Pattern Study Of The Global Initiative’s 2017 Report On The Acute Exacerbation Risk Window For Chronic Obstructive Pulmonary Disease

Objective:To explore the TCM pattern in the risk window period of acute exacerbation of COPD in highaltitude areas based on the grouping comprehensive assessment of the Global Initiative on COPD 2017report,and to analyze the relationship between TCM pattern and population exposure and clinical objective indicators.Methods:In the study,Patients which are in the risk window period of AECOPD from November 2016 to October 2017 and from October 2020 to September 2021 were included.Based on patients’degree of difficulty in breathing,cough,sputum,associated with symptoms,tongue and pulse condition such as acquisition and pattern differentiation of patterns and collect demographic data,exposures,pulmonary ventilation function,blood gas analysis,blood cell analysis,plasma C reactive protein,serum procalcitonin,coagulation function,cellular and humoral immunity,etc,which are the indices of western modern medicine,The distribution of main TCM patterns and the patterns different from the national unified standard were summarized,and the correlation between TCM patterns and population exposure and western modern medical indicators was obtained by Logistic regression analysis.Results:The main TCM pattern distribution in the risk window period of AECOPD:89（20.55%）cases of lungspleen qi deficiency pattern and phlegm pattern,87（20.09%）cases of lungkidney qi deficiency pattern and phlegm pattern,74（17.09%）cases of spleenkidney Yang deficiency pattern and phlegm pattern,38（8.78%）cases of lungkidney Yin deficiency pattern and phlegm pattern,55（12.70%）cases of lungspleen qi deficiency and blood stasis pattern,54（12.47%）cases of lungkidney qi deficiency and blood stasis pattern,17（3.93%）cases of spleenkidney Yang deficiency pattern and blood stasis pattern,and 19（4.39%）cases of lungkidney Yin deficiency pattern and blood stasis pattern.Among them:（1）Sa O₂（OR=1.998,95%CI1.2843.108,P=0.002）,HCO₃^{OR=2.490,95%CI1.6553.959,P<0.001},compared with other patterns,w ere the positive connected factors of lungspleen qi deficiency pattern a nd phlegm pattern;（2）Sa O₂（OR=3.849,95%CI2.5895.721,P<0.001）,PLT（O R=1.021,95%CI1.0081.033,P=0.001）,PT（OR=1.702,95%CI1.1822.450,P=0.004）,Ig M（OR=5.420,95%CI1.05427.868,P=0.043）,compared with other patterns,were the positive connected factors of lungkidney qi deficiency pattern and phlegm pattern.（3）Age（OR=1.154,95%CI 1.0761.238,P<0.001）,Sa O₂（OR=2.514,95%CI 1.5574.058,P<0.001）,WBC（OR=1.620,95%CI1.1862.212,P=0.002）,the percentage of CD3⁺CD4⁺Tcells（OR=1.261,95%CI1.1001.446,P=0.001）,Ig A（OR=5.007,95%CI2.11511.853,P<0.001）,compare d with other patterns,were the positive connected factors of spleen and kidney Yang deficiency pattern and phlegm pattern.（4）FRC（OR=1.230,95%CI1.1261.344,P<0.001）,HCO₃^{OR=1.917,95%CI1.4952.459,P<0.001},Ig A（OR=2.590,95%CI1.3255.065,P=0.005）,were the positive connected factors of lungkidney Yin deficiency pattern and phlegm pattern compared with other patterns.（5）Pa CO₂（OR=1.414,95%CI1.2021.663,P<0.001）,HGB（OR=1.089,95%CI1.0371.143,P=0.001）,APTT（OR=1.431,95%CI1.1621.761,P=0.001）,the ratio of CD3⁺CD4⁺Tcells/CD3⁺CD8⁺Tcells（OR=6.917,95%CI2.84316.832,P<0.001）,compared with other patterns,were the positive connected factors of lungspleen qi deficiency pattern and blood stasis pattern.（6）Sa O₂（OR=1.765,95%CI1.0432.987,P=0.034）compared with other patterns,were the positive connected factors of lungkidney qi deficiency pattern and blood stasis pattern;（7）There are no positive connected factors for spleenkidney Yang deficiency and blood stasis pattern;（8）Pa CO₂（OR=1.579,95%CI1.1512.165,P=0.005）compared with other patterns,was a positive connected factor of lungkidney Yin deficiency pattern and blood stasis pattern.Conclusions:1.The distribution of both deficiency and excess pattern of TCM in the risk window of AECOPD in highaltitude areas of Qinghai province:Lungspleen qi deficiency pattern and phlegm pattern>Lungkidney qi deficiency pattern and phlegm pattern>Spleenkidney Yang deficien cy pattern and phlegm pattern>Lungspleen qi deficiency pattern and blood stasis pattern>Lungkidney qi deficiency pattern and blood stasis pattern>Lungkidney Yin deficiency pattern and phlegm pattern>Lungkidney Yin deficiency pattern and blood stasis pattern>Spleenkidney Yang deficiency pattern and blood stasis pattern。And the spleenkidney Yang deficiency pattern and phlegm pattern is the characteristic pattern of high altitude areas in Qinghai province。2.The characteristics of positive connected factors of TCM patterns in the risk window period of AECOPD:（1）PLT,PT and Ig M were independent positive connected factors of lungkidney qi deficiency pattern and phlegm pattern;Age,WBC and the percentage of CD3⁺CD4⁺Tcells were independent positive connected factors of spleenkidney Yang deficiency pattern and phlegm pattern;FRC was an independent positive connected factor of lungkidney Yin deficiency pattern and phlegm pattern;HGB,APTT,the ratio of CD3⁺CD4⁺Tcells/CD3⁺CD8⁺Tcells were independent positive connected factors of lungspleen qi deficiency pattern and blood stasis pattern.（2）Pa CO₂was the common positive connected factor of lungspleen qi deficiency pattern and blood stasis pattern and lungkidney Yin deficiency pattern and blood stasis pattern;Sa O₂was the common positive connected factor of lungspleen qi deficiency pattern and phlegm pattern,lungkidney qi deficiency pattern and phlegm pattern,spleenkidney Yang deficiency pattern and phlegm pattern and lungkidney qi deficiency pattern and blood stasis pattern;HCO₃^was the common positive connected factor of lungspleen qi deficiency pattern and phlegm pattern and lungkidney Yin deficiency pattern and phlegm pattern;Ig A was the common positive connected factor of spleenkidney Yang deficiency pattern and phlegm pattern and lungkidney Yin deficiency pattern and phlegm pattern.