The Clinical Experience Of Pathogenesis Diagnosis And Tr Eatment And Prospective Clinical Research On The Conne Ctive Tissue Disease With Interstitial Lung Disease Cases Treating By TCM Master Zhou Zhongying

Objective:Based on the outpatient medical records of Professor Zhou Zhongying who has been treating connective tissue disease combined with interstitial lung disease(CT D-ILD)as the basic data,the data mining is used to analyze and research the medical records,to explore the differentiation,treatment ideas and medicine experience of treatment of CTD-ILD and summarizes Professor Zhou Zhongying’s academic thoughts about CTD-ILD,so that his academic thoughts can be more comprehensively inherited,and provide guidance for clinical treatment of CTD-ILD.(2)Through the observation of the clinical efficacy which is Professor Zhou Zhongying’s core prescription for the treatment of CTD-ILD,to explore the pathogenesis of this prescription.Methods:(1)Collect and sort out the outpatient medical records diagnosed CTD-ILD and treated by Professor Zhou Zhongying from 1995 to 2014,and select them accor ding to the inclusion and exclusion criteria.Finally included 128 medical records,established a medical record database,use frequency analysis,association rules,cluster analysis and other methods Study the regularity of symptoms,tongue,pulse,pathogenesis,prescript ions and medicines in medical records,analyze and summarize Professor Zhou Zhongying’s clinical experience in treating CTD-ILD.(2)Using Professor Zhou Zhongying’s core prescription for the treatment of CTD-ILD,"Runfei Huaxian Decoction",63 cases of CTD-ILD patients with "qi and yin injury,phlegm and blood stasis blocking the lung" were divided into the control group and the test group.The control group only used Western medicine treatment,the experimental group was treated with Runfei Huaxian Decoction and Western medicine for 3 months.The patients’ TCM syndrome classification and quant itative scores,serum KL-6,TGF-β1,GM-CSF,IL-17A and Thl7,Treg,collecting lung funotion FVC,,DLCO were collected before and after 3 months of treatment.Using spss25.0 software to analyze the data before and after treatment,and evaluate the efficacy.Results:(1)Data Mining apart:Medical record research A total of 19 patients with CTD-ILD treatment by Professor Zhou Zhongying were collected,including 9 male patients and 10 female patients,with a total of 128 visits.The more frequent symptoms in all visits were cough,dry mouth,wheezing,chest tightness,excessive sputum,joint pain,sticky sputum,fatigue,expectoration,itchy throat,anorexia,loose stools,edema of lower limbs,and mainly tongue The symptoms are dark tongue,thin yellow greasy coating,cracked tongue,little coating,and tooth marks.The main pulse conditions are thin and slippery pulse,narrow pulse,small slippery pulse,small stringy pulse;common pathogenesis can be summarized as qi and yin injuries,Phlegm and blood stasis blocking the lung,lung deficiency and heat depression,liver and kidney deficiency,spleen deficiency and lung weakness,loss of lung qi,rheumatism arthralgia;the commonly used medicines in all consultations are nanshashen,beishashen,maidong,Suzi,Taizishen,zhijiangcan,taoren,zhisangbaipi,shenghuangqi,Iaoguancao.Association rule research shows that the combinations with higher symptom correlation are dry mouth and cough,wheezing and cough,expectoration and wheezing,cough and chest tightness;the combinations with higher correlation of tongue image are dark tongue and thin yellow greasy,Tongue crack and dark tongue,tongue crack and thin yellow and greasy coating,tongue crack,dark tongue and little coating;the combination with higher pulse correlation has slip and number,and slip and string have the highest correlation;pathogenesis is more related high combination of qi and yin injury and phlegm stasis to block the lung,qi and yin injury and lung deficiency and heat depression,qi and yin injury and spleen deficiency and lung weakness,phlegm stasis to block the lung and liver and kidney deficiency;in terms of drug relevance,beishashen,nanshashen,maidong,suzi,taoren,taizishen,zhijiangcan,these drugs have a strong correlation.Through cluster analysis,extract the core formula--"Runfei HuaYu Decoction".(2)Clinical efficacy observation part:After treatment,KL-6,TGF-(31,GM-CSF,IL-17A,Th17,and Treg in the experimental group and the control group were comparable,a nd the difference was not statistically significant(P>0.05)).However,after treatment,the KL-6,TGF-β1,GM-CSF,and IL-17A of the test group were lower than those of the control group and the difference was statistically significant(P<0,05);After treatment,the Th17 of the test group was lower than the control group and the difference was statistic ally significant(P<0.001).After treatment,the Treg of the observation group was greater than that of the control group and the difference was statistically significant(P<0.05);after treatment,the lung function indexes of the two groups were improved.Among them,theFVC,DLCO was greater than the control group and the difference was statistically significant(P<0.001);After treatment,the total scores of TCM syndromes in the two groups were significantly improved compared with those before treatment.Among them,the TCM syndrome scores of the experimental group were smaller than those of the contr of group and the difference was statistically significant(P<0.05).In terms of correlation analysis,the study found that there is a negative correlation between FVC and TGF-β1,IL-17A,TH17(P<0.05),and a positive correlation between FVC and Treg(P<0.05);DL CO and TH17 is a negative correlation(P<0.05),and a positive correlation between DL CO and Treg(P<0.05);TH17 has a positive correlation with TCM syndrome integral,T GF-β1,GM-CSF and IL-17A(P<0.05);Treg is negatively correlated with TCM syndrom e score,TGF-β1,GM-CSF,and IL-17A(P<0.05).Conclusion:(1)Through data mining of Professor Zhou Zhongying’s CTD-ILD diag nosis and treatment records,academic thoughts and clinical experience in the treatment of CTD-ILD were summarized.The pathological nature of CTD-ILD is mostly based on the deficiency and reflect the excess,mixed with deficiency and excess,mainly based on deficiency of lung,spleen and kidney,and phlegm,blood stasis,water and dampness were mixed.Clinically,drugs for replenishing qi and nourishing yin,blood circulation and stasis drugs,antitussive and expectorant drugs,and dispelling wind and dampness drugs are used to treat the disease;Grasping the compound pathogenesis with differentiation and treatment,extracting its core prescription-Runfei Huaxian Decoction for CTD-ILD patients with impairment of both QI and YIN and phlegm and blood stasis obstructing lung.(2)After clinical observation and research,Runfei HuaYu Decoction can effectively improve the clinical symptoms and pulmonary ventilation function(FVC,DLCO)of CTD-ILD patients,and reduce the serum KL-6,TGF-β1,GM-CSF,and IL-17A level,adjust the balance of Th17/Treg.The mechanism of action of Runfei Huaxian Decoction combine d with western medicine in the treatment of CTD-ILD may be related to the immune re sponse of inflammatory cells.By reducing TGF-β1,GM-CSF,IL-17A,Thl7 cells,and in creasing the level of Treg cells,it plays a role in immune regulation and improves symp toms.