| Objective1 The correlation between risk factors and FVC,FEV1,FEV1/FVC and FEV1%prep in958 patients with high risk of COPD in Anhui region was analyzed;2 Multi-dimensional analysis of pulmonary symptom distribution in 958 patients with high risk of COPD in Anhui region under different risk factors;3 To explore the syndrome distribution characteristics of 958 patients with high risk of COPD,and analyze the correlation between TCM syndrome elements and risk factors.MethodsThe multi-center,prospective and cross-sectional survey method was used to investigate the high-risk population of COPD in Anhui region.According to the definition of high-risk population of COPD in the Guidelines for Primary Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease(2018)formulated by the Chinese Medical Association,the score of screening questionnaire(COPD-SQ)was > 16 points.After excluding contraindications for pulmonary function test,mental disorders,serious cardiovascular and cerebrovascular diseases,lung cancer,bronchiectasis and other diseases,a total of 958 high-risk patients were collected.The coding method was based on the coding rules of screening objects in the Early Screening and Comprehensive Intervention Project for COPD High-risk Groups.The early screening and TCM syndrome questionnaire of high-risk COPD population were developed with reference to the relevant contents of Diagnosis of Traditional Chinese Medicine,Internal Medicine of Traditional Chinese Medicine,Syndrome element Differentiation,and Clinical Efficacy Terms of Traditional Chinese Medicine-Syndrome Section in medical colleges and universities.The risk factors and TCM syndromes were investigated and analyzed,and the lung function was tested.Through Epi Data3.1 data recording software,SPSS23.0 statistical software,A database was established for 958 high-risk COPD patients who met the inclusion criteria from 5research institutions in Anhui Province(Anhui Hospital of Traditional Chinese Medicine,Anhui Center for Disease Control and Prevention,Ningguo Hospital of Traditional Chinese Medicine,Taihe Hospital of Traditional Chinese Medicine,Jieshou Hospital of Traditional Chinese Medicine)from June 1,2022 to December 31,2022.The distribution characteristics of risk factors in 958 patients with high risk of COPD in Anhui region were analyzed.The correlation between risk factors and FVC,FEV1,FEV1/FVC and FEV1%prep was analyzed by point two-column correlation analysis,Spearman correlation analysis and multiple linear regression analysis.The distribution characteristics of pulmonary symptoms under different risk factors in high-risk COPD population in Anhui region were analyzed in multiple dimension,and the distribution rules of syndroms were discussed.The correlation between TCM syndrome elements and risk factors was analyzed by binary Logistic regression.Results1 Case inclusionIn this study,958 patients with high risk of COPD were included,all of whom completed the risk factor screening and TCM syndrome questionnaire for high-risk COPD patients,and completed the induction and analysis of TCM syndrome elements and syndrome types simultaneously,and completed lung function examination for 619 patients.2 Result analysis2.1 Distribution characteristics of risk factorsThe baseline data of high-risk COPD population in Anhui region accounted for the top five: male(70.35%),farming(63.57%),rural(63.26%),BMI of 18.5-23.9kg/m2(41.86%),60-69 years old(40.71%);Top 5 risk factors: smoking history(57.20%),secondhand smoke exposure(39.46%),coal and wood heating history(37.58%),asthma,chronic bronchitis,emphysema(32.05%)in immediate family,chronic respiratory disease(27.56%).In this study,the top five risk factors were male,a history of smoking,age 60-69,exposure to secondhand smoke,and use of coal and wood heating.2.2 Correlation between risk factors and FVC,FEV1,FEV1/FVC,FEV1% prep Point-two column correlation analysis and Spearman analysis showed that residence,BMI and education level were positively correlated with FVC(P<0.05).Gender,age,history of smoking,history of second-hand smoke exposure,history of occupational exposure,recurrent lower respiratory tract infection in childhood,history of using coal and wood for heating,asthma,chronic bronchitis,emphysema and chronic respiratory diseases in immediate family members were negatively correlated with FVC(P<0.05).Residence,BMI and education level were positively correlated with FEV1(P<0.05).Gender,age,smoking history,childhood recurrent lower respiratory tract infection,second-hand smoke exposure history,occupational exposure history,immediate family members with asthma,chronic bronchitis,emphysema,chronic respiratory diseases were negatively correlated with FEV1(P<0.05).Gender,history of second-hand smoke exposure,history of using coal and wood for heating were positively correlated with FEV1/FVC(P<0.05).Age was negatively correlated with FEV1/FVC(P<0.05).Residence,age,BMI,history of using coal and wood for heating were positively correlated with FEV1%prep(P<0.05).Education level,smoking history,second-hand smoke exposure history,childhood recurrent lower respiratory tract infection,occupational exposure history,immediate family members with asthma,chronic bronchitis,emphysema,chronic respiratory diseases were negatively correlated with FEV1%prep(P<0.05).2.3 Multiple linear regression analysis of factors affecting lung function FVC,FEV1,FEV1/FVC and FEV1% prepMultiple linear regression results showed that gender,BMI,smoking,age,history of second-hand smoke exposure,occupational exposure and chronic respiratory diseases were independent influencing factors of FVC(β’=-0.524,0.333,-0.292,-0.095,-0.062,-0.094,-0.068,all P<0.05).Gender,age,smoking,BMI,chronic respiratory disease and occupational exposure were independent influencing factors of FEV1(β ’ =-0.489,-0.115,-0.306,0.337,-0.052,-0.100,all P<0.05).Gender and history of using coal and wood for heating were independent influencing factors of FEV1/FVC(β’=0.096,0.128,all P<0.05).BMI,smoking,occupational exposure,asthma,chronic bronchitis and emphysema in immediate family members were independent influencing factors of FEV1%prep(β’=0.340,-0.210,-0.102,-0.111,all P<0.05).2.4 Distribution characteristics of pulmonary system symptoms in high risk COPD populationThe top five pulmonary symptoms were cough(593 cases,61.90%),expectoration(442cases,46.14%),shortness of breath(367 cases,38.31%),throat discomfort(335 cases,34.97%),and shortness of breath(242 cases,25.26%).The top ten symptoms were thirst in 473 cases(49.37%),amnesia in 449 cases(46.87%),waist and knee tenderness in396 cases(41.34%),dizziness and tinnitus in 298 cases(31.11%),and cold and heat discomfort in 284 cases(29.65%).Multi-dimensional analysis of the distribution characteristics of the symptoms of different risk factors in the lower lung system: the top five symptoms of different risk factors in the lower lung system were cough,expectoration,shortness of breath,throat discomfort and shortness of breath.The distribution of cough and sputum was the highest in young recurrent lower respiratory tract infection(77.89% and 66.32%,respectively).The distribution of shortness of breath,throat discomfort and shortness of breath were the highest in chronic respiratory diseases,which were 51.89%,47.73% and35.61%,respectively.Risk factors with a high proportion of all pulmonary symptoms include repeated lower respiratory tract infections in early life,chronic respiratory diseases,asthma in immediate family,chronic bronchitis,emphysema,and occupational exposure.2.5 Correlation between TCM syndrome elements and risk factors in high-risk COPD populationIn the questionnaire of 958 COPD high-risk population,there were 11 main syndrome elements involved,and the top three syndrome elements were qi deficiency(62.00%),phsputum(34.13%)and dampness(26.62%).Lung(64.93%),kidney(410 cases,42.80%)and spleen(109 cases,11.38%)were the top three pathogenic factors.Binary Logistic regression analysis showed that age,smoking history,second-hand smoke exposure history,asthma,chronic bronchitis,emphysema and chronic respiratory diseases in immediate family members were positively correlated with qi deficiency(P<0.05).Female was negatively correlated with sputum(P<0.05),while smoking history,second-hand smoke exposure history,family history of COPD,history of asthma,chronic bronchitis,emphysema and chronic respiratory diseases in immediate family members were positively correlated with sputum(P<0.05).Female was negatively correlated with wetness(P<0.05)),while smoking history,second-hand smoke exposure history and chronic respiratory disease history were positively correlated with wetness(P<0.05).Smoking history,asthma,chronic bronchitis and emphysema in immediate family members were positively correlated with Yin deficiency(P<0.05).Smoking history and recurrent lower respiratory tract infection in childhood were positively correlated with blood stasis(P<0.05).Smoking history,recurrent lower respiratory tract infection in childhood,asthma,chronic bronchitis and emphysema in immediate family members were positively correlated with fever(P<0.05).Yang deficiency was negatively correlated with asthma,chronic bronchitis and emphysema in immediate relatives(P<0.05).Female was negatively correlated with lung(P<0.05),while smoking history,second-hand smoke exposure history,asthma,chronic bronchitis,emphysema and chronic respiratory diseases in immediate family members were positively correlated with lung(P<0.05).Smoking history,asthma,chronic bronchitis,emphysema and chronic respiratory diseases in immediate family members were positively correlated with kidney disease(P<0.05).Smoking history was positively correlated with spleen(P<0.05).Recurrent lower respiratory tract infection in childhood was positively correlated with mental retardation(P<0.05).It can be seen from the above that female is negatively correlated with phlegm,dampness and lung.Age is positively correlated with qi deficiency;Smoking history was positively correlated with qi deficiency,phlegm,dampness,Yin deficiency,blood stasis,lung,kidney and spleen.The history of second-hand smoke exposure was positively correlated with qi deficiency,phlegm,dampness and lung.Asthma,chronic bronchitis and emphysema in immediate relatives were positively correlated with qi deficiency,phsputum,Yin deficiency,heat,lung and kidney,and negatively correlated with Yang deficiency.Chronic respiratory diseases are positively correlated with qi deficiency,phlegm,dampness,lung and kidney.The family history of COPD was positively correlated with phlegm.Recurrent lower respiratory tract infection in childhood was positively correlated with blood stasis,fever and fever.2.6 To analyze the TCM syndrome types of high-risk COPD population Among the 958 high-risk groups of COPD,184 cases had no obvious syndrome,and774 cases had syndrome.The main syndrome types were selected for statistical analysis.The results showed that the top three main syndrome types were lung and kidney qi deficiency syndrome 20.46%(196/958),lung qi deficiency syndrome 15.14%(145/958),and phrem-dampness obstruction syndrome 11.38%(109/958).Other syndrome types include kidney qi deficiency syndrome,lung temper deficiency syndrome,qi deficiency syndrome,Qi and Yin deficiency syndrome,kidney Yang deficiency syndrome,kidney Yin deficiency syndrome,phlegm-heat obstructing lung syndrome,blood stasis syndrome,spleen and kidney Yang deficiency syndrome,lung and kidney qi and Yin deficiency syndrome,phlegm-dampness syndrome,dampness and heat syndrome,and lung qi and Yin deficiency syndrome.Conclusion1 The main risk factors of high risk population of COPD in Anhui region were male,smoking,age(60-69 years old),secondhand smoke exposure,and history of using coal and wood heating.The relevant factors affecting lung function indicators were chronic respiratory disease,asthma in immediate family,chronic bronchitis,emphysema,smoking,secondhand smoke exposure,history of coal and wood heating,occupational exposure,sex,age,and BMI.2 The top five pulmonary symptoms of high-risk COPD population in Anhui region under different risk factors were cough,expectoration,shortness of breath,throat discomfort and shortness of breath.Among them,the distribution of cough and sputum was the highest in young recurrent lower respiratory tract infection,and the distribution of shortness of breath,throat discomfort and shortness of breath was the highest in chronic respiratory diseases.Risk factors with a high proportion of all pulmonary symptoms included repeated lower respiratory tract infections in early life,chronic respiratory disease,asthma in immediate family,chronic bronchitis,emphysema,and occupational exposure.3 TCM syndrome types of high-risk COPD population in Anhui region are mainly lung and kidney qi deficiency syndrome,lung qi deficiency syndrome,phlegm-dampness obstructive lung syndrome.The pathogenic syndrome elements include qi deficiency,phlegm,blood stasis,dampness,Yang deficiency,Yin deficiency and heat,while the pathogenic syndrome elements include lung,spleen,kidney and god.The risk factors associated with TCM syndrome elements mainly include male,age,smoking history,second-hand smoke exposure,repeated lower respiratory tract infection at an early age,family history of COPD,asthma,slow branch,emphysema and chronic respiratory diseases in the immediate family. |
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