耐多药肺结核中医证型与痰菌及肺部病变相关性研究

目的探讨耐多药肺结核（MDR-PTB）中医证型与痰结核分枝杆菌、肺部病变的相关性。方法对13家医院的373例MDR-PTB患者,采用聚类分析、因子分析法揭示MDR-PTB的中医证型分布,探讨不同证型与痰结核菌阳性程度、肺部病变范围之间的关系。结果 MDR-PTB主要分为肺气亏虚、肺肾气阴两虚、阴虚火旺、肺脾气虚4型。阴虚火旺、肺脾气虚、肺肾气阴两虚型痰涂阳性程度均较肺气亏虚型明显（P〈0.05,P〈0.01）,阴虚火旺型痰涂阳性程度较肺肾气阴两虚、肺脾气虚型均明显（P〈0.05）。肺肾气阴两虚、阴虚火旺、肺脾气虚型肺部病变范围均较肺气亏虚型明显（P〈0.05或P〈0.01）,肺肾气阴两虚型肺部病变范围较肺脾气虚、阴虚火旺型明显（P〈0.05,P〈0.01）。结论 MDR-PTB患者肺部病灶范围愈大,涉及脏腑越多,证型越复杂。

Correlation between Syndrome Types of Multi-drug Resistant Pulmonary Tuberculosis and Sputum Bacteria and Pulmonary Lesions

Objective To explore the correlation between syndromes types of multi-drug resistant pulmonary tuberculosis(MDR-PTB) and sputum bacteria and pulmonary lesions.Methods A total of 373 cases in 13 hospitals were involved.The syndrome differentiation of TCM was revealed by cluster and factor analysis,and the correlation between syndrome types of MDR-PTB and sputum bacteria and pulmonary lesions was explored.Results TCM syndromes of MDR-PTB were differentiated for four syndromes:lung qi deficiency,qi and yin deficiency of lung and kidney,hyperactive fire due to yin deficiency,qi deficiency of lung and spleen.The positive degree of smear examination of sputum for tubercle bacillus in syndrome of hyperactive fire due to yin deficiency,qi deficiency syndrome of lung and spleen,qi and yin deficiency syndrome of lung and kidney was more significant than lung qi deficiency syndrome(P<0.05,P<0.01).The positive degree of smear examination of sputum for tubercle bacillus in syndrome of hyperactive fire due to yin deficiency was more significant than qi deficiency syndrome of lung and spleen,qi and yin deficiency syndrome of lung and kidney(P<0.05).The extent of disease in hyperactive fire due to yin deficiency,qi and yin deficiency of lung and kidney,qi deficiency of lung and spleen were more significant than lung qi deficiency(P<0.05,P<0.01).The extent of disease in qi and yin deficiency of lung and kidney was more evident than both hyperactive fire due to yin deficiency,qi deficiency of lung and spleen(P<0.05,P<0.01).Conclusion The more pulmonary lesions in MDR-PTB is,the more organs are involved,and the more complex syndrome of TCM is.