【摘要】 目的 探讨老年肺炎不同严重程度的中医证型演变以及中医证素危险因素。方法 收集210例老年肺炎患者的一般资料，根据CURB-65评分分为低危、中危和高危3个等级，统计分析其中医证型演变；同时采用二分类Logistic回归分析老年肺炎患者中医证素危险因素。结果 本研究最终纳入210例老年肺炎患者，涉及中医证型有痰湿阻肺证、痰热壅肺证、气阴两虚证、风热袭肺证、热闭心包证和脾肾阳虚证。根据CURB-65评分，低危患者127例，以痰湿阻肺证（44.09%）为主；中危患者42例，以痰热壅肺证（42.86%）为主；高危患者41例，以气阴两虚证（41.46%）为主；整体而言，男性多于女性；60～70岁主要相关证素为风和热，次要相关证素为肺、痰和湿；71～80岁主要相关证素为肺、痰和湿，次要相关证素为脾、肾、心包、热、气虚、阴虚、风和阳虚；81～90岁主要相关证素为脾、肾、心包、气虚、阴虚、阳虚；Logistic回归分析中医证素肺[OR=1.430,95%CI(1.251-1.760),P=0.001]、脾[OR=2.379,95%CI(1.465-4.301),P=0.003]、肾[OR=1.267,95%CI(1.065-1.392),P=0.003]、心包[OR=4.892,95%CI(1.110-20.574),P=0.039]和阳虚[OR=1.521,95%CI(1.361-1.641),P=0.001]是老年肺炎高危的危险因素。结论 本研究根据CURB-65评分总结了不同时期的证型证素分布和证素危险因素，有助于提高临床诊断价值。更多还原

【Abstract】 Objective:To investigate the evolution of TCM syndromes at different severity levels of elderly pneumonia and to analyze the risk factors associated with TCM syndrome elements. Methods:A total of 210 elderly patients with pneumonia were enrolled,and their general data were collected. Based on CURB-65 scores,patients were divided into low-risk,medium-risk,and high-risk groups for statistical analysis of the evolution of TCM syndromes. Binary logistic regression was used to analyze the risk factors of TCM syndrome elements in elderly pneumonia patients. Results:The study included 210 elderly pneumonia patients,involving TCM syndromes such as phlegm-dampness obstructing the lung,phlegm-heat congesting the lung,qi-yin deficiency,wind-heat attacking the lung,heat closure of the pericardium,and spleen-kidney yang deficiency. According to CURB-65 scores,there were 127 low-risk patients,mainly presenting with phlegm-dampness obstructing the lung(44.09%);42 mediumrisk patients,mainly presenting with phlegm-heat congesting the lung(42.86%);and 41 high-risk patients,mainly presenting with qi-yin deficiency(41.46%). Overall,males outnumbered females. In the age group of 60～70 years,the primary related syndrome elements were wind and heat,while secondary elements were lung,phlegm,and dampness. In the age group of 71～80 years,the primary related syndrome elements were lung,phlegm,and dampness,while secondary elements were spleen,kidney,pericardium,heat,qi deficiency,yin deficiency,wind,and yang deficiency. In the age group of 81～90 years,the primary related syndrome elements were spleen,kidney,pericardium,qi deficiency,yin deficiency,and yang deficiency. Logistic regression analysis showed that lung[OR=1.430,95%CI(1.251-1.760),P = 0.001],spleen[OR=2.379,95%CI(1.465-4.301),P = 0.003],kidney[OR=1.267,95% CI(1.065-1.392),P = 0.003],pericardium[OR=4.892,95%CI(1.110-20.574),P = 0.039],and yang deficiency[OR=1.521,95%CI(1.361-1.641),P = 0.001]were risk factors for severe elderly pneumonia. Conclusion:This study summarized the distribution and risk factors of syndrome elements at different stages based on CURB-65 scores,which can improve clinical diagnostic value.更多还原