肺间质纤维化临床分期与证候分布规律探讨

目的:探讨肺间质纤维化临床分期与证候学分布规律。方法:回顾性分析了204例肺间质纤维化住院病历,根据患者临床表现、胸部HRCT特点、肺功能以及动脉血气分析情况,分为早期、慢性迁延期和晚期,总结肺间质纤维化临床分期与证候学分布规律。结果:肺纤维化不同分期其证候学分布各有特点,早期(10例)以风寒袭肺和风热犯肺为常见诱因,以痰热郁肺与痰瘀阻络为常见证型,以络脉痹阻,气血不通为基本病机特点;慢性迁延期(64例)证属本虚标实,虚实夹杂,肺痹与肺痿并存,以气虚(肺气虚、脾气虚、肾气虚)血瘀痰阻之证最为常见。肺纤维化晚期(130例)本虚至极,由肺及肾至心,以肺肾两虚、痰瘀阻络为常见证型,以气血不充、络虚不荣为其病机实质特征。结论:肺间质纤维化证候学分布特征与临床分期密切相关。

Discussion of the clinical stages and syndrome patterns of pulmonary fibrosis

Objective: To discuss the clinical stages and syndrome patterns of pulmonary fibrosis.Methods: 204 hospitalized cases with pulmonary fibrosis were analyzed retrospectively,who were divided into early,chronic deferral and late stages according to the clinical manifestations including chest HRCT characteristics,pulmonary function and arterial blood gas analysis.The relationship between the clinical stages and syndrome patterns of pulmonary fibrosis was discussed and concluded.Results: The syndrome patterns of pulmonary fibrosis had their own characteristics in different stages(10 cases).In early stage,wind-cold attacking lung and wind-heat invading lung were the common incentive,heat-phlegm stagnating lung and phlegm-stasis blocking collaterals were the common syndromes,and stoppage of qi and blood and collaterals stagnation were the basic pathogenesis.In chronic deferral stage(64 cases),the syndrome patterns were characteristic of primary deficiency and secondary excess and deficiency-excess in complexity.Feibi and Feiwei coexisted;qi deficiency(deficiency of lung qi,deficiency of spleen qi,deficiency of kidney qi),blood stasis and phlegm stagnation were the commonest syndrome.In late stage(130 cases),primary deficiency deteriorated to the extremity,from the lung to the kidney and the heart eventually.The lung-kidney deficiency and phlegm-stasis blocking collateral were the common syndrome.Depletion of qi and blood and lack of nourishment of collaterals were the basic pathogenesis.Conclusion:The syndrome patterns of pulmonary fibrosis are closely correlated with its clinical stages.