Study On The Correlation Between Traditional Chinese Medicine Syndrome Types And Hematology Ratios In Elderly CAP And Professor Qi Wensheng's Medication Rule

Background:Regardless of developed countries or developing countries,older adults account for a large proportion of patients with Community-acquired Pneumonia(CAP)in the community.Relevant statistical analysis shows that China has as many as 2.51 million cases of CAP per year,with 125,100 deaths,of which older adults over the age of 65 account for 70%,and CAP accounts for 60%of older adult infectious diseases,and is one of the main causes of death in older adults.Older adults have low immunity,poor physical foundations,high incidence of CAP,and are prone to complications,leading to poor prognosis and an increased risk of progressing to severe pneumonia,which is one of the important reasons for death in ICU patients.Clinical statistics show that the proportion of older patients in adult severe pneumonia patients is about 62%,and the mortality rate is about 49%,with a respiratory failure rate as high as 83%,bringing severe health problems and economic burden to the Chinese population.Moreover,multiple factors such as difficult and accurate acquisition of pathogenic testing results,abuse of antibiotics,and severe bacterial resistance make the diagnosis and treatment of old age CAP bottlenecked,so pursuing more superior diagnostic and treatment methods has become the primary concern of clinical doctors.When the body is under stress or acute dehydration,blood ratio indicators in the form of NLR,PLR,CAR,and PAR are less affected than traditional indicators(such as WBC,CRP,PCT,NEUT%,LY%)to a lesser extent.Therefore,blood ratio indicators are more stable and can fully and accurately reflect the body’s state.In recent years,a large number of studies have shown that blood ratio can be used as a simple and effective inflammatory evaluation indicator,which has good clinical value in evaluating the severity and prognosis of CAP.Research Objective:This study aims to compare the differences in various indicators among elderly CAP patients with different traditional Chinese medicine(TCM)patterns,in order to judge the differences in the degree of inflammation and body condition,and analyze the advantages of blood ratio compared with traditional inflammatory indicators.It is intended to explore the degree of improvement in the condition of elderly CAP patients with different TCM patterns under TCM intervention,summarize the medication rules used by Professor Qi in the treatment of elderly CAP,and summarize the experience of Professor Qi in the treatment of elderly CAP.Therefore,the correct selection and optimization of the treatment plan for elderly CAP is established,and the clinical cure rate is improved,providing new ideas for the use of TCM to treat the disease,and providing support and theoretical basis for future prospective trials.Methods:(1)The gender,age,TCM patterns,basic diseases,CURB-65 scores,ALB,NEUT%,PLT,CRP,LY%,PCT,WBC,D-Dimer and other raw clinical data of elderly CAP patients who visited the emergency room of Guang’anmen Hospital from January 1,2016 to December 31,2021 were initially sorted using the Excel library building method,and the structured clinical data of the patients were obtained.The data were subjected to statistical data mining using SPSS26.0 software to analyze the correlation between the TCM pattern and the blood ratio index and inflammatory indicators of the patients.(2)The gender,age,TCM patterns,basic diseases,CURB-65 scores,ALB,NEUT%,PLT,CRP,LY%,PCT,WBC,D-Dimer and other raw clinical data of elderly CAP patients who visited the emergency room at Guang’anmen Hospital from January 1,2016 to December 31,2021 were initially sorted using the Excel library building method.The data were classified,integrated and subjected to data mining using statistical methods,and the medication was analyzed using association rule analysis of the drug usage.SPSS26.0 software and R language programming were used to analyze the high-frequency drug clustering.The medication usage was analyzed using association rule analysis.The drug combinations with support greater than 7%and confidence greater than 0.6 were selected,sorted according to the frequency of drug combinations from high to low,and the drug association combinations with support of 20%and confidence greater than 0.75 were finally selected.The common drug combinations used by Professor Qi were summarized based on Professor Qi’s treatment experience.Results:(1)On day 0 of the inter-group treatment,there were no significant differences in NLR,PLR,PAR,or NLR*CURB-65 values among the six groups.There were significant differences in CAR values between the Lung-Spleen Qi Deficiency group and the Phlegm-Damp Obstructing Lung group,and the latter group had higher values.There were no significant differences in CAR values among the other groups.There were no significant differences in ALB,NEUT%,PLT,CRP,LY%,PCT,WBC,or D-Dimer values among the six groups.There were significant differences in Δ(NLR*CURB-65)values among the six groups,and the Phlegm-Heat Internal Smoldering group had higher values than the Lung-Spleen Qi Deficiency group,while the Phlegm-Stasis Mutual Constraint group had higher values than the Lung-Spleen Qi Deficiency group.There were no significant differences in ΔPLR,ΔCAR,ΔNLR,or ΔPAR values among the six groups.(2)Of the 1757 herbs in the 150 prescriptions included in this study,there were 182 types of herbs,with 54 herbs used more than 10 times.Professor Qi used four types of herbs,namely cold,warm,neutral,and cool,in descending order of frequency.The top five frequently used herbs in the 150 prescriptions included licorice,gypsum,ephedra,scutellaria,and peony,which accounted for 70%,36.7%,34.7%,34.0%,and 33.3%,respectively.Professor Qi used more heat-clearing herbs in the treatment of elderly CAP,followed by tonifying herbs,phlegm-resolving and cough-relieving herbs,exterior-releasing herbs,and qi-regulating herbs.The average doses of the top three drugs were 11.06g for licorice,33.25g for gypsum,and 10.75g for ephedra.Through the analysis of drug association rules,it was found that under the condition of 20%support,the confidence of the combination of scutellaria,gypsum,and licorice was 0.97,the confidence of the combination of trichosanthes root,ephedra,gypsum,and stir-fried almonds was 1,the confidence of the combination of bamboo leaves,coix seed,gypsum,and licorice was 1,and the confidence of the combination of pinellia ternata,gypsum,and licorice was 1.Conclusion:(1)Among the TCM syndromes of elderly CAP patients,the Phlegm-Heat Internal Smoldering Syndrome was the most common,while the Lung-Spleen Qi Deficiency Syndrome and the Phlegm-Damp Obstructing Lung Syndrome were less common.Patients with Phlegm-Damp Obstructing Lung Syndrome had higher levels of cell and tissue damage than those with Lung-Spleen Qi Deficiency Syndrome,and were more likely to be accompanied by long-term poor nutritional status and poor prognosis.Hematological ratio indicators such as Δ(NLR*CURB-65)and CAR are more comprehensive and sensitive than traditional inflammatory markers such as NEUT%,LY%,CRP,and ALB.Combined treatment with TCM prescriptions and conventional Western medicine can effectively improve the inflammatory levels of elderly CAP patients with six syndromes,with better curative effect in the Phlegm-Heat Internal Smoldering Syndrome and the Phlegm-Stasis Mutual Constraint Syndrome over the Lung-Spleen Qi Deficiency Syndrome in the short term.(2)Professor Qi emphasized the combination of eliminating evil and strengthening the body in the treatment of elderly CAP,focusing on clearing heat and tonifying deficiency,relieving cough and resolving phlegm,releasing exterior and resolving dampness,regulating qi and dredging collaterals etc.The classification of drugs is mostly based on the "lung,stomach,spleen,heart,and liver" meridians.Commonly used drug combinations include ephedra-stir-fried almonds,ephedra-gypsum,trichosanthes root-gypsum-licorice,trichosanthes root-epherda-gypsum-stir-fried almonds,bamboo leaves-coix seed-gypsum-licorice etc.,most of which come from the book "Treatise on Febrile Diseases".Professor Qi Wensheng’s prescriptions are precise and effective,with small doses,comprehensive considerations,and multidimensional attack characteristics.