The Study Of TCM Syndrome Characteristics And Risk Factors Of Overlapping Syndrome Of COPD-OSAHS

ObjectiveBy observing the basic conditions,previous conditions,clinical manifestations,TCM tongue and pulse,syndrome manifestations and test indicators of overlap syndrome(OS)patients,chronic obstructive pulmonary disease(COPD)patients and obstructive sleep apnea hypopne syndrome(OSAHS)patients,the differences among the three patients and the risk factors leading to the incidence of OS were analyzed,aiming to provide the basis for clinical diagnosis and screening,and to improve the diagnosis rate of OS.MethodsPatients receiving inpatient treatment in Guangdong Hospital of Traditional Chinese Medicine from October 2017 to October 2020 were selected.A total of 345 patients were included according to the diagnostic criteria set out in the 2017 Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Pulmonary Disease(GOLD)guidelines and the Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome(2011 Revision).Among them,there were 112 cases in OS group,116 cases in COPD group and 117 cases in OSAHS group.By looking at the patient’s clinical medical records,record the basic information(sex,age,height,body weight),the past situation(medical history,history of smoking history,history of alcoholism,infections,allergy),clinical manifestation(fever,chills,cough,sputum,stuffy nose,rurny nose,sleep snoring,awake at night due to oppressed,daytime sleepiness,dry mouth,bitter mouth,dry pharynx,throat itching,sore throat,chest stuffy chest pain,shortness of breath,severe shortness of breath after activity,sweating,eat and sleep,piss and poop,etc.),TCM tongue pulse syndrome(tongue color,tongue body shape,the color of the coat on the tongue,the texture of the tongue coating,pulse condition and syndrome type),test indicators(routine blood,blood fat,blood gas analysis,C-reactive protein).After data verification and missing value processing,SPSSV22.0 was used to compare the differences between groups.For qualitative data,Chi-square test was used for comparison among three groups;for quantitative data,analysis of variance was used for comparison between groups;for risk factors of OS,binary logistics regression analysis was used for statistical analysis.Results1.In terms of basic conditions,there was no statistical difference in gender among the OS group,COPD group and OSAHS group(P>0.05),but male patients in the three groups were higher than female patients in terms of composition ratio.In terms of age,the mean age of OS group was lower than COPD group and higher than OSAHS group(P<0.05).In terms of BMI index,the average BMI of the OS group was lower than that of the OSAHS group and higher than that of the COPD group(P<0.05).2.In terms of previous conditions,there were no statistical differences in hypertension,diabetes,alcoholism,infectious diseases and allergies among the OS group,COPD group and OSAHS group(P>0.05).In terms of coronary heart disease,the prevalence of coronary heart disease in the OS group was higher than that in the COPD group(P<0.0125),but there was no statistical difference between the OS group and the OSAHS group(P>0.0125).In terms of cerebral infarction,the prevalence of cerebral infarction in the OS group was higher than that in the OSAHS group(P<0.0125),but there was no statistical difference between the OS group and the COPD group(P>0.0125).In terms of smoking,the smoking rate in the OS group was higher than that in the OSAHS group(P<0.0125),but there was no significant difference between the OS group and the COPD group(P>0.0125).3.In terms of clinical symptoms,there were no statistical differences in chills,fever,runny-nose,bitter mouth,chest tightness,palpitation,chest pain,backache,limb pain and dry and hard stools among the OS group,COPD group and OSAHS group(P>0.05).There was no statistical difference in nasal congestion and poor appetite between OS group and COPD group,OSAHS group(P>0.0125).In terms of the manifestation of increased nocturia,the incidence rate of OS patients was higher than that of OSAHS patients and COPD patients(P<0.0125).The incidence rate of OS patients was lower than COPD patients(P<0.0125)and higher than OSAHS patients(P<0.0125)in terms of sputum,shortness of breath,severe shortness of breath after activity.In terms of sleep snoring,the incidence rate of OS patients was lower than that of OSAHS patients(P<0.0125),and higher than that of COPD patients(P<0.0125).In terms of cough and edema of limbs,the incidence probability of OS patients was not statistically different from that of COPD patients(P>0.0125),but higher than that of OSAHS patients(P<0.0125).In terms of dry mouth,dry pharynx,fatigue,spontaneous sweating,waking at night and daytime drowsiness,the incidence rate of OS patients was not statistically different from that of OSAHS patients(P>0.0125),but higher than that of COPD patients(P<0.0125).The incidence probability of OS patients was lower than that of OSAHS patients(P<.0.0125),but there was no statistical difference compared with COPD patients(P>0.0125).Compared with OSAHS patients,OS patients were more prone to stool constipation(P<0.0125).and OSAHS patients were more prone to stool constipation(P<0.0125).but there was no statistical difference between OS patients and COPD patients(P>0.0125).4.In terms of TCM tongue signs,there were no statistical differences among OS group,COPD group and OSAHS group in terms of pale white tongue,reduced tongue coating,superficial tongue coating and thick and greasy tongue coating(P>0.05).There was no statistical difference in red tongue performance between OS group and COPD group,OSAHS group(P>0.0125).There was no statistical difference between the OS group and COPD group in the appearance of dim tongue and dark red tongue(P>0.0125),but the frequency was higher than that of the OSAHS group(P<0.0125).The frequency of light red tongue in the OS group was lower than that in the OSAHS group(P<0.0125),but there was no statistical difference between the OS group and COPD group(P>0.0125).In terms of white tongue coating,the frequency of OS group was higher than that of COPD group(P<0.0125),but there was no statistical difference between OS group and OSAHS group(P>0.0125).In terms of yellow tongue coating,the frequency of OS group was lower than COPD group(P<0.0125),but there was no statistical difference between OS group and OSAHS group(P>0.0125).5.In terms of pulse of traditional Chinese medicine.there was no statistical difference between OS group,COPD group and OSAHS group in the situation of sinking pulse and chord pulse(P>0.05).In terms of rapid pulse,the frequency of the OS group was lower than that of the COPD group(P<0.0125),but had no statistical significance with the OSAHS group(P>0.0125).In terms of sliding pulse,the frequency of OS group was lower than that of OSAHS group(P<0.0125),but had no statistical significance with COPD group(P>0.0125).In terms of fine pulse,the frequency of OS group was higher-than that of OSAHS group(P<0.0125),but there was no statistical significance with COPD group(P>0.0125).6.In terms of TCM syndromes,there was no statistical difference between OS group,COPD group and OSAHS group in the syndromes of mutual accumulation of phlegm and blood stasis(P>0.05).In terms of phlegm and dampness internal obstruction syndrome,the frequency of-OS group was lower than that of COPD group and OSAHS group(P<0.01 25).In terms of phlegm-heat accumulation syndrome type,the frequency of OS group was lower than COPD group(P<0.0125).but there was no statistical difference between OS group and OSAHS group(P>0.0125).In the syndrome type of Qi deficiency and phlegm stasis,the frequency of OS group was higher than that of COPD group and OSAHS group(P<0.0125).In terms of lung and spleen qi deficiency syndrome type and spleen-kidney deficiency syndrome type,the frequency of OS group was lower than COPD group(P<0.0125),but there was no statistical difference between OS group and OSAHS group(P>0.0125).7.In terms of testing indicators,there were no statistical differences in eosinophils count(Eosin),total cholesterol(TC),partial oxygen pressure(PO2)and blood oxygen saturation(SATO2)among OS group,COPD group and OSAHS group(P>0.05).The mean values of white blood cell count(WBC).neutrophil count(NEUT),C-reactive protein(CRP)and partial pressure of carbon dioxide(PCO2)in OS group were lower than those in COPD group(P<0.05),but there was no statistical difference between OS group and OSAHS group(P>0.05).In terms of triglyceride(TG),the mean value of OS group was lower than that of OSAHS group(P<0.05),but there was no statistical difference compared with COPD group(P>0.05).8.In terms of risk factors,statistically significant clinical features was brought into the Logistic model for analysis.After variable screening,the main influencing factors were as follows:sputum cough(OR:4.086,95%CI:1.825-9.145),sleep snoring(OR:4.022,95%CI:1.993-8.119),increased nocturia(OR:2.911,95%CI:1.650-5.137),with OR values greater than 1.Conclusion1.OS patients are more likely to occur in young-elderly male patients at the early stage of obesity.2.0S patients are more likely to lead to complications.3.Compared with COPD and OSAHS patients,OS patients showed no significant aggravation in the main clinical manifestations,and even showed a tendency of alleviation,Age and obesity were the influencing factors.4.The main manifestations of OS patients are pale-dark tongue or dark-red tongue,white tongue coating,fine-sliding pulse or fine-stringed pulse,and the syndrome of Qi deficiency and phlegm stasis is the main syndrome type.5.Compared with COPD and OSAHS,sputum coughing,sleep snoring and increased nocturia are related to the incidence of OS.