompanied by the the syndrome deficiency of heart-QI and blood stasis and the syndrome of dampness-stagnation intestines is probably the most common accompanying syndrome in COPD patients with pneumonia and the syndrome of blood stasis is mainly in deficiency syndrome,so the root reason of formation of blood stasis is deficiency.The majority of patients with spleen-kidney deficiency syndrome are elderly patients over 75 years old and Dyspnea is more pronounced.The NE%level of spleen-kidney deficiency syndrome was significantly higher than that of lung-spleen-spleen deficiency syndrome,the CRP level of evil attack outside lung syndrome was higher than that of lung and spleen-QI deficiency syndrome,and the level of D-dimer of turbid phlegm obstructing lung was significantly higher than that of lung and spleen-QI deficiency syndrome.There was no difference in biochemical indexes and blood gas analysis among the syndromes.3.The study reveals that candida albicans and atypical pathogens had a high detection rate.The most common syndrome type of Candida albicans infection was turbid phlegm obstructing lung,spleen-kidney deficiency and evil attack outside lung,and the syndrome type of mycoplasma pneumoniae was turbid phlegm obstructing lung.