Clinical Observation And Study On TCM Syndromes And Respiratory Microecology Of Secondary Digestive Tract-respiratory Tract Fistul

Background:Acquired Digestive tract-Respiratory fistula(ADRF)is an abnormal channel between the digestive tract and respiratory tract,which prevents patients from eating normally and leads to uncontrollable lung infections due to continuous aspiration.The general situation rapidly worsens.Its clinical treatment is difficult,the fistula is difficult to heal,the quality of life is poor,and the mortality rate is high.Most patients die due to malnutrition,aspiration pneumonia,and severe infection.Traditional Chinese medicine takes the overall concept and treatment based on syndrome differentiation as the guiding ideology,which has its unique advantages in the treatment of lung infectious diseases.Objective:To observe the characteristics of traditional Chinese medicine symptoms,syndrome elements,and distribution of syndrome types in patients with secondary gastrointestinal respiratory fistula upon admission;Based on pathogenic metagenomics detection technology,the species distribution and abundance of pathogenic microorganisms and respiratory tract microbiota in patients with secondary gastrointestinal respiratory fistula were analyzed,and the respiratory tract microbiota composition in patients with gastrointestinal respiratory fistula was observed;Analyze the correlation between respiratory microbiota and traditional Chinese medicine syndromes and clinical outcomes of digestive tract respiratory fistula,and compare the differences in microbiota composition among different TCM syndrome groups;Compare the differences in microecological composition among different TCM syndrome groups.Method:This study adopts a cross-sectional survey research method,referring to the "Syndrome Differentiation Factor Scale" in Professor Zhu Wenfeng’s "Syndrome Differentiation and Syndrome Differentiation" to standardize the patient’s four diagnostic information and develop a clinical Chinese medicine syndrome collection table.Patients who were diagnosed with secondary gastrointestinal respiratory fistula at Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine and the Respiratory Department of Tongzhou Hospital from January 2021 to December 2022 were continuously included in the Chinese medicine syndrome collection table,Retain alveolar lavage fluid for pathogen metagenomic testing and establish a database.The weight calculation of evidence elements adopts the simplified measurement method of evidence elements.All data were analyzed using SPSS 26.0 statistical software.Result:1.General information:A total of 58 patients with ADRF were collected in this study;including 21 cases of B-DRF(36.20%)and 37 cases of M-DRF(63.30%).Malignant fistula patients were more common than benign fistula patients.33 patients with M-DRF were mainly secondary to esophageal cancer,accounting for 89.18%.Among them,54%of patients developed respiratory fistula during the tumor treatment process;The occurrence of 14 cases of B-DRF is mainly related to anastomotic leakage after radical resection of esophageal cancer,accounting for 66.67%.The main clinical manifestations of ADRF patients upon admission are frequent coughing and excessive sputum production,followed by weight loss and fatigue,accounting for 68.96%and 65.52%of the total number;respectively.Among them,M-DRF patients have a higher proportion of weight loss and fatigue compared to B-DRF,and their nutritional status is worse.The fistula of M-DRF patients was mainly located in Zone Ⅶ in 15 cases,accounting for 40.54%,while the fistula of B-DRF patients was mainly located in Zone Ⅱ in 10 cases,accounting for 47.61%.The fistula size of ADRF patients in this study was[0.1-5]cm,with an average of 1.48±1.54cm.The fistula size of M-DRF patients was slightly larger than that of B-DRF patients,1.75 ± 1.82cm vs 1.03 ±0.73 cm.However,there was no statistically significant difference in fistula size between the two groups.Y-shaped metal covered stent is the most commonly used type of airway stent in M-DRF and B-DRF patients,with a total of 31 cases,accounting for 64.58%.The total effective rate(CR+CCR+PR)for efficacy evaluation after stent placement was 95.83%,with 60.41%of patients experiencing partial relief of clinical symptoms through the placement of airway stents,and 33.33%of patients experiencing complete relief of clinical symptoms.Following up for 5-32 months,there were 23 survivors(39.66%),36 deaths(60.34%),32 deaths in M-DRF patients,and 4 deaths in B-DRF patients,with the deaths mainly concentrated in the M-DRF group.The overall survival time(OS)of M-DRF was 0.3,12 months,with an average OS of 4.72 ± 3.10 months.The median OS is 4 months.2.Distribution of Traditional Chinese Medicine Syndromes:The observation table of traditional Chinese medicine syndromes for ADRF patients in this study involves a total of 59 information items related to the four diagnostic methods of traditional Chinese medicine,including 42 symptom information,11 tongue information,and 6 pulse information.Coughing and expectoration are the main symptoms of patients upon admission.In terms of accompanying symptoms,M-DRF patients have more symptoms,mainly characterized by fatigue and fatigue(78.38%),poor sleep(78.38%),long-term lack of food(72.97%),asthma(59.46%),lazy speech(56.75%),low voice(51.35%)and other qi deficiency syndromes,while B-DRF patients have fewer symptoms,mainly characterized by stomach loss and decreased symptoms such as acid reflux and heartburn(76.19%).The tongue veins are mainly dark red,greasy coating,and smooth veins.3.Traditional Chinese Medicine Syndrome Elements:The disease location syndrome elements are mainly lung(100%)and spleen(20.69%),while the disease nature syndrome elements are mainly phlegm(81.03%),qi deficiency(48.28%),and yin deficiency(27.59%).M-DRF has a higher frequency of qi deficiency(P=0.005)and yin deficiency(P=0.02),and the difference is statistically significant.4.Traditional Chinese Medicine Syndrome Type:M-DRF is mainly characterized by 18 cases of phlegm turbidity obstructing the lung syndrome,accounting for 48.65%of the total number of people.It often coexists with lung spleen deficiency syndrome and qi yin deficiency syndrome,with 6 cases and 5 cases respectively;Secondly,there were 8 cases of phlegm heat obstructing the lung syndrome,accounting for 21.62%of the total population.There were mainly 4 cases of deficiency of both qi and yin,and 1 case of deficiency of lung and spleen qi;There were 7 cases of cold drink induced lung arrest,accounting for 18.92%of the total population.Among them,4 cases had both qi and yin deficiency,and 3 cases had both lung and spleen qi deficiency.B-DRF is mainly characterized by phlegm turbidity obstructing the lung syndrome and phlegm heat obstructing the lung syndrome,with 13 cases and 5 cases,respectively,accounting for 61.90%and 23.81%of the total population.The difference in syndrome types between M-DRF patients and B-DRF patients is not statistically significant.5.The respiratory tract microbiome group of ADRF was dominated by pathogens,of which bacteria were detected in high sequence with high relative abundance.M-DRF was dominated by Pseudomonas aeruginosa and Enterococcus,with 8 cases(44.44%)and 3 cases(16.66%)respectively.B-DRF was dominated by Pseudomonas aeruginosa,Corynebacterium striatum,and Oligomonas maltophilia,with 7 cases(70%)and 5 cases(50%)respectively.6.Streptococcus accounted for the largest proportion in the detection of human microbiota in the lower respiratory tract of ADRF,with a high relative abundance,followed by Monospora.The maximum number of M-DRF microbial species detected was 19 species of Prevotella,followed by 17,12 and 10 species of Streptococcus,Actinomyces and Monads,respectively;19 species of Streptococcus were the most detected species of B-DRF microbial bacteria,followed by Prevo,actinomycetes and Neisseria,with 16,9 and 9 species respectively.The dominant microbial genera in ADRF microecology are Streptococcus,Prevotella,and Actinobacteria.Conclusion:1.The incidence rate of M-DRF is higher than that of B-DRF,in which the male is higher than the female,and the age group with high incidence is 60-69 years old.M-DRF is mainly secondary to esophageal cancer,and the occurrence of B-DRF is mainly related to anastomotic leakage after radical resection of esophageal cancer.2.If coughing and recurrent lung infections occur after esophageal cancer surgery or during the treatment process,it should be suspected as an airway fistula and diagnosis and treatment should be immediately implemented.To evaluate the condition of the fistula and airway,all patients should undergo bronchoscopy.3.The M-DRF fistula is mainly located in Zone VII of the airway,while the B-DRF fistula is mainly located in Zone Ⅱ of the airway.Airway stents can safely and effectively alleviate patients’ clinical symptoms and reduce lung infections.The most commonly used is the Y-shaped metal coated bracket.4.The nutritional status of M-DRF is worse than that of B-DRF,and it is necessary to improve healthcare and patient awareness of nutrition.Because nutrition is related to the healing of the fistula.5.B-DRF has a good prognosis,M-DRF has a short survival period,high mortality rate,and an average OS of 4.72±3.10 months.The median OS is in 4 months.6.ADRF patients have a variety of symptoms upon admission,with the main symptoms being cough,expectoration,asthma,acid reflux and heartburn,fatigue and fatigue,poor sleep,dark red tongue,greasy coating,and slippery pulse.7.ADRF disease location syndrome elements involve the lungs,heart,spleen,kidneys,and stomach.The disease nature syndrome elements include phlegm,qi deficiency,yin deficiency,heat,closure,yang deficiency,dampness,non fixation,water stagnation,blood stasis,and qi stagnation.8.Clinical differentiation is mainly based on lung and phlegm,with a mixed nature of deficiency and excess.This deficiency is mainly characterized by deficiency of lung and spleen qi,deficiency of spleen and stomach yang,and deficiency of qi and yin,while the standard deficiency is phlegm turbidity and water consumption.The common clinical syndrome types are:cold yin obstructing the lung syndrome,phlegm turbidity obstructing the lung syndrome,phlegm heat obstructing the lung,deficiency of both qi and yin,and lung spleen deficiency syndrome.9.The detection of ADRF pathogenic microorganisms is mainly Pseudomonas aeruginosa,Enterococcus,Escherichia coli,Corynebacterium striatum,Stenotrophomonas maltophilia and Klebsiella pneumoniae.10.Enterococcus and Corynebacterium striatum are less common than previously reported.This study suggests that ADRF is more likely to be infected with colonized bacteria in the digestive tract due to aspiration,and attention should be paid to the infection of gram-positive bacteria.11.The main bacteria detected in the lower respiratory tract microecology are Streptococcus,Micromonas,Veronicus,Prevotella,Actinomyces,Fusobacteria,dystrophies,CO2 Fibrophages,Schaalia,of which Streptococcus has the highest relative abundance,accounting for a high proportion,followed by Monospora.12.Patients with deficiency syndrome and those with a survival period of less than 3 months have a high sequence of pathogenic microorganisms detected,with a relatively high abundance and less detection of microbiological bacteria.The imbalance of microbiota may be related to the survival period of M-DRF.