Study On TCM Syndrome Elements And Pathogenesis Of Chronic Obstructive Pulmonary Disease Complicated With Chronic Heart Failure Based On Latent Class Model

Objectives: 1.Exploring the the distribution of TCM syndrome elements,the correlation between syndrome elements and clinical features in chronic obstructive pulmonary disease(COPD)combined with chronic heart failure(CHF).2.Exploring the distribution of syndrome types,the heterogeneity of syndrome elements,and the differences in clinical features between different syndrome types in patients with COPD combined with CHF based on latent class analysis of syndrome elements.3.Exploring the TCM pathogenesis of COPD combined with CHF on the basis of syndrome elements and ancient and modern literature.Methods: 1.This study is a single-centre cross-sectional study based on hospital electronic medical records from real world.Data were obtained from the electronic medical records of patients hospitalized with COPD combined with CHF at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to December 2021.Clinical information of patients was extracted from the electronic medical records,including basic demographic information,hospitalization information,underlying disease information,and relevant laboratory test information.The study design and reporting followed the STROBE statement,and the estimated sample size was 112 cases.2.The patient’s syndrome elements were obtained by extracting the symptoms and signs of the patient on the first day of admission,calculating the corresponding syndrome elements score and determining whether the syndrome elements could be established.3.All analyses were completed by R and Rstudio.the Shapiro-Wilk test determined whether the measures conformed to a normal distribution.Normally distributed measures are expressed as x±s and non-normally distributed measures are expressed as medians and quartiles.Count information is expressed as frequencies.4.A latent class model was constructed using the po LCA R package to identify latent classes(syndrome types)using syndrome elements as features.The latent classes were named according to the differences between clinical experience and the evidence.Hypothesis tests for differences in clinical characteristics between latent classes were conducted using t-tests or Wilcox rank sum tests for continuous data from two independent samples,ANOVA or Mann-Whitney U-tests for continuous data from multiple independent samples,and chisquare tests for categorical data.For categorical data,the chi-square test was used.P < 0.05 was defined as a statistically significant difference.5.A preliminary exploration of the Chinese medical pathogenesis of COPD combined with CHF was conducted in conjunction with ancient and modern literature.Results: 1.The 131 patients with COPD combined with CHF were included.The Lung,heart,kidney,qi deficiency,phlegm and yang deficiency were the basic evidence elements with a frequency higher than 90%.2.Latent class analysis classified COPD combined with CHF into three syndrome types(latent class),named as Lung and Kidney Qi and Yin deficiency evidence(Class 1),Superficial Cold and Internal Drinking evidence(Class 2),and Yin deficiency and Yang hyperactivity evidence(Class 3).3.The frequencies of spleen,dampness,dampness,water stagnation and blood stasis were not significantly different among the three types of symptoms.The frequency of evidence of liver,spleen,dampness,qi stagnation,blood deficiency,yin deficiency,yang hyperactivity,drinking and blood stasis in Class 3 exceeded 40%.4.4.The Class 2 and Class 3 had significantly higher proportions of symptoms of Table,Stomach,Chest and Diaphragm,Qi Stagnation and Blood Deficiency than Class 1.Class 3had significantly higher proportions of symptoms of Liver,Heart and Mind,Yin Deficiency and Yang Hyperactivity compared to Class 1 and Class 2.The proportion of cold elements was significantly higher and the proportion of hot elements was significantly lower in Class1 and Class 2 compared to Class 3.5.The Class 1 and Class 2 had higher NT-pro BNP,higher anteroposterior left ventricular diameter and a higher proportion of NYHA 4 patients compared to class 3.class 1 had a higher proportion of smoking history than Class 3.class 1 had a significantly lower absolute eosinophil count,percentage of eosinophils,and hemoglobin compared to class 1 and class2.Class 3 had significantly lower absolute basophil counts,basophil percentages,and hemoglobin than Class 1 and Class 2.Class 1 had lower creatine kinase and higher glomerular filtration rate than Class 2 and Class 3.6.For comorbidity ratios,the Class 3 had a higher hypertension classification and lower pulmonary hypertension comorbidity than Class 1 and Class 2.Class 3 had significantly higher comorbidity ratios for hypertension,cerebrovascular disease,interstitial lung disease,and an age-corrected Charlson comorbidity index than Class 1,but had a lower frequency of respiratory failure.Conclusions: 1.The lung,heart,kidney,qi deficiency,phlegm and yang deficiency are the basic evidence elements of COPD combined with CHF.2.The Class 1 is characterized by spleen,dampness,yin deficiency,drinking and blood stasis;Class 2 is characterized by table,spleen,chest and diaphragm,cold,dampness,blood deficiency,yin deficiency,drinking,water stagnation and blood stasis;Class 3 is characterized by liver,spleen,dampness,qi stagnation,blood deficiency,yin deficiency,yang hyperactivity,drinking and blood stasis.3.The COPD combined with CHF can be classified into three syndrome types:deficiency of both lung and kidney qi and yin(Class 1),superficial cold and internal fluid(Class 2),and yin deficiency and hyperactivity of yang(Class 3).4.The basic pathogenesis of COPD combined with CHF can be summarised as deficiency and actuality: the original deficiency is mainly due to the joint subsidence of the Zhong qi and the Zong qi,while the symptoms are due to phlegm and blood stasis.