The Distribution Of TCM Syndromes Of Community-acquired Pneumonia In The Elderly And Its Relationship With Etiology

Objective:Through analyzing characteristics of the etiology,Traditional Chinese medicine syndrome(TCM-syndrome)type distribution,and the relationship between TCM-syndrome type and inflammation markers,such as white blood cell(WBC)count,percentage of neutrophils(NE%),C-reactive protein(CRP),procalcitonin(PCT)and some disease severity score as CURB-65,pneumonia severity index(PSI),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)in elderly patients with community acquired pneumonia(CAP),to provide sample evidence for etiology distribution among CAP in the elderly and objective basis for the treatment of CAP in the elderly,so as to guide clinical diagnosis and treatment.Methods:Using retrospective research method,the medical records of 127 inpatients diagnosed as elderly community-acquired pneumonia in the emergency department(including ICU)and respiratory department of the Dongzhimen Hospital from January 2018 to December 2018 were collected,including general clinical data(gender,age,time of onset,previous medical history,fever,length of stay in hospital,prognosis,etc.),inflammation markers(WBC,NE%,CRP,PCT,etc.),disease severity score(CURB-65,PSI,APACHE Ⅱ,SOFA),etiology and TCM syndrome types.Using SPSS 26.0 software to statistically analyze the relationship between TCM syndromes and etiology,inflammatory markers and disease severity score,and initially obtaining the elderly CAP etiology,TCM syndrome distribution and the relationship between TCM syndromes and etiology,inflammatory markers and disease severity score.Results:1.The number of men and women is similar in the 127 cases of elderly patients with CAP.Nearly 70%of the patients are 65～84 years old,and there is no significant difference in the gender distribution of patients of different ages.Older community acquired pneumonia patients have more onset in winter and spring.Since the beginning of winter,the incidence rate has shown an upward trend until the great colder reaches its peak,which is consistent with the seasonal characteristic of respiratory infectious disease.64.1%of elderly CAP patients with 1～3 basic disease,hypertension,diabetes,cerebrovascular disease,coronary heart disease and hyperlipidemia are the most common 5 basic disease.During the onset,40.2%of elderly CAP patients did not have fever as the first symptom,and 49.6%had moderate to low fever.The incidence of severe CAP in the elderly is 5.5%.The mortality rate of CAP in the elderly is 5.5%,and the mortality rate of severe CAP is 42.9%.2.The distribution of Traditional Chinese Medicine syndrome type in the elderly with CAP is as follows:Syndrome of phlegm-heat obstructing the lung>Syndrome of phlegm-dampness obstructing the lung>Syndrome of wind and heat invading the lung=Syndrome of qi and yin deficiency>Syndrome of lung and spleen qi deficiency>Syndrome of pathogenic trapping>Syndrome of heat closing pericardium3.The relationship between TCM-syndrome and inflammation markers:WBC of different TCM syndromes in elderly CAP patients from high to low are syndrome of pathogenic trapping,syndrome of lung and spleen qi deficiency,syndrome of phlegm-heat obstructing the lung,syndrome of qi and yin deficiency,syndrome of heat closing pericardium,syndrome of wind and heat invading the lung,syndrome of phlegm-dampness obstructing the lung,and there is a statistical difference between syndrome of phlegm-dampness obstructing the lung and syndrome of phlegm-heat obstructing the lung(p=0.02),syndrome of phlegm-dampness obstructing the lung and syndrome of pathogenic trapping(p=0.02).NE%of different TCM syndromes from high to low are syndrome of pathogenic trapping,syndrome of heat closing pericardium,syndrome of phlegm-heat obstructing the lung,syndrome of lung and spleen qi deficiency,syndrome of wind and heat invading the lung,syndrome of qi and yin deficiency,syndrome of phlegm-dampness obstructing the lung,and there is no statistical difference between different TCM syndromes.There is no statistical difference in CRP and PCT between different TCM syndromes.4.The relationship between TCM-syndrome and disease severity score:There is a significantly statistical difference in CURB-65 between Syndrome of pathogenic trapping and Syndrome of wind and heat invading the lung,Syndrome of phlegm-heat obstructing the lung,Syndrome of phlegm-dampness obstructing the lung and Syndrome of qi and yin deficiency.There is a significantly statistical difference in PSI between Syndrome of pathogenic trapping and Syndrome of wind and heat invading the lung,Syndrome of phlegm-heat obstructing the lung,Syndrome of phlegm-dampness obstructing the lung,Syndrome of lung and spleen qi deficiency and Syndrome of qi and yin deficiency.There is no statistical difference in APACHE Ⅱ between different TCM-syndromes.There is a significantly statistical difference in SOFA between Syndrome of pathogenic trapping and Syndrome of phlegm-dampness obstructing the lung and Syndrome of lung and spleen qi deficiency.5.Correlation between TCM-syndrome and etiology:The pathogenic distribution of the elderly CAP is more common with Gram-negative bacteria,fungi and viruses.While the etiology of patients with severe CAP is mainly virus(especially influenza virus).Bacteria and fungi are more common in syndrome of phlegm-heat obstructing the lung and syndrome of phlegm-dampness obstructing the lung.There are correlations between TCM syndromes and etiology.Common pathogens in wind and heat invading the lung syndrome are influenza B virus,parainfluenza virus,respiratory syncytial virus,adenovirus,mycoplasma pneumoniae.Common pathogens in phlegm-heat obstructing the lung syndrome are influenza B virus,respiratory syncytial virus,influenza A virus,parainfluenza virus,legionella pneumophila.Common pathogens in phlegm-dampness obstructing the lung syndrome are influenza B virus,respiratory syncytial virus,parainfluenza virus,pseudomonas aeruginosa,mycoplasma pneumoniae.Common pathogens in lung and spleen qi deficiency syndrome are respiratory syncytial virus,mycoplasma pneumoniae,legionella pneumophila.Common pathogens in qi and yin deficiency syndrome are mycoplasma pneumoniae,influenza B virus,parainfluenza virus,cytomegalovirus,candida albicans.Common pathogens in heat closing pericardium syndrome are influenza B virus,influenza A virus,escherichia coli.Common pathogens in pathogenic trapping syndrome are influenza B virus,influenza A virus,respiratory syncytial virus.Respiratory syncytial virus is commonly found in phlegm-heat obstructing the lung syndrome and phlegm-dampness obstructing the lung syndrome,followed by wind and heat invading the lung syndrome,lung and spleen qi deficiency syndrome,and pathogenic trapping syndrome;Influenza A virus is mainly due to phlegm-heat obstructing the lung syndrome,followed by pathogenic trapping syndrome and heat closing pericardium syndrome,while influenza B virus mainly phlegm-heat obstructing the lung syndrome and phlegm-dampness obstructing the lung syndrome,followed by wind and heat invading the lung syndrome,pathogenic trapping syndrome,heat closing pericardium syndrome and qi and yin deficiency syndrome;Parainfluenza virus is commonly seen in phlegm-heat obstructing the lung syndrome,wind and heat invading the lung syndrome and phlegm-dampness obstructing the lung syndrome,and it also can be seen in qi and yin deficiency syndrome;Mycoplasma pneumoniae is common in qi and yin deficiency syndrome,followed by wind and heat invading the lung syndrome,phlegm-heat obstructing the lung syndrome,phlegm-dampness obstructing the lung syndrome and lung and spleen qi deficiency syndrome;Legionella pneumophila is more commonly seen in the syndrome of phlegm-heat obstructing the lung,and also can be seen in the syndrome of lung and spleen qi deficiency.Pseudomonas aeruginosa is seen in phlegm-dampness obstructing the lung syndrome and phlegm-heat obstructing the lung syndrome.Candida albicans are more common in phlegm-heat obstructing the lung syndrome,followed by wind and heat invading the lung syndrome,phlegm-dampness obstructing the lung syndrome and qi and yin deficiency syndrome.Conclusion:In this study,127 elderly patients with community acquired pneumonia were studied for their etiology,distribution characteristics of TCM syndrome type,and correlation between TCM syndrome and laboratory examination,disease severity score and etiology.The following conclusions are initially drawn:1.The common TCM syndromes of community acquired pneumonia in the elderly are phlegm-heat obstructing the lung syndrome and phlegm-dampness obstructing the lung syndrome.At the same time,it is necessary to take into account the characteristics of qi deficiency in elderly patients.2.The pathogenic distribution of CAP in the elderly is mainly Gram-negative bacteria,fungi and viruses.Different pathogenic microorganisms have correlation with TCM syndrome.3.CURB-65 score,PSI score,APACHE Ⅱ,and SOFA can not only be used to judge the severity and mortality risk of elderly CAP patients,but also have correlation between the different TCM syndromes of the elderly CAP.In the future,we can explore the possibility of the above-mentioned scoring system being an objective indicator of classifying TCM syndromes in the elderly CAP.