特发性肺纤维化患者咳喘相关病证特点及中医临床证治研究

【作者】 王玥；

【导师】 王玉光；

【作者基本信息】 北京中医药大学 ， 中医内科学（专业学位）， 2019， 硕士

【摘要】 研究目的:1.通过对特发性肺间质纤维化(idiopathic pulmonary fibrosis,IPF)的患者的临床观察,描述IPF患者咳嗽及呼吸困难的临床特征和病机。2.通过为期12月的随访观察,评价中医药缓解IPF进行性呼吸困难及难治性咳嗽等症状的临床疗效。3.通过分析临床典型病案,探讨中医药治疗IPF咳喘的靶点及优势,以期为IPF临床诊治提供更多思路。研究方法:1.纳入2016年10月至2018年12月在北京中医医院呼吸科门诊或病房就诊的IPF患者,通过采集患者中医症状信息,描述咳嗽、咳痰和呼吸困难等症候学特点,归纳IPF咳嗽和呼吸困难的病机特点。2.对纳入的IPF患者进行临床随访观察,根据患者四诊信息进行辨证论治,分别于0、3、6、12月评估患者LCQ、CRP、咳嗽及呼吸困难视觉评分、肺功能和6分钟步行试验等指标,对中医药治疗IPF进行疗效评价分析。3.列举中医药治疗IPF难治性咳嗽及呼吸困难验案,为临床治疗IPF提供新的思路。研究结果:1.IPF患者咳嗽特点:IPF患者,咳嗽主要以白天及清晨为著,夜间咳嗽较少;主要咳嗽诱发/加重因素为油烟异味刺激、活动和冷空气刺激,多伴随咽痒,IPF患者咳嗽主要伴随症状为咳甚气短、胸闷和疲劳,平卧位则咳嗽可减轻。2.IPF患者咳痰特点:IPF患者痰量少、色白、质黏、泡沫样,痰较难咳出,痰出则咳减。3.IPF呼吸困难特点:IPF呼吸困难患者动则气短,平卧或静息可减轻,呼吸浅快、气难吸入、声低息短、气不够用、吸气不到底、上气不接下气等,多伴有胸部闷胀感,少有张口抬肩等辅助呼吸方式。4.IPF中医证治特点:IPF患者首先病位在肺,随着病情加重肾迁延受累,IPF主要为虚证和虚实夹杂证,以肺肾阳气虚损为主,夹有痰浊、瘀血、气滞。治疗应以补益肺肾为主,兼顾痰浊湿邪。5.中医疗效分析:中药治疗IPF患者3个月后,IPF患者咳嗽视觉评分、呼吸困难视觉评分和呼吸困难CRP评分较治疗前明显下降,有统计学差异(P<0.05),并在6个月内呈平稳趋势;治疗12个后LCQ评分趋于平稳;肺功能方面,治疗12月后DLCO SB较治疗前上升,无统计学差异(P=0.32),FVC(L)6月内保持平稳,12月后较治疗前下降,有统计学差异(P=0.004),FVC下降数值为180ml,下降速率为6.52%;中药治疗3月后,6MWT血氧饱和度数值呈上升趋势,此后逐渐下降,治疗前后差异无统计学差异(P=0.44)。中药治疗3个月后6分钟步行试验距离和最低血氧饱和度较治疗前上升,氧饱和度差值下降,治疗12个月后6分钟步行距离较前上升(P=0.51)。研究结论:IPF咳嗽为内伤咳嗽,呼吸困难表现为虚喘的证候;肺气宗气亏虚,肺不布津以及肾的气化无力是痰浊的产生的根本原因。临床治疗IPF咳嗽和呼吸困难当以补益肺肾为主,兼顾痰湿,尤其后期肾阴阳两虚应当以双补阴阳为要2.中医药治疗IPF能明显减少患者咳嗽频次、减轻咳嗽程度以及呼吸困难症状,提高患者生活质量,使患者在一定时间内维持病情稳定。更多还原

【Abstract】 Objectives:1.Describe the clinical features of cough and dyspnea in patients with IPF by clinical observation of patients with idiopathic pulmonary fibrosis(IPF).2.Through a one-year follow-up observation,evaluate the clinical efficacy of Chinese medicine in relieving IPF progressive dyspnea and refractory cough and improving quality of life.3.Through analyzing the typical clinical cases and explore the target and advantages of traditional Chinese medicine in the treatment of IPF and cough,provide more ideas for clinical diagnosis and treatment of IPF.Methods:1.The IPF patients who were admitted to the respiratory department clinic or ward of the Beijing Chinese Medicine Hospital from October 2016 to December 2018,The symptom characteristics of cough,cough and dyspnea were described by collecting information on TCM symptoms of patients.2.Clinical follow-up observation of the included IPF patients,according to the patient’s four diagnostic information for syndrome differentiation and treatment,evaluation of patients LCQ CRP,lung function and 6-minute walk test in 0,3,6 and 12 months,respectively,and evaluation and analysis of Chinese medicine treatment efficacy for IPF.3.List Chinese medicine treatment of IPF refractory cough and dyspnea test case,and provide new ideas for clinical treatment of IPF.Research result:1.IPF patients with cough characteristics:IPF patients’s cough mainly in the day and early morning,less cough at night;the main cough induction/aggravation factors are soot odor stimulation,activity and cold air stimulation,and is often accompanied by pruritus of pharynx;The main symptoms associated with cough in patients with IPF are cough and shortness of breath,chest tightness and fatigue.Sitting position increased cough,recumbent position decreased cough。2.The characteristics of cough in patients with IPF:The main feature of patients with IPF is coughing a small amount of white foamy sticky sputum,which is more difficult to cough and sputum.3.IPF dyspnea characteristics:IPF chronic progressive dyspnea descriptors are mainly:shortness of breath,rapid breathing,difficulty in inhaling gas,insufficient use of gas,out of breath,and has less auxiliary breathing methods such as open mouth-breathing and lifting-shoulder-breathing。Lying down relieves breathing difficulties;4.IPF TCM syndrome characteristics:IPF patients with the disease aggravated lung-kidney prolonged involvement,IPF mainly for deficiency syndrome or false and real mixed syndrome,mainly yang qi deficiency,can be turbid,phlegm,treatment should mainly replenish the lungs and kidneys,taking into account the phlegm and dampness。After 3 months of treatment of IPF patients with simple Chinese medicine,the cough visual score,dyspnea visual score and dyspnea CRP score of IPF patients were significantly lower than those before treatment,there was statistical difference(P<0.05),and were presented within 6 months;DLCO SB increased after treatment of 12 months,there was no statistical difference(P=0.38),FVC(L)decreased compared with before treatment,there was statistical difference(P=0.004),FVC decreased value was 180ml,The rate of decline is 6.52%;After 3 months of treatment with traditional Chinese medicine,the oxygen saturation value after 6MWT showed an upward trend,and then gradually decreased.There was no significant difference before and after treatment(P=0.44).The distance of the 6-minute walk test after 12 months of TCM treatment was significantly higher than that before treatment,and the difference has no statistically significance(P=0.04).Conclusion:1.IPF cough is caused by internal causes.Its cough characteristics are characterized by wind-like cough;the cause of dyspnea is positive qi deficiency;the lungs have a deficiency of qi,the lungs cannot transport water,and the gasification of the kidney has no strength.Is the root cause of turbidity.In the clinical treatment of IPF cough and dyspnea,it is mainly to nourish the lungs and kidneys,taking into account the phlegm and dampness,especially the yin and yang deficiency in the late kidney,we should pay attention to supplementing Yin and Yang at the same time.2.Chinese medicine treatment of IPF can significantly reduce the frequency of cough,reduce the degree of cough and dyspnea,improve the quality of life of patients,and keep patients stable for a certain period of time..更多还原