Investigation On TCM Syndrome Of Stable Stage Of Bronchiectasis

1. Research backgroundBronchiectasis is a chronic inflammatory disease occurred to air passage, which results in repeated pyogenic infection and is pathological and permanent expansion of bronchial tree caused by various reasons. In acute exacerbation period, treatment in the western medicine is mainly by resisting infection and controlling symptoms, while in stable period, not too many treatment ways are applied. It is urgently needed to tackle how to reduce symptoms, improve quality of life, anddecrease number of times of acute exacerbation in stable period.With unique advantages for treating bronchiectasis in stable period, TCM is also found to have rather many cases of curing bronchiectasis in stable period after reviewing of literature. Yet there are little clinical investigation and research for syndrome patterns in stable period of bronchiectasis. Besides, the research on syndrome patterns of bronchiectasis is mainly focused on acute exacerbation period, or analyze simultaneously the acute exacerbation period and stable period, which leads to less comprehensive and deep cognition about syndrome patterns types in stable period of bronchiectasis.Currently there is devoid of literature as to whether syndrome patterns in stable period of bronchiectasis is related to sufferer’s constitution, body mass index, psychology, body’s immunologic function. Thus it is necessary toconduct clinical investigation and research on syndrome patterns in stable period of bronchiectasis, explore the types of syndrome patterns, and provide syndrome patter basis for treatment of bronchiectasis in stable period using TCM.2. Clinical research2.1 PurposeTo analyze distribution of syndrome patterns types in stable period of bronchiectasis by clinical investigation and research on TCM syndrome patterns in stable period of bronchiectasis, and explore the correlation of syndrome patterns with constitution, depression and anxiety state, body mass index, disease severity, pulmonary function(FVC, FEV1), seven immunity items (IgA, IgE, IgM, IgG, C3, C4, CH50), IL-6, TNF-a to guide clinical treatment.2.2 MethodThe 98 bronchiectasis sufferers as the object of this investigation are from cases in respiratory policlinic of Xiyuan Hospital of TCM Science Academy from September 2015 to March 2016.8 cases were rejected due to incomplete materials, and the rest 90 cases conform to standard. Differentiation of symptoms and signs and typing were conducted through collecting materials of four diagnostic methods for the sufferers in stable period of bronchiectasis. SAS9.2 system was employed to analyze the correlation of sufferers’ constitution grading, severity grading, depression and anxiety grading, pulmonary function (FVC, FEV1), seven immunity items (IgA, IgE, IgM, IgG, C3, C4, CH50), IL-6, TNF-a with syndrome patterns. In gathering statistics of sufferers’constitution types, "maybe" certain constitution and "is" certain constitution are all treated as "is" for calculation.Variance analysis is applied when the measurement data obey normal distribution and variance is equal; Welch is applied when the measurement data obey normal distribution but variance is unequal. Kruska-WallisiH is applied when measurement data does not obey normal distribution. The enumeration data are tested using χ2. When n<40 or T<1, or X2≈a after testing using χ2, Fisher precise probabilistic method is used for statistics. Assume test systems all use two-sided test, when a=0.05 and P<0.05, statistics difference is present; when P<0.01, obvious statistics difference is present.2.3Result2.3.1 Distribution of syndrome patterns in stable period of bronchiectasisAfter differentiation of symptoms and signs and typing for sufferers of bronchiectasis in stable period, the result shows that the top one is 42 cases of insufficiency of the spleen and lung qi(46.7%),24 cases (26.7%) of stagnation of the liver-qi come the second, then 12 cases (13%) of deficiency of both qi and y in and 12 cases (13%) of deficiency of both the lung and the kidney follow.2.3.2Analysis on the correlation of gender and syndrome patterns in stable period of bronchiectasisAmong 90 sufferers of bronchiectasis in stable period,37 cases are male, accounting for 41.10%,53 cases are female, accounting for 58.90%. The gender composition of each syndrome pattern is respectively in turn as follows:for insufficiency of the spleen and lung qi, the male accounts for 23.81%, the female accounts for 76.19%; for deficiency of both qi and yin, the male accounts for 33.33%, the female accounts for 66.67%; for deficiency of both the lung and the kidney, the male accounts for 41.67%, the female accounts for 58.33%; for stagnation of the liver-qi, the male accounts for 58.33%, and the female accounts for 41.67%.2.3.3Analysis on the constituent ratio of body mass index and syndrome patterns in stable period of bronchiectasisData analysis show 42 sufferers have normal weight (46.67%),31 sufferers have underweight (34.44%),15 sufferers have overweight (16.67%),2 sufferers have obesity (2.22%); The constituent ratios of BMI in four syndrome patterns are different, the BMI being too low for insufficiency of the spleen and lung qi is the most, accounting for 52.88%, and then stagnation of the liver-qi (25.00%, deficiency of both the lung and the kidney (8.33%), deficiency of both qi and yin (16.67%) follow in turn.2.3.4The correlation of depression and anxiety state with syndrome patterns in stable period of bronchiectasisAmong 90 sufferers of bronchiectasis in stable period, sufferers of maybe depression are 32 cases (35.56%), sufferers of maybe obvious depression are 13 cases, accounting for (14.44%), normal sufferers are 45 cases (50.00%); sufferers of maybe anxiety are 7 cases (7.78%), sufferers of maybe obvious anxiety are 5 cases (5.56%), normal sufferers are 78 cases (86.67%); the constituent ratio of depression among four syndrome patterns are significantly obvious. In sufferers of maybe depression, the stagnation of the liver-qi accounts for 62.50%; deficiency of both the lung and the kidney comes second, accounting for 33.33%; the third-ranking is insufficiency of the spleen and lung qi, accounting for 26.19%; maybe depression is least in deficiency of both qi and yin, accounting for 16.67%. In sufferers of obvious depression, the most is stagnation of the liver-qi, accounting for 20.83%; deficiency of both qi and yin comes the second, accounting for 16.67%; the third-ranking is insufficiency of the spleen and lung qi, accounting for 14.29%; obvious depression in deficiency of both the lung and the kidney accounts for 0.00%.2.3.5Analysis on the correlation of constitution and syndrome patterns in stable period of bronchiectasisThe sufferer quantity of constitutions of deficiency of qi and insufficiency of yang are both the most, and that for constitution of stagnation of qi comes the second, with constituent ratio of 16.96%; then in turn are blood stasis constitution, special constitution, gentle constitution, with constituent ratios respectively being 4.59%,4.59%,3.53%; the ratios of constitution distribution in each syndrome pattern are different. In sufferers of deficiency of both the lung and the kidney, constitution of insufficiency of yang is the most, accounting for 91.67%; in sufferers of insufficiency of the spleen and lung qi, the constitution of deficiency of qi is the most, accounting for 83.33%; in sufferers of stagnation of the liver-qi, the constitution of stagnation of qi is the most, accounting for 75.00%, In sufferers of deficiency of both qi and yin, constitutions of TCM deficiency of yin and deficiency of qi are the most, accounting for 75.00% and 83.33% respectively.2.3.6Analysis on correlation of syndrome patterns in stable period of bronchiectasis with anxiety state, severity indices, test index, pulmonary functionAnalysis on correlation of syndrome patterns in stable period of bronchiectasis with anxiety state, severity indices, test index (IgA, IgG, CH50, IgM, IgE, C3, C4, IL-6, TNF-a), pulmonary function has no statistics significance.3. Conclusion3.1 In investigation on syndrome patterns in stable period of bronchiectasis, the insufficiency of the spleen and lung qi is the most, then stagnation of the liver-qi, deficiency of both qi and yin, deficiency of both the lung and the kidney follow in turn.3.2 The sufferers of low BMI in stable period of bronchiectasis are in large number, up to 33.33%, while sufferers of overweight and obesity are in small number. In sufferers of insufficiency of the spleen and lung qi, the sufferers of too low BMI are the most, up to 52.88%.3.3 In the sufferers of bronchiectasis in stable period, the sufferers of constitutions of deficiency of qi and insufficiency of yang are the most, accounting for 22.61%, then sufferers of constiution of stagnation of qi come the second.3.4 Syndrome patterns of bronchiectasis are closely related to constitution. In sufferers of insufficiency of the spleen and lung qi, constitutions of deficiency of qi and insufficiency of yang are in large number; in sufferers of deficiency of both the lung and the kidney, the constitution of insufficiency of yang is in large number; in sufferers of deficiency of both qi and yin, the constitutions of deficiency of qi and deficiency of yin are in large number; in sufferers of stagnation of the liver-qi, constitution of TCM stagnation of qi is in large number.3.5 In stable period of bronchiectasis, sufferers of depression are in large number. The sufferers of maybe depression account for 32.20%, and sufferers of maybe obvious depression are 14.40%. Thereinto stagnation of the liver-qi is most closely related to depression. In sufferers of stagnation of the liver-qi, sufferers of maybe depression are 62.50%, and sufferers of maybe obvious depression are 20.83%.