Study On The Distribution Pattern Of Syndrome Factors In Patients With Stable Chronic Obstructive Pulmonary Disease Combined With Insomni

Objective:By collecting the clinical information of patients with stable chronic obstructive pulmonary disease(COPD),the patients with insomnia and those without insomnia were compared,and the distribution characteristics of syndrome elements in patients with stable COPD complicated with insomnia were summarized.so as to provide clinical dialectical basis for the clinical diagnosis and treatment of patients with stable COPD complicated with insomnia.Methods:Using the research method of cross-sectional survey,COPD patients in theoutpatient or inpatient department of Dongzhimen Hospital of Peking University of Traditional Chinese Medicine from December 2018 to November 2021 were selected as the research objects.The research objects were divided into insomnia group(observation group)and non-insomnia group(control group)according to whether the patients were accompanied with insomnia.The clinical information(four diagnostic information,TCM syndrome scale,etc.)of the two groups of patients at stable stage was collected.The syndrome element calculation method of Zhu Wenfeng’s syndrome element syndrome differentiation was adopted,and the syndrome element integral>70 was recorded as the threshold for the existence of the syndrome element.IBM SPSS Statistics 20.0 software was used for statistical records to analyze the general data and syndrome element distribution of the two groups of patients.If the data of measurement and were in normal distribution,t test was used.The measurement data and enumeration data that do not conform to the normal distribution are tested by nonparametric test or chi-square test.The correlation between syndrome elements was summarized by cluster analysis.Results:1 Baseline data:154 patients with stable COPD were included in the study.There were 83 patients in stable COPD with insomnia group(observation group),with an average age of 70.494±10.238.There were 53 males(67.53%),30 females(36.14%),53(63.86%)had smoking history,60(72.29%)had drinking history,38(57.78%)had normal weight,33(39.76%)had overweight,and 12(14.46%)had obesity.71 COPD patients without insomnia(control group),mean age was 69.44±9.312,male 51(71.83%),female 20(28.17%),55(77.46%)had smoking history,58(81.69%)had drinking history.There were 46 people with normal weight(64.79%),14 people with overweight(19.72%)and 11 people with obesity(15.49%).There was no significant difference in age,gender,smoking history and drinking history between the two groups(P>0.05).There was no significant difference between the two groups in GOLD classification of COPD and mMRC questionnaire evaluation results,and there was significant difference in CAT questionnaire score.The CAT score of the insomnia group was higher than that of the non-insomnia group.2 Distribution of syndrome elements in each group:2.1 Chronic obstructive pulmonary disease combined with insomnia group:A total of 83 people in the observation group were selected.The syndrome elements extracted in the disease location were lung(100%),heart and spirit(brain)(55.42%),kidney(53.01%),spleen(49.40%),heart(27.71%),liver(20.48%),surface(4.82%),stomach(2.41%),gallbladder(1.20%),and chest diaphragm(1.20%).A total of 16 disease syndrome elements were extracted,which were qi deficiency(85.54%),phlegm(83.13%),yang deficiency(75.90%),drinking(75.90%),blood stasis(37.35%),blood deficiency(36.14%),qi stagnation(30.12%),fire and heat(26.51%),yin deficiency(20.48%),dampness(19.28%),blood heat(14.46%),cold(10.84%),qi deficiency(2.41%),yang hyperactivity(2.41%),essence deficiency(2.41%)and yang floating(1.20%).2.2 Chronic obstructive pulmonary disease without insomnia group:A total of 71 patients in the control group were selected,and the syndrome elements of the disease location extracted were lung(98.59%),kidney(56.34%),heart(26.76%),liver(18.31%),spleen(18.31%),mind(brain)(7.04%),table(2.82%)and chest diaphragm(1.41%).A total of 13 syndrome elements were extracted,including phlegm(91.55%),qi deficiency(83.10%),yang deficiency(73.24%),drinking(46.48%),blood stasis(39.44%),blood deficiency(26.76%),qi stagnation(29.58%),fire heat(26.76%),yin deficiency(16.90%),dampness(21.13%),blood heat(12.68%),cold(8.45%),and qi deficiency(1.41%).2.3 Comparison of syndrome elements between the two groups:the frequency of disease location in the observation group was 262 times,with an average of 3.16 disease locations,and the frequency of disease location in the control group was 161 times,with an average of 2.27 disease locations.The disease frequency of the observation group was 410 times,with an average of 4.94.The disease frequency of the control group was 339 times,with an average of 4.77 disease locations,and the syndrome elements with frequency less than 5%were excluded.Chi-square test was performed for the same syndrome factor(mind and spleen)with frequency greater than 5%between the two groups.There was a statistically significant difference between the observation group and the control group in the location of heart(brain)and spleen(P<0.05).3 Cluster analysis results:3.1 The frequency of syndrome elements in the location of chronic obstructive pulmonary disease combined with insomnia group was 262 times,and the frequency of syndrome elements in the nature was 410 times.The syndrome elements with a total proportion less than 5%were excluded,and the remaining syndrome elements were clustered.According to the results of cluster analysis combined with the actual situation,they were divided into two categories.The first category was fire-heat,qi stagnation,heart,liver,blood deficiency,drinking,blood stasis and kidney.The second category is qi deficiency,yang deficiency,lung,phlegm,mind(brain),spleen.Combined with the basic theory of traditional Chinese medicine and related clinical experience,the disease location syndrome elements and disease nature syndrome elements were combined.The first type of syndrome elements can be combined with qi stagnation and heat syndrome,heart and liver blood deficiency syndrome,blood stasis syndrome,kidney deficiency and stop drinking syndrome;The second kind of syndromes can be combined with lung qi deficiency,yang qi deficiency,phlegm obstructing lung,phlegm disturbing heart(mind),lung and spleen qi deficiency,lung and spleen yang deficiency,spleen deficiency and phlegm turbidity,heart(mind)spleen yang deficiency,heart(mind)spleen qi deficiency.3.2 The frequency of disease location syndrome elements in COPD without insomnia group was 161 times,and the frequency of disease nature syndrome elements was 339 times.The syndrome elements with a total proportion of less than 5%were eliminated,and the remaining syndrome elements were analyzed by cluster analysis.According to the results of cluster analysis and the actual situation,they were divided into two categories.The first category was qi stagnation,fire heat,heart,liver,blood deficiency,spleen,drinking,blood stasis and kidney.The second category was qi deficiency,yang deficiency,lung and phlegm.Combined with the basic theory of traditional Chinese medicine and related clinical experience,the disease location syndrome elements and disease nature syndrome elements are combined.The first type of syndrome elements can be combined with qi stagnation and heat syndrome,heart and liver blood deficiency syndrome,heart and spleen blood deficiency syndrome,liver depression and spleen syndrome,spleen deficiency and drink syndrome,drink and blood stasis syndrome,kidney deficiency and drink stop syndrome;the second type of syndromes can be combined with lung qi deficiency syndrome;yang qi deficiency syndrome,phlegm turbidity obstructing lung syndrome.Conclusion:1 There was no difference in age,gender,smoking history and drinking history between the COPD insomnia group and the COPD non-insomnia group,but the BMI index of the insomnia group was lower than that of the non-insomnia group.There was no difference in GOLD classification and mMRC classification between the COPD insomnia group and the COPD non-insomnia group,but the CAT score of the COPD insomnia group was higher than that of the COPD non-insomnia group,indicating that the quality of life of the COPD insomnia group was lower than that of the COPD non-insomnia group.2 There are mainly lung,spleen,kidney,heart and liver in COPD insomnia group and COPD non-insomnia group,and the highest frequency of lung disease location syndrome elements shows that the disease location of COPD patients is mainly lung,and the spleen,kidney,even heart and liver can be involved in the later stage.The occurrence frequency of syndrome elements of central spirit(brain)and spleen in the chronic obstructive pulmonary insomnia group was higher than that in the control group,which may be because the spleen was the foundation of acquired nature,the source of qi and blood biochemistry,the dysfunction of spleen transportation and transformation,the inability of qi and blood to nourish the mind,or the sinking of spleen qi deficiency and the exuberance of heart fire,leading to the occurrence of insomnia.The two groups of disease syndrome elements are mainly qi deficiency,phlegm,yang deficiency,drink,blood stasis,blood deficiency,qi stagnation,fire,yin deficiency,wet,blood heat,indicating that the condition of patients with chronic obstructive pulmonary disease is mixed with deficiency and excess,deficiency is given priority to with qi deficiency and yang deficiency,excess is given priority to with phlegm and blood stasis.3 The difference between chronic obstructive pulmonary insomnia group and non-insomnia group is mainly related to the syndrome elements of spleen and heart spirit.According to the results of cluster analysis,the syndrome elements of central spirit and spleen in chronic obstructive pulmonary insomnia group are classified into the syndrome elements of lung,phlegm,qi deficiency and yang deficiency.Therefore,compared with the chronic obstructive pulmonary disease group without insomnia,the additional syndromes in the chronic obstructive pulmonary disease group with insomnia are mainly lung-spleen qi deficiency syndrome,lung-spleen yang deficiency syndrome,spleen deficiency with phlegm syndrome,phlegm turbidity disturbing the heart syndrome,heart(mind)spleen yang deficiency syndrome,and heart(mind)spleen qi deficiency syndrome.The causes of insomnia in patients with COPD may be lung qi deficiency,qi and yang deficiency more involved in the spleen,spleen qi or spleen yang deficiency,spleen transport disorders,phlegm increased,resulting in mental disorders or disturbed by phlegm,and finally insomnia.Therefore,for patients with COPD combined with insomnia,attention should be paid to the functional regulation of spleen,mind(brain)in general treatment.