Study On The Clinical Characteristics And Medication Rules Of Hospitalized Patients With Rheumatoid Arthritis Associated With Interstitial Lung Disease

Objective:By our hospital screening,sorting out and analyzing Rheumatoid arthritis associated with Interstitial Lung Disease data of hospitalized patients,explore the RA-ILD syndromes distribution,analysis of traditional Chinese medicine clinical drug treatment of RA-ILD law,traditional Chinese and western medicine diagnosis and treatment plan characteristics,conclude the doctor of traditional Chinese medicine and treatment of RA-ILD medicine experience,in order to get a better clinical guide.Research methods:Hospitalized patients with RA-ILD between January 2011 and December 2018 in China academy of Chinese medicine Science Guanganmen Hospital were reviewed and analyzed the clinical data,during analysis conforms to the general clinical data,standards were syndromes of traditional Chinese medicine,traditional Chinese and western medicine diagnosis and treatment schemes,clinical symptoms,laboratory indexes,pulmonary functions,chest high-resolution CT signs of differences.The patient's first dose of internal Chinese medicine prescription was input into the TCM inheritance auxiliary platform V2.5,and the drug use law of RA-ILD patients was mined by association analysis,cluster analysis,complex system entropy clustering and other methods.Results:1.General clinical dataAccording to the inclusion criteria,a total of 162 cases were selected,including 38 males(23.5%)and 124 females(76.5%),with the age ranging from 38 years old to 87 years old.54.3%of patients with RA-ILD had a course of disease between 4 and 16 years.There was no statistically significant difference in smoking duration and number of daily cigarettes among patients with RA-ILD who had quit smoking.There was no statistical difference in the amount and duration of drinking between those who had quit and those who had been drinking.Cold dew(6.8%)and start of winter(6.8%)were the most common seasons for RA-ILD patients.In the sequence of onset of RA and ILD,there were 141 cases(94.6%)of RA before ILD,12 cases(7.4%)of RA and ILD at the same time,and 8 cases(4.9%)of ILD before RA.The mean time span of ILD onset for RA was 8.37±7.86 years and that of ILD onset for RA was 2.56±2.86 years.The time span of RA onset in ILD was longer than that of ILD onset,and there was a statistical difference between the two(P=0.04).The systemic symptoms were joint pain(23.6%),chest tightness(15.4%),dry mouth(15.3%),chest tightness(29.8%),cough(28.2%),and sputum cough(24.7%)Diffusion dysfunction was most common in lung function,with 24 cases(30%)of ventilation dysfunction,20 cases(83.3%)of ventilation dysfunction,10 cases(41.7%)of obstructive dysfunction,and 50 cases(64.1%)of diffusion dysfunction,with the same degree of impairment.The HRCT findings of RA-ILD patients were mainly pleural thickening(22.4%),cable strip-like changes(19.5%),nodule shadow(16.4%),mesh shadow(13.3%),and ground glass shadow(11.7%)2.TCM syndrome law analysisThe main syndromes are Dampness-heat bizu,deficiency of qi and Yin with dampness-heat bizu,dampness-heat bizu with blood stasis in collaterals,dampness-heat bizu with liver-kidney insufficiency.There were statistical differences between the age of rheumatic bizu syndrome and the liver and kidney insufficiency syndrome(P=0.004),qi and blood deficiency syndrome(P=0.018),qi and Yin deficiency syndrome(P=0.028),and phlegm and blood stasis syndrome(P=0.023).There was a statistical difference between the age of liver-kidney insufficiency syndrome and that of damp-heat bi syndrome(P=0.016).The average age of patients with dampness bi syndrome was less than that of deficiency of liver and kidney,deficiency of qi and blood.The average age of patients with phlegm and blood stasis syndrome was greater than that of qi and Yin deficiency syndrome.When RA was first developed,the time span of liver and kidney insufficiency was statistically different from that of qi and Yin deficiency(P=0.028),and that of qi and Yin deficiency was statistically different from that of damp and heat bi(P=0.002)and phlegm and blood stasis bi(P=0.015).When RA first started,the time span of qi and Yin deficiency syndrome was longer than that of liver and kidney deficiency syndrome,dampness-heat bi obstruction syndrome,and phlegm and blood stasis bi obstruction syndrome.There were no statistical differences in fever,rash,joint pain,dry mouth,morning stiffness,chest tightness,palpitations,shortness of breath,and fatigue among patients with different syndrome types,but there were statistical differences in muscle pain(P=0.048)and dry eyes(P=0.000).Patients with qi-blood deficiency and damp-heat bi block syndrome often see muscle pain,while patients with qi-yin deficiency and damp-heat bi block syndrome often see dry eyes.There was no statistical difference in clubbing finger and lung burst sounds of each syndrome type,but there was a statistical difference in cyanosis(P=0.010),and cyanosis symptoms of phlegm and blood stasis syndrome were prominent.There was no statistical difference in WBC,RBC,HGB,serum albumin,immunoglobulin IgA,IgG,IgM,anti-ccp,blood sedimentation,CRP,blood gas analysis oxygen partial pressure,carbon dioxide partial pressure.There was no statistical difference in the tumor markers CEA and CA19-9 of each syndrome type,but there was a statistical difference in CA15-3(P=0.003),and the level of rheumatic bizu syndrome was higher than that of the other six syndrome types.There was no statistical difference in the degree and type of disturbance of pulmonary ventilation function and pulmonary diffusion function among the syndromes.HRCT imaging features of different syndrome types:ground glass shadow,patchy shadow,grid shadow,cable and stripe change,Mosaic perfusion,nodule shadow,pulmonary bullae,pleural thickening,subpleural line,pericardial effusion,and cellular shadow all showed no statistical difference.Among them,the patchy shadow(P=0.067)and nodule shadow(P=0.097)had marginal significance.Qi-yin deficiency syndrome,dampness-heat bi-blocking syndrome is often seen in the patchy shadow,nodular shadow 3.Medication law analysisAmong 162 patients included in this study,156 prescriptions were effective,including 307 traditional Chinese medicines.The treatment drugs with a frequency of more than 20 are angelica,raw Astragalus,chuanniuxi,Poria,Danshen,liquorice,red peony,honeysuckle,tangerine peel,Smilax,Dendrobium,Curcuma,Gentiana,Qingfengteng,stir fried Atractylodes,honeysuckle vine,raw rehmannia,Qiang Huo,raw Coix,cooked rehmannia,chuanxiong,Atractylodes,Scutellaria,bupleurum,Fangfeng,Chuanshanlong,forsythia,zhiyuanzhi,Alisma,yam.Anemarrhena,rattan,fried almond,Cotoneaster,salt cypress,stir fried Atractylodes lanceolata,Cheqianzi When the support degree of association rule analysis is 20,45 groups of commonly used Chinese medicine combinations are obtained,and the top six high-frequency Chinese medicine combinations are chuanniuxi Astragalus,liquorice angelica,Dendrobium Astragalus,angelica Astragalus,honeysuckle Astragalus and Angelica tuckahoe.At the same time,if the reliability is 0.6,17 high-frequency TCM combinations can be found.Cluster analysis was carried out with a correlation degree of 8 and a penalty degree of 2.A total of 13 pairs of high correlation drugs with a correlation coefficient of>0.03 were selected:Radix Astragali-Radix Glehniae,Radix Aucklandiae-Chrysanthemum indicum,Dendrobium-smallpox,Scutellaria-Bletilla,Coptis-Chrysanthemum indicum,Atractylodes Rhizoma-Tribulus terrestris,Scutellaria-Phyllostachys,Atractylodes Rhizoma-Anemarrhena,gypsum-Fritillaria thunbergii,Coptis-fried Fructus aurantia.Based on the entropy cluster analysis of complex system,30 new core drug combinations were obtained.Based on the entropy cluster analysis of complex system,the unsupervised entropy hierarchical clustering algorithm was used to get 15 new prescriptions.The new prescriptions were 1:beehive;zedoary vinegar,Chuanshanlong,sinomenia,Smilax glabra;2:Trichosanthes kirilowii,tangerine peel,woodbutterfly,Qianhu,indigo naturalis;3 white peony,Angelica dahurica,leech,asarum;new prescription 4:Forsythia,raw gypsum,Chixiaodou,stir fried Atractylodes;new prescription 5:prepared rehmannia,angelica,mulberry parasitism,plantain,talcum powder;new prescription 6:Zhuru,buckwheat,Platycodon grandiflorum,Zhebei;new prescription 7:Qiang Huo,Fangfeng,Sangzhi,Yinchen,Kushen;new prescription 8:Radix Polygalae,raw Astragalus,Beishashen,Huangqin,chuanniuxi;New prescription 9:Polyporus,Alisma orientalis,Poria cocos,stir fried Atractylodes rhizome,peony peel;new prescription 10:Panax notoginseng,Zanthoxylum,Rhizoma Drynariae,Eupolyphaga,Rhizoma Polygonatum;new prescription 11:Sinomenium?Salvia miltiorrhiza,Smilax glabra,Phellodendron salicinae,phellodendron,stir fried Atractylodes rhizome,peony peel;new prescription 12:raw keel,jiuhuangjing,orange,jiucornus flesh;new prescription 13:Gualou,Rhodiola,fried almond,mulberry peel,buckwheat;new prescription 14:Tribulus terrestris,hemp kernel,Prunella vulgaris,lily;new prescription 15:raw oyster,jiuhuangjing,orange,jiucornus flesh 4.Features of integrated traditional Chinese and western medicine diagnosis and treatment schemeAccording to the frequency from high to low,the top four Chinese patent medicines are Tripterygium glycosides,Kunxian capsule,Bailing capsule and Jinshuibao capsule in order.There were 23 kinds of injections used,and the first six were danhong injection,Cervus and cucumis polypeptide injection,bone peptide injection,Tanreqing injection,bone peptide injection and ambroxol hydrochloride injection,among which Danhong injection was the most frequently used.Four kinds of glucocorticoids were used accumulatively,all of which were mediumeffect glucocorticoids,mainly prednisolone acetate tablets and prednisolone acetate tablets There are 4 types of immunosuppressive agents,mainly flunomide.The combination of glucocorticoid and immunosuppressant was mainly used as immunosuppressant alone.Conclusion:1.Characteristics of the onset of RA-ILD patients:most of the patients were female,with a long course of disease,and the onset of RA was the first.2.RA-ILD TCM syndrome type rule:the key syndrome of RA-ILD may be dampness and heat bi syndrome,qi and Yin deficiency syndrome,liver and kidney insufficiency syndrome;The pathogenesis was deficiency of qi and Yin.deficiency of liver and kidney,and dampness-heat and blood stasis3.RA-ILD combined TCM and western medicine treatment program features The traditional Chinese medicine of RA-ILD was treated with tripterygium wilfordii preparation and cordyceps sinensis preparation with immunomodulatory effect Western medicine is to dissolve phlegm spasmolysis asthma,fight infection,often combine tripterygium wilfordii preparation and cordyceps sinensis preparation4.RA-ILD common medicine to clear heat and humidity,blood circulation and collaterals,yiqi and deficiency,the core drug for Dendrobium,honeysuckle,raw Astragalus,chuanniuxi,angelica.The new prescription can be used for dampness-heat bi syndrome,deficiency of liver and kidney syndrome,phlegm heat accumulate lung syndrome,qi Yin deficiency syndrome,phlegm stasis syndrome.