慢性阻塞性肺病的中医证候学调查研究

【作者】 王玉光；

【导师】 周平安； 张洪玉；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2004， 博士

【摘要】 本研究在北京市市区随机选择某一社区的常住人口,以肺功能测定作为诊断慢性阻塞性肺病(COPD)的金标准,以整群抽样、入户调查的方式对大于 40岁的 1639 人进行了流行病学调查,得到城市 COPD 病人的中西医基线资料,采用病例对照研究的方法对 COPD 患者的病因进行了推断,对 COPD 的中医证候学进行了调查研究,提出中医防治 COPD 的策略和方案。 社区 COPD 的基线资料:1.社区大于 40 岁人群的 COPD 患病率为 9.01%,平均年龄为 65.26±12.35 岁,男女比例在 1.54:1 左右, 60 岁以上患者占总病例的 77.27%。2.COPD 患者中约 45%无慢性气道炎症史,未得到诊断和相关防治方面的建议。3.病例对照研究发现,吸烟在所有可能危险因素中作用最大,开始吸烟年龄、吸烟指数、吸烟总量与 COPD 患病率相关;儿童期上呼吸道感染次数、儿童期气管炎病史与 COPD 的患病率存在线性关系;家族性呼吸病史对于COPD 具有致病作用;无机粉尘暴露是具有独立作用的危险因素,在非吸烟男性COPD 患者中,以职业暴露史所占的病因比例最大;卧室与居室是否分开,烹饪方式与疾病发病之间有相关关系。 中医证候学基线资料表明:中医症状、体征汇总发现在肺脾肾三脏虚证的分布中,肺气虚出现的频率最高,脾气虚的证候在轻中重三级患者中普遍存在,肺脾虚证贯穿于 COPD 发展过程的始终;肾阳虚、肾阴虚证和痰浊证、血瘀证在ⅡB 和Ⅲ级中分布居多。在 COPD 的发展进程中存在着由肺气虚向脾气虚和肾虚的发展趋势,在虚证程度逐渐加重的同时,实证出现频率也明显增加。ⅡB 和Ⅲ级 COPD 的中医证候表现为虚实夹杂。COPD 损伤的主要是气、阳,由阳损阴,血瘀痰浊交阻使得本病变成沉疴固疾。COPD 复合证的出现频率即较单证为多,即使在Ⅰ、ⅡA 级患者中复合证也广为存在。 中医虚证证候的病例对照研究发现: COPD 患者运动耐力下降的特点是:在运动负荷下,呼吸浅快,吸气时间短于呼气时间,类似于古人对于肾不纳气证呼吸症状的描述:动则喘甚,呼多吸少,吸气尤难。膈肌功能不全是 COPD 运动耐力下降的主要发生机制,肾不纳气证是膈肌功能不全的表现形式,以肺脾虚证表现为主的轻中度 COPD 患者已存在着运动耐力的下降,肾不纳气证在肾虚组和肺脾气虚组存在着程度上的不同,其病理本质是运动耐力的下降,是膈肌功能不全,与 COPD 气流受限、肺过度充气以及营养不良等相关。本次调查中还发现,COPD 中医虚证组营养不良发生率为 25%,呼吸肌肌力、耐力与人体营养测量指标存在相关性。由此提出补肾纳气法、健脾助运法可从不同角度改善呼吸肌的肌力耐力,从而防治 COPD 的呼吸衰竭。更多还原

【Abstract】 This research chose permanent residents of one community at randomin the urban area of Beijing, to use lung function exam as the goldstandard of diagnosing COPD, the ways of sampling in whole group andinvestigating 1639 people over 40 years of age on epidemiology, in orderto get urban COPD patient’s traditional Chinese and western medicinebase-line materials, adopt the comparative study method of the case toinfer COPD patient’s cause of disease, and to investigate on TCMsymptomatology of COPD, bring up TCM tactics and scheme of preventingand curing COPD. The base-line materials of community with COPD: 1.about 9.01% of COPDpatients are over 40 years of age, mean age is 65.26+-12.35, theproportions of men and women are 1.54: 1, 77.27% of the total case areover 60 years old. 2. About 45% of COPD patients have no history ofchronicle inflammation of air way, never got diagnosed or receivedrelevant suggestion of preventing and curing the disease. 3. the studydiscovered that smoking may be the most dangerous factor in all, theinitial age to smoke, index of smoking, total amount of smoking correlatewith COPD begin; the links between bronchitis occurred in childhood andlater COPD patients; the history of family respiratory diseases、inorganic powder dusts exposing acts independently as the dangerousfactor, among the non-smoking male COPD patients, largest proportion aredue to patient’s occupation who exposes to the cause of disease ; thematter of living room and bedroom is separated, and the relations betweenthis disease and the cooking style are also relevant. The base-line materials of TCM Syndrome study shows: Symptoms areclassified for 7 types of TCM syndromes, TCM mainly distributes threedeficiency organs of lung, spleen and kidney, deficiency of qi of lungappear most frequently, deficiency of qi of spleen appear to be mostcommon among all three degrees(I.II III), deficiency of qi of lung andspleen carry out evolution in COPD all the time; The deficiency of bothyang and yin of kidney, the turbid phlegm and blood stasis are majoritydistributed in IIB and III degrees. The deficiency of lung, spleen andkidney have become the development process in COPD, as the degree ofdeficiency is gradually aggravated, the excess syndrome appear morefrequently, TCM syndrome of IIB and III degree the patients appear tobe both the deficiency and excess conditions, COPD is mainly damaged qi,yang, moreover impairment of yang impeding of yin, blood stagnation, andphlegm retention make this pathological become more complicated. Morecompound symptoms are found than individual symptom when diagnosed withCOPD. This also occurs in I,IIA degrees. The deficiency symptom of TCM comparison study discovers: COPD 3<WP=5>4 慢性阻塞性肺疾病中医证候学调查研究patient’s movement have lower endurance, rapid and light breathing undermovement, the time of breathing in is shorter than the time of exhaling,similar to original TCM description that kidney failed to promoterespiration: difficult breathing, dyspnea and hypopnea. Malfunctioningof diaphragm muscle is the major mechanism of COPD patient with lowermovement endurance. Failure of kidney to promote respiration is theexpression of incomplete diaphragm functioning, for those patients withmoderate degree of lung spleen deficiency may suffer all above symptoms,as its pathology expects declining movement of endurance, diaphragmmuscle malfunction, COPD with limited air flow, lung over inflated andnutrition condition, etc.. This research also discovers that in TCMdeficiency group, 25% of patients with malnutrition. Respiratory muscle,strength endurance and human nutrition measurement are interrelated.Therefore, we conclude by reinforcing kidney to improve inspiration,invigorating spleen and replenishing qi in order to prevent and cureCOPD.更多还原