耐多药肺结核患者中医证素与临床特征的初步研究

目的探讨耐多药肺结核(MDR-PTB)患者年龄、病程及肺部X线表现与中医证素间的关系,以指导临床中医治疗。方法选择2013年1月至2015年12月同济大学附属上海市肺科医院、首都医科大学附属北京胸科医院、解放军总医院第八医学中心等18家结核病定点医院确诊的且自愿接受本研究调查方案的740例问卷有效的MDR-PTB患者;排除年龄、病程、肺部空洞、病灶累及情况等临床特征(观察项目)信息资料不符的患者后,共纳入615例患者。调查问卷为完成"十二五"传染病专项耐药肺结核中医药项目课题时专家组所讨论确定,包括患者基本信息(姓名、性别、年龄等)、临床相关资料(既往症状、就诊时症状、病程、肺部空洞、病灶累及情况等),以及症情评判等内容;共发放1000份调查问卷,收回850份,有效740份,有效率为87.06%。采用SPSS 21.0软件进行数据的统计学分析,探讨观察项目与中医证素间的分布规律及相互关系。结果本研究入选患者中医证素判定由高到低分别为阴虚[55.1%(339/615)]、气虚[54.0%(332/615)]、痰浊[26.7%(164/615)]、火热[26.3%(162/615)]和阳虚...

Investigation of correlation between traditional Chinese medicine synbrome elements and clinical characteristics of patients with multidrug-resistant pulmonary tuberculosis

Objective To explore the correlation between the age, course of disease and pulmonary X-ray manifestation of multidrug-resistant pulmonary tuberculosis (MDR-PTB) patients and traditional Chinese medicine (TCM) syndrome elements, in order to guide TCM treatments. Methods All of 740 valid cases of MDR-PTB patients were surveyed ranging from 18 tuberculosis-designated hospitals, including Shanghai Pulmonary Hospital affiliated to Tongji University, Beijing Chest Hospital affiliated to Capital Medical University and the 8th Medical Center of Chinese PLA General Hospital, etc. Those patients were diagnosed between January, 2013 and December, 2015 and their course of diseases were all less than 6 months. As some patients’ clinical characteristics, such as age, course of disease, cavity and focal involvement, were insufficient, 615 cases were finally adopted. The survey questionnaire containing personal information of patients (name, gender, age, etc) was used, information also related to clinical treatments (previous symptoms, current symptoms, course of disease, cavity and focal involvement) and medical diagnosis. All the data was discussed and recognized by the panel participated in Drug-Resistant Tuberculosis of TCM Project during 12th-Five-Year Plan for Infectious Disease. One thousand pieces of questionnaire were offered, and 850 pieces returned back with information filled, while 740 pieces were eventually recognized as valid. The valid rate achieved 87.06%. SPSS 21.0 was used to analyze the data, in order to explored the correlation between different types of syndrome elements and these study objects mentioned above and their distribution. Results In this study, 5 types of TCM syndrome elements could be concluded according to their frequency: Yin deficiency (55.1% (339/615)), Qi deficiency (54.0% (332/615)), phlegm-turbidity (26.7% (164/615)), hyperactive fire (26.3% (162/615)), and Yang deficiency (15.0% (92/615)). The median age (M(Q₁,Q₃)) of patients developed with Qi deficiency, Yin deficiency and Yang deficiency were 40.0 (28.0,51.0), 40.0 (28.0,50.0) and 45.0 (28.0,53.0), respectively; all of them were significantly older than those of patients without the three TCM syndrome elements mentioned above (34.0 (25.0,47.0), 34.0 (26.0,48.0) and 36.0 (26.0,49.0), respectively) (Z=8.944, P=0.003; Z=8.043, P=0.005; Z=5.185, P=0.023). Furthermore, with their age grows, these patients were likely to suffer with severer Qi deficiency (lighter ones 38.0 (28.0, 51.0); severer ones 45.0 (29.0, 53.0)) (Z=6.350, P=0.042). Both the courses of disease of patients with Qi deficiency and Yang deficiency (averaged 24.0 (8.0, 60.0) and 28.0 (11.0,68.0) months, respectively) and their diameters of biggest cavity (averaged 1.5 (0.0, 3.0) and 1.5 (0.0, 3.0) cm, respectively) were significantly longer than those of patients without Qi and Yang deficiency (courses of disease: 18.0 (5.0, 39.8) and 18.0 (6.0, 48.0) months, respectively; diameters of biggest cavity: 1.3 (0.0,2.4) and 1.5 (0.0, 2.6) cm, respectively) (Z=8.642, P=0.003; Z=17.954, P<0.001; Z=4.191, P=0.041; Z=6.709, P=0.010). Additionally, patients with longer course of disease tend to suffer with severer Qi deficiency and hyperactive fire (lighter ones 27.0 (8.5, 59.0) months, severer ones 28.0 (11.0, 72.0) months; lighter ones 12.5 (5.3, 39.3) months, severer ones 26.0 (12.0, 60.0) months)(Z=12.725, P=0.002; Z=6.997, P=0.030). As to the rates of cavity, patients with hyperactive fire (79.6% (129/162)) were much higher than those without the syndrome elements (70.0% (317/453)) (Z=4.869, P=0.031). Conclusion MDR-PTB patients with Yin deficiency are the majority. It is helpful to guide TCM treatment by discerning and analyzing the correlation between clinical characteristics, such as age, course of disease and occurance rate of cavity as well as its biggest diameter, and the TCM syndrome elements.