基于聚类分析的不同证候慢性阻塞性肺疾病患者临床表型特点研究

目的 分析不同证候慢性阻塞性肺疾病患者临床表型的特点.方法 收集120例COPD患者的人口统计学、病程、体质量指数（BMI）、吸烟指数、急性加重频率、合并症、呼吸困难程度（mMRC评分）、COPD评估测试（CAT）、肺功能等资料,进行统计学分析.结果 根据证候学特征,120例患者中气虚血瘀、痰热郁肺证50例,阴虚血瘀、热痰恋肺证10例,气阴两虚、痰瘀互阻证22例,脾肾阳虚、水湿泛滥证16例,风邪外袭证22例.各组患者在性别分布,年龄,吸烟指数等方面差异无统计学意义（P＞0.05）,但在病程,BMI,FEV1％ pred等方面差异具有统计学意义（P＜0.05）.结论 聚类分析显示不同证候患者存在不同临床特征,气虚血瘀、痰热郁肺证患者年龄小,体质量超重,病程短,病情轻;脾肾阳虚、水湿泛滥证患者年龄大,病程长,病情重;阴虚血瘀、热痰恋肺证患者以老年不吸烟女性多见;气阴两虚、痰瘀互阻证患者营养状况较差;风邪外袭证患者常合并高脂血症和心律失常,提示高脂血症合并心律失常可能成为COPD患者感受外邪的危险因素之一.

Discussion on Clinical Phenotype Characteristics of Different Syndromes of Patients with Chronic Obstructive Pulmonary Based on Cluster Analysis

Objective： To analyze the clinical phenotype characteristics of different syndromes of patients with chronic obstructive pulmonary. Methods： Data of demography, disease duration, body mass index （BMI）, smoking index, frequency of exacerbations, complications, degree of dyspnea （MMRC）, COPD assessment test （CAT）, pul- monary function and so on of 120 COPD cases were collected and statistically analyzed. Results： According to characteristic of syndrome, 120 patients were divided into five TCM syndrome type： 50 cases with Qi deficiency and blood stasis,and phlegm heat obstructing lung;10 cases with Yin deficiency and blood stasis,phlegm,and lung heat;22 cases with deficiency of both Qi and Yin,and phlegm and blood stasis;16 cases with deficiency of spleen and kidney Yang,water wet flood;22 cases with wind evil external attack. There were no significant differ- ences in gender,age ,and smoking index in each group. There were significant differences in disease duration, BMI, FEVI% pred in each group. Conclusion： Different patients have different clinical features based on cluster analysis. The patients with Qi deficiency and blood stasis,and phlegm heat obstructing lung were younger,over- weight,having shorter course of disease and light condition;Patients with deficiency of spleen and kidney Yang, and water wet flood were older, having longer course of disease and severe condition;Old female without smoking were few with Yin deficiency and blood stasis, phlegm and lung heat;Patients with poor nutritional status is often associated with deficiency of both Qi and Yin, phlegm and blood stasis ;The wind evil external attack syndrome often associated with hyperlipidemia and arrhythmia, suggesting that hyperlipemia and arrhythmia in patients with COPD may be one of the risk factors of wind evil external attack.