Analysis Of Syndrome Characteristics And Diagnostic Model Of COPD With Lung And Kidney Qi Deficiency And Blood Stasis Syndrom

Objective:In this study,through the clinical collection of chronic obstructive pulmonary disease（COPD）cases related information,using macroscopic syndrome differentiation of traditional Chinese medicine and western medicine micro index combining innovative diagnostic method,based on modern statistical analysis technology,explore the COPD pneumon-kidney qi deficiency and blood stasis syndromes related factors,build the clinical prediction model of combined disease,to gain higher degree of sensitivity and specific results,In order to provide reliable clinical basis for the early diagnosis and prevention of COPD,to provide quantitative evidence for the diagnosis of related syndromes,it also lays the foundation for the standardization of Traditional Chinese medicine.Method:This study is based on outpatient and the inpatient’s collection of questionnaire as the foundation of liaoning university of traditional Chinese medicine hospital,from September 2019 to October 2021,according to the discharge standard,select the COPD（Deficiency of lung and kidney qi and blood stasis syndrome）,153 cases of patients with COPD（non Deficiency of lung and kidney qi and blood stasis syndrome）,146 cases of patients,And collect general data of two groups of subjects（age,gender,course of disease,smoking index,dietary habits,physical activity,and past medical history related diseases）.Acute exacerbations（number of acute exacerbations per year,severity of acute exacerbations）;Signs（barrel-like chest,tactile fibrillation,unvoiced percussion,dry and wet rales,clubbing fingers,cyanosis）and related assessment scales（CAT,m MRC）;Laboratory examination related indicators（WBC,NEUT,LYMPH,CRP,HGB,FIB,D-D,PT,APTT）.Related auxiliary examinations（respiratory metabolic indicators:arterial blood gas analysis（Pa O2,Pa CO2）;Pulmonary function grading of severity of airflow restriction in COPD patients;Lung CT examination（with or without emphysema）and TCM syndrome information obtained from the four clinics to establish a database.Adopt the method of retrospective analysis,using SPSS software and R,ordinal data of two groups of patients with single factor analysis and logistic regression analysis,multiple factors will ultimately determine the variables to establish the model,and through the area under the ROC curve,goodness-of-fit test,calibration of test,calculate the net benefit ratio model from the Angle of comprehensive evaluation,The final display is in the form of a column chart.Result:1.Syndrome related factors analysis results showed that there were statistically significant differences between the two groups in age,disease course,smoking index,number of acute exacerbations per year,cyanosis,CAT score,m MRC,Pa CO2 and pulmonary function grading of airflow restriction severity in COPD patients（P<0.05）.However,there were no significant differences in gender,dietary habits,physical exercise,history related diseases,severity of acute exacerbations,WBC,NEUT,LYMPH,CRP,HGB,FIB,D-D,PT,APTT,Pa O2 and lung CT examination（P>0.05）.There were statistically significant differences between the two groups in shortness of breath,colds,soreness of waist and knee,spontaneous sweating,frequency of urination,tinnitus,cyanosis symptoms,purple and dark tongue and pulse（P<0.05）.There was no significant difference in wheezing,chest tightness,cough,sputum,fatigue,bad wind and facial edema（P>0.05）.2.COPD lung and kidney deficiency and blood stasis model build results show that:th e multiple factors analysis,age,disease duration,smoking index,pulmonary function c lassification,spontaneous perspiration,lumbar debility,shortness of breath,statistically difference,dark purple tongue,Finally,these 8 indicators were included in the constru ction of COPD syndrome diagnosis model of pneumo-kidney qi deficiency combined with blood stasis get the formula is:P=1/（1+exp（-（age*0.091+disease duration*0.062+disease course of smoking index*0.515-Pa CO₂*0.036+GOLD grade*0.312+since sweat*0.539+lumbar debility*0.352+shortness of breath*0.416+dark purple tongue*0.442-11.135））]3.Evaluation and verification of the clinical prediction model of PULMONARY kidney qi deficiency and blood stasis syndrome of COPD:1）The AUC value of the area under ROC curve of the diagnostic model was 0.866（95%CI:0.827-0.905）,the sensitivity was 74.5%,the specificity was 80.3%,and the Yoden index was 0.548,the predictive critical value of the diagnostic model is 0.5860,indicating good differentiation of the model;2）Goodness of fit test of the model:its Chi-square value is 7.645,degree of freedom is 8,and P=0.469（P>0.05）,indicating that there is no significant difference between the predicted value of the model and the actual observed value,and the model has a good fit.3)Calibration test:The Calibration curve of this graph is close to the ideal curve by drawing Calibration curve visualization,so the model has good Calibration ability.4)Clinical DCA decision curve analysis:when the high risk threshold>0.1,there is a good clinical net benefit.Conclusion:1.This study has identified the syndrome related factors of COPD pulmonary kidney qi deficiency and blood stasis syndrome,mainly including age,disease course,smoking index,arterial partial pressure of carbon dioxide（Pa CO2）,lung function grade;And soft waist and knee,spontaneous sweating,shortness of breath,purple and dark tongue are the main characteristics of COPD pulmonary kidney qi deficiency and blood stasis syndrome of TRADITIONAL Chinese medicine syndrome.The model established by the above related factors has certain value for the early diagnosis of disease,and can provide a reference for clinicians.2.In this study,an innovative diagnostic method combining macro syndrome differentiation of TCM and micro indicators of western medicine was adopted.In the process of syndrome diagnosis,physical and chemical indicators of western medicine besides symptoms and signs were introduced,namely the diagnostic criteria combining macro and micro indicators.Microcosmic syndrome differentiation can not only deepen the syndromes on the deep understanding,also for the modernization of TCM syndrome development provides a new research method,and relying on modern data analysis method,research on TCM diagnosis and treatment of COPD has a certain meaning,at the same time,the future construction of remote diagnosis of traditional Chinese medicine auxiliary platform provides a new way of thinking,but also lay a foundation for the standardization of traditional Chinese medicine,Promoting the development of TRADITIONAL Chinese medicine and introducing it to the world.