Study On The Clinical Features And TCM Syndromes Distribution Rules Of Stable COPD Different Phenotypes

Objective:To study the clinical features and TCM syndromes distribution rules of different clinical phenotypes of chronic obstructive pulmonary disease(COPD)at stable phase:the asthma-COPD overlap syndrome(ACOS)phenotype and emphysema phenotype in COPD,and explore the correlation between TCM syndromes and clinical indices in ACOS phenotype and emphysema phenotype.Methods:A total of 140 patients with stable COPD who met the inclusion and exclusion criteria were enrolled in Zhangzhou Affiliated TCM Hospital of Fujian University of Traditional Chinese Medicine respiratory out-patient and inpatient from December 2015 to March 2017.70 cases were assigned to ACOS phenotype and emphysema phenotype respectively.Lung function test and chest CT scan were performed.The COPD assessment and test questionnaire(CAT),the clinical observation form and the information form of TCM four diagnosis methods had been filled.Six-minutes walking distance(6MWD)had been measured.The phenotypes and TCM syndromes were judged and identified based on the clinical features and the information of TCM four diagnosis.The mathematical and statistical methods had been used to explore the clinical features and TCM syndromes distribution in different phenotypes.The differences of the clinical indices in different TCM syndromes in two phenotypes were also assessed.Result:1.The patients with ACOS had higher prevalence of female ratio,longer disease duration and experience acute exacerbations with higher frequency than those with emphysema phenotype(P<0.01,respectively).While for emphysema phenotype,the patients were generally older than patients with ACOS(P<0.05).The patients with emphysema phenotype showed higher smoking index,lower weight index and higher the low attenuation areas percentage of whole fung fields(LAA%)in chest CT than those with ACOS.(P<0.01,respectively).2.FEV1,FEV,%pre,FEV1/FVC,DLCO-SB,MEF75,and MEF50 in patients with emphysema phenotype were significantly lower than those in patients with ACOS(P<0.01,respectively);Furthermore,comparison of lung function grades:the cases of grade II in ACOS phenotype were more than those in emphysema phenotype.while the number of grade IV in patients with ACOS were less than those in patients with emphysema phenotype(P<0.01,respectively).3.LAA%from all the patients were negatively correlated with FEV1%pre,DLco-SB and 6MWD[r =-0.48,r ?-0.47,r =-0.40,respectively(P<0.01,respectively)]and positively correlated with CAT total points(r=0.35,P<0.01).4.The CAT scores of wheezing,activity endurance,sleep quality and CAT total points in patients with ACOS were significantly lower than those in patients with emphysema phenotype.5.6MWD in patients with ACOS were significantly longer than those in patients with emphysema phenotype(P<0.05).6.Comparison of single TCM syndromes in two groups:single TCM syndromes of ACOS phenotype included:lung qi asthenia,lung and spleen qi asthenia,lung and kidney qi asthenia,lung and kidney qi and yin asthenia,wind-cold invading lung,exogenous cold and interior fluid-retention,accumulation of phlegmatic heat in the lung,and turbid-phlegm retention in the lung.Single TCM syndromes of emphysema phenotype included:lung qi asthenia,lung and spleen qi asthenia,lung and kidney qi asthenia,lung and kidney qi and yin asthenia,accumulation of phlegmatic heat in the lung and turbid-phlegm retention in the lung.Comparative analysis showed that lung qi asthenia,exogenous cold and interior fluid-retention were mainly TCM syndromes in ACOS phenotype,while lung and kidney qi and yin asthenia and accumulation of phlegmatic heat in the lung were mainly TCM syndromes in emphysema phenotype(P<0.01,respectively).7.Comparison of TCM syndromes in two groups:composition ratio of TCM syndromes in ACOS phenotype over 7%from high to low in turn were as follow:lung qi asthenia,lung and spleen qi asthenia,lung and spleen qi asthenia accompanied by turbid-phlegm retention in the lung,lung and spleen qi asthenia accompanied by exogenous cold and interior fluid-retention,lung and kidney qi and yin asthenia accompanied with turbid-phlegm retention in the lung,and lung and kidney qi and yin asthenia accompanied by blood stasis.The disease location involved in the lung and spleen have accounted for 45.2%of major TCM syndromes.Composition ratio of TCM syndromes in the emphysema phenotype over 7%from high to low were as follow:lung and kidney qi and yin asthenia accompanied by accumulation of turbid-phlegm and blood stasis in the lung,lung and spleen qi asthenia accompanied with turbid-phlegm and blood stasis retention in the lung,lung and kidney qi and yin asthenia accompanied by turbid-phlegm retention in the lung,lung and kidney qi and yin asthenia,lung and kidney qi and yin asthenia accompanied by accumulation of phlegmatic heat and blood stasis in the lung,and lung and spleen qi asthenia accompanied blood stasis.The disease location involved in the lung and kidney have accounted for 55.5%of major TCM syndromes.8.Correlations between TCM syndromes with lung function,LAA%,6MWD and CAT total points in ACOS phenotype:6MWD of patients with TCM syndrome of lung and kidney qi and yin asthenia accompanied by accumulation of turbid-phlegm and blood stasis in the lung and lung and kidney qi and yin asthenia accompanied by blood stasis were significantly shorter than those of patients with lung qi asthenia and lung and spleen qi asthenia in ACOS phenotype(P<0.05,respectively).The total points of CAT in patients with TCM syndrome of lung and spleen qi asthenia accompanied by turbid-phlegm retention in the lung and lung and kidney qi and yin asthenia accompanied by accumulation of turbid-phlegm and blood stasis in the lung were statistically higher than those of patients with lung qi asthenia and lung and spleen qi asthenia accompanied by exogenous cold and interior fluid-retention in ACOS phenotype.(P<0.05,respectively).9.Correlations between TCM syndromes with lung function,LAA%,6MWD and CAT total points in emphysema phenotype:FEV1 of patients with TCM syndrome of lung and kidney qi and yin asthenia accompanied by accumulation of turbid-phlegm and blood stasis in the lung,lung and kidney qi and yin asthenia accompanied by turbid-phlegm retention in the lung and lung and kidney qi and yin asthenia accompanied by accumulation of phlegmatic heat and blood stasis in the lung were significantly lower than those of patients with lung and spleen qi asthenia accompanied by blood stasis in emphysema phenotype(P<0.05,respectively).And 6MWD in patients with TCM syndrome of lung and kidney qi and yin asthenia accompanied by turbid-phlegm retention in the lung were shorter than those of patients with lung and spleen qi asthenia accompanied by blood stasis and lung and kidney qi and yin asthenia in emphysema phenotype,while 6MWD in patients with lung and kidney qi and yin asthenia accompanied by turbid-phlegm retention in the lung were shorter than those of patients with lung and spleen qi asthenia accompanied by blood stasis,lung and kidney qi and yin asthenia and lung and spleen qi asthenia accompanied by accumulation of turbid-phlegm in the lung in emphysema phenotype(P<0.05,respectively).Conclusion:1.The ACOS group showed a higher prevalence of female ratio and longer disease duration and more experience acute exacerbations as compare with emphysema phenotype.While for emphysema phenotype,the patients were relatively older,showed higher smoking index,lower weight index.2.Lung function of emphysema phenotype were significantly lower than those in patients with ACOS phenotype,CAT total scores were higher than those in patients with ACOS phenotype.The emphysema phenotype showed shorter 6MWD in comparison with ACOS phenotype.3.FEV1%pre,DLco-SB,and 6MWD reduced as LAA%increased;CAT total points increased as LAA%increased.4.The pathological changes of COPD were "ben" deficiency and "biao" excess and concurrence of deficiency and excess.The "ben" deficiency was mainly caused by the deficiency of lung,spleen and kidney.The "biao" excess was mainly due to turbid-phlegm retention and blood stasis.Lung and spleen qi asthenia was as the basic TCM syndrome in patients with ACOS phenotype,which mainly manifested as lung and spleen qi asthenia accompanied by turbid-phlegm retention in the lung or exogenous cold and interior fluid-retention.Lung and kidney qi and yin asthenia was as the basic TCM syndrome in patients with emphysema phenotype,which mainly manifested as lung and kidney qi and yin asthenia accompanied by turbid-phlegm retention and blood stasis in the lung or turbid-phlegm retention in the lung or accumulation of phlegmatic heat in the lung.5.Concurrence of deficiency and excess of TCM syndromes were mainly TCM syndromes' characteristic in both phenotypes.The activity tolerance decreased in patients with coexisted TCM syndromes compared with those of patients with single TCM syndromes.And the quality of life was influenced more significantly in patients whose disease location involved in lung and kidney as compare with those of patients whose disease location involving in lung or lung and spleen.6.According to TCM syndrome characteristics of ACOS phenotype and emphysema phenotype,it will guide therapeutic methods such as strengthening spleen and resolving phlegm,warming the lung to resolve fluid-retention,and tonifying lung and nourishing kidney,resolving phlegm and removing blood stasis respectively to improve clinical symptoms of patients with different phenotypes.