北京地区271例肺结节患者中医证候分布特征研究

目的：分析北京地区肺结节（PN）的中医证候分布特征。方法：收集北京地区271例肺结节患者的中医四诊信息，运用主成分分析法，结合证候要素判定标准确定肺结节的中医证候要素特点，再应用系统聚类分析法对条目进行聚类分析，探索北京地区肺结节的中医证候分布特征。结果：肺结节的证候要素主要为痰浊、痰湿、气虚、血瘀和阳气虚。聚类分析结果显示，肺结节的中医证候以肺气虚证占比最多（34.3%），其余依次为肺气阴两虚证（19.2%）、瘀血阻络证（17.7%）、痰热郁肺（16.2%）、肝郁气滞（12.5%）。结论：肺结节的病位主要在肺，属虚实夹杂、本虚标实之证;临床可分为肺气虚证、痰热郁肺证、肺气阴两虚证、肝郁气滞证、瘀血阻络证，其中以肺气虚证、肺气阴两虚证占比较高。在治疗和辨证过程中，要首重气阴两虚的问题，适时加用补气养阴，强肺气，润肺脉，使气血调达通畅，则邪无以聚。

Distribution Characteristics of Traditional Chinese Medicine Syndromes in 271 Patients with Pulmonary Nodules in Beijing

To analyze the distribution characteristics of traditional Chinese medicine(TCM) syndromes of pulmonary nodules(PNs) in Beijing.Methods:The medical data of four examinations in TCM of 271 PNs patients from Beijing were collected.The characteristics of TCM syndrome elements of PNs were determined by principal component analysis(PCA) combined with the criteria of syndrome elements.Subsequently,hierarchical cluster analysis was used to explore the TCM syndrome distribution characteristics of PNs in Beijing.Results:The syndrome elements of PNs were mainly phlegm turbidity,phlegm dampness,qi deficiency,blood stasis,and yang qi deficiency.The results of cluster analysis showed that the TCM syndromes of PNs were predominated by lung qi deficiency(34.3%),followed by lung qi and yin deficiency(19.2%),blood stasis obstructing collaterals(17.7%),phlegm-heat stagnation in the lung(16.2%),and liver stagnation and qi stagnation(12.5%).Conclusion:PNs are mainly in the lung,and are asthenia in origin and sthenia in superficiality and deficiency-excess in complexity.They can be clinically classified as lung qi deficiency,phlegm-heat stagnation in the lung,lung qi and yin deficiency,liver depression and qi stagnation,and blood stasis obstructing collaterals.The proportions of lung qi deficiency syndrome and lung qi and yin deficiency syndrome are high.In the treatment and syndrome differentiation,the deficiency of both qi and yin should be highlighted,and the treatment methods of tonifying qi and nourishing yin,strengthening lung qi,and moistening lung vessels should be applied,so that qi and blood can be regulated and smoothly flowed,and pathogenic factors cannot be accumulated.