Study On The Correlation Between TCM Syndrome Types,Inflammatory Index And PSI Score Of Community-acquired Pneumonia

ObjectiveBy studying the correlation between different TCM syndrome types of community acquired pneumonia(CAP)and inflammatory indicators such as procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),neutrophil absolute value to lymphocyte absolute value ratio(NLR)and pneumonia severity score(PSI),The relationship between the distribution of TCM syndrome types of CAP and the scores of PCT,hs-CRP,NLR and PSI was preliminarily obtained,which provided more objective basis for TCM syndrome differentiation,so as to improve the accuracy of TCM syndrome differentiation in patients with CAP.As PCT,hs-CRP and NLR have discriminative effects on pathogen infection of CAP,this study also lays a foundation for the prediction of pathogens that may be infected by TCM syndrome types of CAP,and provides a basis for TCM combined with appropriate anti-infection treatment,thus improving the effectiveness and accuracy of the combined diagnosis and treatment of CAP with traditional Chinese and western medicine.MethodsA total of 205 patients admitted to the Department of Respiratory and Critical Care Medicine of Yunnan First People’s Hospital from November 2021 to December 2022 who were diagnosed as non-severe community-acquired pneumonia were collected.General data,clinical symptoms,and related inflammatory indicators(PCT,hs-CRP,NLR)of the patients were collected,and PSI score was performed.At the same time,according to the standard of TCM classification and syndrome differentiation,TCM syndrome information of patients was extracted and classified according to the questionnaire,and patients were divided into mild group and severe group according to the final outcome.Statistical methods such as variance analysis,rank sum test and Chi-square test were used to analyze the differences of PCT,hs-CRP,NLR and PSI scores among different TCM syndrome types and the differences of clinical outcomes among different syndrome types.Binary logistic regression was used to analyze the risk factors associated with different clinical outcomes of CAP.In this study,SPSS27.0software was used for statistical analysis.Results1.205 effective samples were finally included,and the proportions of each TCM syndrome type in descending order were: wind heat attacking the lung(21.5%),phlegm-heat obstructing the lung(21%),phlegm turbidity obstructing the lung(16.6%),external cold and internal heat(16.1%),lung-spleen qi deficiency(12.7%)and qi-Yin deficiency(12.2%).2.Among the 205 patients with CAP,there were 116 male patients and 89 female patients,and there was no statistical difference in the sex composition ratio of syndrome types among all groups(P > 0.05).3.The samples included in this study ranged from 18 to 91 years old,44 cases(21.5%)ranged from 18 to 39 years old,84 cases(41%)ranged from 40 to 64 years old,66 cases(32.2%)ranged from 65 to 79 years old and 11 cases(5.4%)were over 79 years old.The syndrome types of different ages from large to small were: external cold and internal heat syndrome,Qi and Yin deficiency syndrome,lung-spleen qi deficiency syndrome,phlegm-heat obstructing lung syndrome,phlegm-turbidity obstructive lung syndrome,wind and heat attacking lung syndrome.There were statistical differences in age between the syndrome of wind heat attacking the lung and the syndrome of external cold and internal heat,the syndrome of phlegm-heat obstructing the lung and the syndrome of deficiency of Qi and Yin(P < 0.05),and there were statistically significant differences between the syndrome and external cold and internal heat(P < 0.01).In the aspect of concurrent syndrome,There was significant statistical difference between the group over 79 years old,the group from 18 to 39 years old and the group from 40 to 64 years old(P < 0.01).Qi-deficiency(27.3%)and Qi-Yin deficiency(9.1%)were the main cases in patients aged 65-79,and Qideficiency(27.3%)and Qi-yin deficiency(9.1%)were the main cases in patients aged over79.4.There was a significant statistical difference in the proportion of clinical outcome of each group of syndrome types.The proportion of syndrome types that turned to severe disease from high to low was as follows: lung-spleen qi deficiency syndrome(34.6%),phlegm-turbidity obstructive lung syndrome(23.5%),phlegm-heat obstructing lung syndrome(20.9%),external cold and internal heat syndrome(12.1%),Qi-Yin deficiency syndrome(4%),wind heat attacking lung syndrome(2.3%).There were statistically significant differences in clinical outcomes between the syndrome of lung-spleen qi deficiency and the syndrome of wind-heat attacking lung and the syndrome of Qi-yin deficiency(P < 0.05),among which there was statistically significant difference between the syndrome and the syndrome of wind-heat attacking lung(P < 0.01).5.205 samples were hospitalized for 5～49 days,and the average length of hospitalization was 11.88±0.415 days.There was no statistical difference in the composition ratio of the average length of hospitalization among all groups(P=0.199 > 0.05),and there was no statistical difference in the detection of pathogens among all groups(P > 0.05).6.There were statistical differences in the PCT level of the syndrome types in each group(P < 0.05),among which the PCT level of the syndrome of cold outside and heat inside was statistically different from the syndrome of wind heat attack on the lung,the syndrome of phlegm turbidity blocking the lung,and the syndrome of Qi-Yin deficiency(P <0.05),and the PCT level of the syndrome of phlegm heat obstructing the lung was statistically different from the syndrome of phlegm turbidity blocking the lung(P < 0.05).7.There were statistically significant differences in the hs-CRP level among all the syndrome types(P < 0.01).There were statistically significant differences between the hs-CRP level of phlegm-heat obstructing lung syndrome and all the syndrome types except the syndrome of heat-in-cold syndrome(P < 0.05),and there were statistically significant differences between the hs-CRP level of phlegm-heat obstructing lung syndrome and lung-spleen qi deficiency syndrome(P < 0.01).The hs-CRP level in the syndrome of external cold and internal heat was significantly different from that in the syndrome of phlegm-turbidity blocking lung and lung-spleen qi deficiency(P < 0.05).8.There was a significant statistical difference in the NLR level of each syndrome type(P < 0.01).The NLR level of phlegm-heat obstructing lung syndrome was statistically different from that of other syndrome types(P < 0.05),and that of wind-heat attacking lung syndrome was statistically different(P < 0.01).9.There were significant statistical differences in the PSI score of each syndrome type(P < 0.01),and the PSI score of the syndrome of wind-heat attacking lung had statistical differences with all other syndrome types(P < 0.05),and there were significant statistical differences with the syndrome of external cold and internal heat,phlegm-heat obstructing lung syndrome(P < 0.01).PSI grading: There were statistical differences between the syndrome of wind heat attacking lung and the other 4 groups except the syndrome of Qi and Yin deficiency(P < 0.05),among which the syndrome of wind heat attacking lung and the syndrome of external cold and internal heat had significant statistical differences(P < 0.01).PSI score risk stratification: there was significant statistical difference between the syndrome of wind heat attacking lung and the syndrome of external cold and internal heat(P < 0.01).10.According to different clinical outcomes,205 samples in this study were divided into the improvement group and the severe group,among which 173 cases were in the improvement group and 32 cases were in the severe group.There were 26 male patients(81.3%)and 6 female patients(18.8%)in the serious condition group,and there was a statistical difference in age distribution between the improvement group and the serious condition group(P < 0.05).Binary logistic regression showed that NLR and PSI scores were risk factors for severe clinical outcome in patients with CAP(P < 0.05).Conclusion1.In terms of TCM syndrome types and age of patients,the incidence of wind heat attacking lung syndrome is younger than other syndrome types,and the incidence of external cold and internal heat syndrome is older.In terms of complicated syndrome,elderly patients are more likely to have complicated syndrome,which is mainly caused by phlegm-dampness,phlegm-heat combined with Qi deficiency and Qi Yin deficiency.Therefore,the syndrome mixed with deficiency and substance is mainly used.2.In terms of TCM syndrome types and clinical outcomes,patients with lung Qi deficiency syndrome are more likely to become severe,which may be related to the fact that elderly patients were the majority of patients with lung-spleen qi deficiency syndrome in this study.3.TCM syndrome type is correlated with inflammatory indicators and PSI score,the rise of PCT level is related to the syndrome of external cold and internal heat and phlegm-heat obstructing lung,the rise of hs-CRP and NLR is related to the syndrome of phlegm-heat obstructing lung,and the low PSI score is related to the syndrome of wind heat attacking lung.4.In this study,the increased levels of PCT,hs-CRP and NLR were mainly seen in phlegm-heat obstruction and lung syndrome,external cold and internal heat syndrome,indicating that bacterial infection was the main type in these two syndromic types,suggesting that in the integrated treatment of traditional Chinese and western medicine for CAP,antibiotics could be appropriately combined with traditional Chinese medicine treatment in the early stage to shorten the course of CAP and improve the efficacy.5.In the clinical outcome of CAP patients,NLR and PSI score are risk factors for the clinical outcome of CAP patients to be severe.The higher the value of such indicators,the more severe the eventual outcome of patients.