| ObjectiveAt present,patients with lung transplantation lack TCM syndrome research,and the syndrome types are mostly summarized by clinical experience.The subjectiveness of syndrome naming is strong,and the syndromes are not uniform in clinical treatment.This study applies scientific statistical methods to collect clinically relevant information of lung transplant patients to objectively explore the symptoms and syndrome characteristics of patients at different stages of lung transplantation.It is intended to summarize the clinical syndromes of TCM patients with lung transplantation,provide evidence-based medical evidence for the classification of TCM syndromes of the disease,and provide relevant theoretical basis for clinical syndrome differentiation treatment.It is a useful exploration for the correlation between TCM syndrome types and clinical indicators,and the relevance of medication.MethodsThis study used a prospective,observational cross-sectional survey approach.Inpatients in the Lung Transplantation Center of the China-Japan Friendship Hospital from November 2017 to November 2018 were selected in strict accordance with the inclusion and exclusion criteria.Refer to the TCM Syndrome Diagnostic Criteria of the Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine(2002),Diagnosis of Traditional Chinese Medicine,,combined with guidelines for lung transplantation and related TCM syndromes and syndrome research.After discussion by relevant clinical experts and evidence-based medical experts,the Information Collection Form for TCM Syndrome Research in Lung Transplantation Patients was drawn up.The collection includes demographic general conditions,symptoms,signs,laboratory tests and other information,and the collected clinical information is managed by Excel 2010 software.After the completion of the entry,the verification is performed again.SPSS 20 was used for statistical analysis of clinical data.Descriptive statistical methods were used to analyze the basic data of patients at different stages of lung transplantation(Before lung transplantation,1-15 days after lung transplantation,15-30 days after lung transplantation,1-6 months after lung transplantation,and more than 6 months after lung transplantation)TCM syndrome information was analyzed by composition ratio analysis,cluster analysis and factor analysis.The relationship between laboratory indexes at different stages of lung transplantation was studied by analysis of variance.Results1.General information:This study collected 67 cases of effective cases,226 cases.There were 10 females(14.9%)and 57 males(85.1%).The minimum age is 22 years old and the maximum age is 75 years old.The primary disease was diagnosed as interstitial lung disease in 52 cases(77.6%),chronic obstructive pulmonary disease in 7 cases(10.4%),pulmonary hypertension in 3 cases(4.48%),bronchiectasis in 3 cases(4.48%),severe pneumonia in 1 case(1.5%),1 case of pneumoconiosis(1.5%).There were 45 cases(67.2%)of smoking history,including 2 cases(5%)with less than 10 years of smoking,11 cases(27.5%)in 10-20 years,and 18 cases(45%)in 20-30 years,9 cases(22.5%)over 31 years.Among them,there were 8 cases(20%)with less than 10 cigarettes per day,19 cases(47.5%)with 11-20 cigarettes,6 cases(15%)with 30 cigarettes per day,and 7 cases with 40 cigarettes per day(17.5%).2.TCM Syndrome Information:This study included 226 cases of data,and the data was entered into SPSS 20 for descriptive frequency analysis and system cluster analysis.In the first part,all the sample data were clustered and analyzed to obtain five categories:lung qi deficiency syndrome,spleen and kidney qi deficiency syndrome,yin deficiency syndrome,spleen yang deficiency and blood stasis syndrome,blood deficiency and dampness syndrome.In the second part,226 cases were divided into five stages according to the operation time:42 cases in the first stage(preoperative),52 cases in the second stage(1-15 days after surgery),39 cases in the third stage(15-30 after surgery),53 cases in the fourth stage(1-6 months after surgery),and 40 cases in the fifth stage(postoperatively more than 6 months before),frequency analysis and cluster analysis for each stage of data.Symptom frequency analysis results:Before the lung transplantation,it was the phlegm obstruction of the lungs and blood stasis syndrome.1-15 days after surgery,it was the syndrome of phlegm-heating obstruction of the lungs and yin deficiency.15-30 days after surgery was the syndrome of lung spleen deficiency and kidney yang deficiency.1-6 months after surgery was the syndrome of lung and kidney qi deficiency.More than 6 months after surgery was the syndrome of kidney yang deficiency and qi deficiency.Clustering analysis results at each stage:Before the lung transplantation,it was the lungs qi deficiency syndrome,yin deficiency syndrome,phlegm obstruction of the lungs and blood stasis syndrome.1-15 days after surgery,it was the syndrome of tan meng shen qiao,qi and yin deficiency and dampness heat syndrome.15-30 days after surgery was qi deficiency syndrome,blood deficiency syndrome,spleen deficiency syndrome,heart and kidney yang deficiency.1-6 months after surgery was qi deficiency syndrome,lung and kidney qi deficiency syndrome,and kidney yin deficiency syndrome.More than 6 months after surgery was spleen-qi deficiency syndrome,yang deficiency syndrome,and kidney essence deficiency syndrome.3.Laboratory indicators at different stages of lung transplantation:The results of WBC,PCT,Cr data were significantly higher than the other four stages in the 1-15 days after lung transplantation(P<0.05),suggesting infection and impaired kidney function.The CD8 results after lung transplantation were significantly lower than those before lung transplantation(P<0.05).Compared with the first stage,CD4 cells were significantly decreased in the second stage and the fifth stage(P<0.05).The results of arterial blood lactic acid in the 15-30 days after lung transplantation were significantly higher than the other stages(P<0.05),suggesting the infection status.The results of lung function tests after lung transplantation showed an increasing trend of DLCO,which was significantly better than preoperative lung function(P<0.05).The distance of the six-minute walking test of patients at various stages after lung transplantation gradually increased,which was statistically different from the preoperative results(P<0.05),that suggest the cardiopulmonary function improved steadily.The mean values of Hb,PLT,ALT,BNP,FEV1/FVC and PACO2 were analyzed at different stages of lung transplantation,and the results were not statistically different(P>0.05).Conclusion1.Smoking is a major risk factor for lung transplant patients.2.The results of the study on the distribution of TCM syndrome types in different stages of lung transplantation surgery show that:The overall symptom clustering is divided into five categories,of which the deficiency syndrome is dominant.There are three types of single deficiency syndrome:lung qi deficiency,kidney qi deficiency,yin deficiency syndrome.Two types of the mix of excess and deficiency syndrome:blood deficiency and dampness,qi deficiency and blood stasis syndrome.No TCM excessive syndrome has been found.Distribution characteristics of each stage of the syndrome:Preoperative and early postoperative period were the mix of excess and deficiency TCM syndromes,more than 15 days after surgery,the deficiency syndrome was the main.The TCM syndromes before lung transplantation was qi deficiency and blood stasis syndrome.The TCM syndromes of 1-15 days after lung transplantation was qi and yin deficiency and dampness syndrome.The TCM syndromes of 15-30 days after lung transplantation was qi and blood deficiency,spleen and kidney yang deficiency syndrome.The TCM syndromes of 1-6 months after lung transplantation was lung and kidney qi and yin deficiency.The TCM syndromes more than 6 months after lung transplantation was spleen qi deficiency,kidney yang deficiency syndrome.3.Laboratory studies have shown that WBC,PCT,Lac and Cr data were significantly higher than the other stages at 1-15 days after surgery,which means that both qi and yin deficiency and damp-heat syndrome were significa ntly higher than other stages.It is suggested that this type of syndrome has obvious inflammatory reaction,infection,organ hypoxia,and kidney dysfunction.The values of CD4 and CD8 cells decreased significantly at all stages after operation,suggesting that the low immune function was associated with deficiency syndrome.The decreased lung function and 6MWT were associated with blood stasis syndrome. |
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