【作者】 杨燕；

【导师】 肖泓；

【作者基本信息】 云南中医学院 ， 中西医结合临床， 2016， 硕士

【摘要】 目的:分析探讨肺气虚证和痰热壅肺证慢性阻塞性肺疾病患者段支气管及亚段支气管重塑的特点与差异,探讨肺胀两型中医证型与气道重塑HRCT定量的相关性,为肺胀的临床诊断、治疗及疗效评价提供客观理论依据。方法:选择2013年8月至2014年11月在云南省中医医院内科就诊的92例肺胀患者为研究对象,选择同期在体检中心体检的正常人群为对照组。其中,辨证属肺气虚证肺胀者45例,痰热壅肺证者47例,正常对照组40例。对受试者行胸部HRCT扫描,观察双肺病变,并利用胸部容积复合采集和重建软件(thoracic volume complex acquirement and reconstruction,Thoracic VCAR)的气道自动分析功能对双肺上叶尖(后)段、尖(后)亚段支气管进行测定,分别测量支气管的管壁厚度(wall thickness,WT)、管腔内径(inner diameter,Din)、管壁面积(wall area,WA)及管壁面积百分比(percentage of wall area,WA%),再对其结果进行对比分析,探讨两种证型肺胀患者气道重塑(airway remodeling,ARM)的特点及差别。结果:1.肺胀肺气虚证及痰热壅肺证患者的段和亚段支气管均存在气道重塑,HRCT上表现为不同程度的支气管壁增厚和管腔狭窄。2.肺气虚证患者的气道重塑主要发生在段支气管,亚段支气管的改变无痰热壅肺证患者明显,差异有统计学意义(P<0.05),表现为WT增大、Din缩小、WA%增大,但WA无明显变化。3.痰热壅肺证患者的气道重塑在段、亚段支气管均有发生,表现为WT增大、Din缩小、WA%增大,同时WA也增大。4.痰热壅肺证患者支气管增厚程度较肺气虚证患者明显,肺气虚证患者肺气肿征象较痰热壅肺证患者明显,两种征象存在统计学差异(P<0.05)。肺部渗出性病变在痰热壅肺证者较多见。结论:肺胀肺气虚证及肺胀痰热壅肺证患者的段和亚段支气管均存在气道重塑。肺气虚证患者的气道重塑主要发生在段支气管。痰热壅肺证患者的气道重塑主要在亚段支气管更明显。肺胀痰热壅肺证患者支气管增厚程度及肺部渗出性病灶较肺气虚证者明显。肺胀肺气虚证患者肺气肿征象较痰热壅肺证者明显。不同中医证型肺胀在肺实质、气道重塑等方面存在的差异和相关性可在不同程度上揭示肺胀病机特点的个体差异性,有助于揭示病变的实质和病机。HRCT能有效评价肺气虚证、痰热壅肺证肺胀患者的支气管改变和重塑情况。更多还原

【Abstract】 Objective:To investigate the characteristics and differences of chronic obstructive pulmonary disease(COPD) in patients with Fei Qi deficiency syndromeand syndrome of phlegmheat obstructing lung,discussion of two types of lung inflation syndrome type and airway remodeling(ARM) high resolution computed tomography(HRCT) quantitative correlation,and to provide evidence for clinical diagnosis and treatment, treatment and efficacy evaluation.Methods:The subjects were selectedfrom Aug 2013 to 2014 Nov by Traditional Chinese Medicine(TCM) Hospital of Yunnan Province, normal people as control group were selected the same period in physical examination center.Total 92 cases, syndrome differentiation of chronic obstructive pulmonary disease(COPD) is Fei Qi deficiency syndrome in 45 patients,syndromeof phlegmheat obstructing lungin 47 cases, and 40 normalsubjects.HRCTwere performed in the subjects,observed lung lesions changes in Medical Imaging.We used the thoracic volume complex acquirement andreconstruction(VCAR) software to analyze the Wall thickness(WT), inner diameter(Din), wall area(WA),percentage of wall area(WA%) of upper lobe apical segmental and sub-segmental bronchias well as lower lobe posterior basal segmental and sub-segmentalbronchi of right and left lung, and then the results were compared and analyzed, to explore the characteristics and differences of airway remodeling in patients with different types of COPD.Results:1. Airway remodeling of all COPD patients were existed in segmental and sub-segmental bronchi,we observeddifferent degrees of bronchial wall thickening and luminal narrowingby HRCT examination.2. Airway remodeling of Fei Qi deficiency syndrome patients existed mainly in segmental bronchi, and airway remodeling of syndromeof phlegmheat obstructing lungpatients was more apparent in sub-segmentalbronchi,the difference was statistically significant(P<0.05). Airway remodelingis displayed as the WT increase, narrowing the din, WA% increase, but WA no changesignificantly.3.Airway remodeling of syndromeof phlegmheat obstructing lung patients was more apparent in segmental and sub-segmentalbronchi.Airway remodelingis displayed as the WT increase, narrowing the din, WA% increase, but WA no changesignificantly.4.Bronchial WTincreased grading and emphysema signs are statistical differencewith Fei Qi deficiency syndrome and syndromeof phlegmheat obstructing lung.WTincreased withsyndromeof phlegmheat obstructing lungwere obvious.COPD Patients with Fei Qi Deficiency signs of emphysema, compared with syndromeof phlegmheat obstructing lungwere significantly. The differences of the two signs was statistically significant(P<0.05).Exudative lesions in the lung phlegm obstruct the lung are more common.Conclusions:Airway remodeling of Fei Qi deficiency syndrome and syndromeof phlegmheat obstructing lung were existed in segmental and sub-segmental bronchi.Airway remodeling of Fei Qi deficiency syndrome patients existed mainly in segmental bronchi.Airway remodeling of syndromeof phlegmheat obstructing lungpatients were existed mainlyin sub-segmental bronchi.Bronchial WTincreased grading and emphysema signs are statistical differencewith Fei Qi deficiency syndrome and syndromeof phlegmheat obstructing lung.WTincreased withsyndromeof phlegmheat obstructing lungwere obvious.Signs of emphysema with Fei Qi deficiency syndrome were obvious.Exudative lesions in the lung phlegm obstruct the lung are more common.The differences and correlations of COPD with different TCM syndromes in lung parenchyma and airway remodeling can reveal individual differences in the characteristics of COPD’s disease in different degrees, and help to reveal the essence and pathogenesis of COPD. HRCT can effectively evaluate the changes and airwayremodeling of COPD patients.更多还原