Study On The Distribution Of Traditional Chinese Medicine Syndrome Elements Of Bronchiectasis Caused By Drug-resistant Bacteria

Objective: To study the clinical syndrome characteristics of bronchiectasis of drug-resistant bacteria and the rules of distribution of Traditional Chinese Medicine(TCM)syndrome elements and the relationship between TCM syndrome elements and clinical characteristics,to aggregating common types of clinical syndrome,and to clarify the core pathogenesis of the disease.To provide theoretical basis for early identification and accurate dialectical differentiation of patients with bronchiectasis of drug-resistant bacteria.Methods: A retroactive study was conducted on 91 patients with drug-resistant bacteria bronchiectasis from January 2012 to September 2022,in the affiliated Hospital of Shandong University of TCM.By searching the data of inpatient ID,gender,age,date of admission and discharge,diagnosis information,basic condition,basic diseases,laboratory data,imaging examination results and so on were collected.According to the quantification of TCM syndrome elements and diagnostic criteria,calculate the corresponding syndrome factor score and determine whether the syndrome element is established,diagnose and sum up the corresponding disease location,disease syndrome element and classification.The Excel software was used to determine the clinical data table,SPSS26.0 statistical software was used for the processing of data statistics.Summarize the distribution and correlation of TCM syndrome elements between syndrome elements and different clinical data,and collect TCM syndrome types.Results:1.General data: 91 patients were collected in this study,including 48 males(52.75%)and 43 females(47.25%).The age range of patients was 31-94 years old,with a mean age of 67.75 ±13.69 years.The main distribution departments were respiratory department(61.54%)and ICU(12.09%).81 patients(10.99%)had a history of hospitalization,and the correlation between the number of previous hospitalizations and the age was positive(r=0.267).The mean duration of hospitalization was 22.33 ±14.09 days,and the median duration was 19 days.10 patients(10.99%)died during hospitalization.84 patients(92.31%)were complicated with one or more underlying diseases.2.Laboratory examination: a total of 146 pathogenic bacteria strains were traced in respiratory tract samples of 91 patients,of which 110 strains(75.34%)were gram-negative bacteria,chiefly Pseudomonas aeruginosa(PA),Acinetobacter baumannii and Klebsiella pneumoniae.8 strains(5.48%)of gram-positive bacteria were chiefly Staphylococcus aureus and Streptococcus pneumoniae,and 28 strains of fungi(19.18%)were mainly Candida.In the drug susceptibility test of bacterial culture,general drug resistance was found in 27 cases(29.67%),multiple drug resistance in 61 cases(67.03%),and pan-drug resistance in 3 cases(3.30%).Among the inflammatory indexes,the WBC level was higher than the normal value in 43 cases(47.25%),the NEUT% level was higher than the normal value in 57 cases(62.64%),and the CRP level was higher than the normal value in 86cases(94.51%).3.Imaging examination: Chest CT of 84 patients(92.31%)showed bronchiectasis and surrounding lesions involving multiple lobes.In addition,the most frequent imageology were emphysema(45.05%),followed by pleural effusion(23.08%),interstitial changes(13.19%)and pericardial effusion(3.30%).4.Distribution law of syndrome elements of traditional Chinese medicine: there were5 syndrome elements of disease location and 9 of disease qualities.The location syndrome elements from high to low are: lung(97.80%),kidney(72.53%),heart(72.53%),surface(62.64%)and spleen(58.24%).The qualities syndrome elements from high to low are:sputum(100%),qi deficiency(90.11%),yin deficiency(84.62%),yang deficiency(71.43%),heat(71.43%),blood stasis(65.93%),drinking(57.14%),dampness(53.85%),and blood deficiency(45.05%).The combination of four disease positions(40.66%)and five disease positions(21.98%)was the most.The combination of qualities syndrome elements was principally consisted of six diseases qualities(19.78%),seven diseases qualities(19.78%)and eight diseases qualities(24.18%).Classification of disease qualities syndrome elements according to deficiency and excess,found that all patients were a blend of deficiency and excess,and the main disease qualitiy was excess(87.91%).5.Correlation between TCM Syndrome elements and various data: death patients are more likely to have phlegm syndrome elements(P<0.05).To long-term bedridden patients,there was greater possibility to be diagnosed of spleen and blood deficiency syndrome eletments,less possibility to be diagnosed of surface,yin deficiency and heat syndrome elements(P<0.05).Hypoproteinemia patients were more likely to be diagnosed of spleen,blood deficiency and blood stasis syndrome elements(P<0.05).In patients with invasive operation,there were greater possibility of diagnosis of blood deficiency syndrome elements,less possibility of diagnosis of episodic,heat and yin deficiency syndrome elements(P<0.05).Patients with a history of using broad-spectrum antibiotics were more likely to be diagnosed of blood deficiency,dampness and spleen syndrome elements(P<0.05).With the increase of drug resistance of bacteria,the possibility of dampness syndrome elements was greater(P<0.05).The infection of gram-negative bacteria had negative correlation with the grade of damp syndrome(P<0.05 r<0).The infection of gram-positive bacteria had positive correlation with the grade of dampness syndrome(P<0.05 r>0).There was a remarkable positive correlation between fungal infection and the grade of kidney and blood stasis syndrome(P<0.01).The grade of kidney and heat syndrome elements had active correlation with WBC(P<0.05,r>0).There was a prominent active correlation between heart,phlegm and blood stasis syndrome grade and NEUT%(P<0.05,r>0).There was a positive correlation between spleen syndrome elements and the number of diseased pulmonary lobes(P<0.05 r>0).6.Syndrome type induction: the results of comprehensive cluster analysis and factor analysis can be summarized into five categories: syndrome of turbid phlegm blocking lung,syndrome of weakness of heart and kidney yang and phlegm obstructing lung,syndrome of weakness in spleen and kidney yang and phlegm-dampness intercepting lung,syndrome of spleen weakness and dampness hold-up and phlegm and blood retarding in the lung,syndrome of weakness of both qi and yin and phlegm-heat remaining the lung.7.Risk factors: the hazard factors of PA infection in patients with drug-resistant bacteria bronchiectasis were in bed permanently,invasive medical procedures and abnormal CRP levels,and the independent risk factors for death in patients with drug-resistant bacteria bronchiectasis were water and electrolyte disturbance,hypoproteinemia,pleural effusion,infection of three or more bacteria and fungal infection.Conclusion:1.Most of the patients with drug-resistant bronchiectasis are over 60 years old,and often have a variety of underlying diseases.The chest CT findings are mainly multi-lobe involvement.Drug-resistant gram-negative bacteria were the major bacteria,and PA was the main delegate.The condition is complex and easy to repeat.2.The core disease of patients with bronchiectasis infected by drug-resistant bacteria is located in the lung and can involve heart,spleen,kidney and surface;the main pathological factors are phlegm,followed by qi deficiency,yin deficiency,heat,yang deficiency,blood stasis,drinking,dampness and blood deficiency.3.Unstable muscle surface and external pathogen invasion are the most common causes of repeated acute attack of bronchiectasis caused by drug-resistant bacteria.the loss of Zang-fu organs,qi and blood,yin and yang,phlegm,blood stasis and heat pathogen are the key pathogenesis.4.The clinical syndrome types of bronchiectasis caused by drug-resistant bacteria can be divided into five types: syndrome of turbid phlegm blocking lung,syndrome of weakness of heart and kidney yang and phlegm obstructing lung,syndrome of weakness in spleen and kidney yang and phlegm-dampness intercepting lung,syndrome of spleen weakness and dampness hold-up and phlegm and blood retarding in the lung,syndrome of weakness of both qi and yin and phlegm-heat remaining the lung.5.Modern diagnostic techniques such as peripheral blood leukocyte,neutrophil percentage,chest CT and drug sensitivity test results can be used as reference indicators to provide more evidence for TCM syndrome differentiation of patients with bronchiectasis infected by drug-resistant bacteria.