| ObjectivePneumonia is a very common disease among the elder and is often thought as "an old friend of the elder's". For the unspecific clinical symptoms, it is hard to diagnose pneumonia in the elder in time and the pneumonia becomes the primary direct cause of the elder's death. Due to its significant mortality rate among the elderly, we need to make better managements of the disease with our aging population. A randomized, double-blind, parallel-group clinical trial is conducted to assess the treatments of elderly pneumonia using Chinese medicine. The etiology of elderly pneumonia is weak healthy qi and the invasion of stasis toxin, thus our study uses Chinese medicine to reinforce healthy qi and purge toxins. Concurrently, with the results from the study, a statistical analysis is conducted to sum up various patterns and syndromes of elderly pneumonia. Another aspect of this study is to search for a more specific biomarker for elderly pneumonia. Then analyze its significance and further its uses in future diagnosis of elderly pneumonia.MethodTheoretical StudyBy analysis of the relevant literature and clinical studies of elderly pneumonia, investigate its TCM pathogenesis and discuss its appropriate treatments.Clinical Study1.Randomized, double-blind, parallel group clinical trial with 76 patients with newly diagnosed Community-acquired Pneumonia (CAP) in the elderly. The treatment group was given antibiotics with Chinese medicine, while the control group was given antibiotics with placebo.2.Cluster analysis of Chinese medicine patterns and syndromes of 76 patients.Laboratory StudyPneumonia Severity Index (PSI) and CURB-65 score were used to assess the severity of CAP in the elderly in this study. The blood serum was collected from patients both before and after treatments. Then ELISA test was used to obtain the concentration of Procalcitonin (PCT) and Adrenomedullin (ADM) in the blood serum. The aim is to establish relations of PCT and ADM with the severity of CAP in the elderly. ResultsTheoretical StudyBased on a literature review and clinical study, the basic pathogenesis of the disease and treatment were established. The basic pathogenesis of elderly pneumonia was the weak healthy qi, and Qi and Yin deficiency existed throughout the disease. The treatments should be to enforce the healthy qi, including enforcing qi and yin. The secondary pathogenesis of senile pneumonia are heat, poison, phlegm and blood stasis. The treatments should be make dispelling evil qi as basic principle, including detoxification, promoting blood circulation, removing blood stasis and clearing phlegm.Clinical Study1.Clinical results:(1)Effect on disease:The total efficient rate of the treatment group is higher than that of the control group (p<0.05).(2)Effect on TCM syndrome:The total efficient rate of the treatment group is higher than that of the control group (p<0.05).(3) Effect on every single symptom:On clearing phlegm and relieving dry mouth and throat, the treatment group was more effective than the control group. But there was no significant difference in control of cough, fever, wheezing and chest distress between the two group. (4)In both groups, there was a significant decrease in white blood cell count, neutrophil percentage and PaCO2 respectively. However, only the difference of neutrophil percentage between the two group is statistically significant.2.By means of professional knowledge and clinical experience, the cluster analysis of CAP in the elderly was summed up into 5 categories. Type 1:Cough, constipation, hard stools, red tongue and thready pulse. Type 2:Yellow sputum, weak cough and fever. Type 3: dysphoria in chestpalms-soles, white sputum, dry mouth, dry throat and thirst. Type 4: Difficulty in expectoration of sputum, wheezing, breathlessness, chest tightness, sweat, lethargy, palpitation, prone to cold spells, poor appetite. Type 5:Dark lips and fingernails, dusky red tongue, yellow coating, greasy coating, wiry pulse and slippery pulse.Laboratory StudyThe severity of 30 elderly CAP patients were categorized into 3 groups (low-risk, medium-risk, high-risk) and the concentrations of PCT and ADM between these groups were statistically significant (p<0.01). As the severity of CAP increased, the concentration of PCT and ADM increased.ConclusionsTheoretical StudyThe etiology of elderly pneumonia is weakened healthy qi and the invasion of stasis toxin, thus our study uses Chinese medicine to reinforce healthy qi and purge toxins. We must both reinforce healthy qi and purge toxins, so a satisfactory outcome can be received.Clinical Study1. The Chinese medicine methods of reinforcing healthy qi and purging toxins were able to improve the treatments of CAP in the elderly patients and got excellent response. By comparing accumulated points on specific symptoms of the two group, the sputum production acquired best and significant results after treatments, which may prove that this therapeutic principle could improve the symptoms of elderly pneumonia.2.By means of professional knowledge and clinical experience, the most common syndrome of elderly CAP was deficiency of qi-yin and obstruction of both phlegm-heat and blood stasis.Laboratory StudyThe results show the relationships of blood serum PCT and ADM concentration with PSI and CURB-65. PCT and ADM levels can reflect CAP severity. And it is a direct correlation. Therefore, PCT and ADM could be used in the prognosis of CAP in the elderly.
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