The Study Of Correlation Between Syndrome Characteristics Of Phlegm-heat Accumulated In The Lung And Inflammatory Parameters In Patients With Lung Heat Disease Of Wind-warm

OBJECTIVE:To study the character of phlegm syndrome,heat syndrome and composite syndrome of patients with lung heat disease of wind-warm(i.e.community acquired pneumonia,CAP)recruited in this research,analyzing the correlation between their symptoms,signs and laboratory parameters,such as the differentiation and count of white blood cells(WBC);levels of procalcitonin(PCT),C-reactive protein(CRP),erythrocyte Sedimentation(ESR),D-dimer,prealbumin(Pre-Alb),fractional exhaled nitric oxide(FEND)and sputum smear,exploring the relationship of inflammatory markers and "heat syndrome"as well as "sputum syndrome",so that shedding a light on the type differentiation of phlegm-heat accumulated in the lung in patients with lung heat disease of wind-warm(CAP).METHODS:The clinical data from 135 patients with lung heat disease of wind-warm(CAP)was collected.General data such as height,body weight,gender,age;clinical data such as the count of WBC,PCT,CRP,ESR,D-dimer,Pre-Alb,FENO and result of sputum smear were analyzed by statistical software(IBM SPSS 20.0).Depending on specific purposes,different statistical methods were used to discover the correlation between symptoms,signs and inflammatory parameters.The factors that might influence the duration of hospitalization and expression of composite syndrome were analyzed by Logistic regression.RESULTS:1.According to their clinical manifestations,135 cases of phlegm-heat accumulated in the lung heat disease of wind-warm were collected in this study.50 patients were diagnosed with simple lung heat disease of wind-warm and 85 with composite syndrome.Among them there were 72 cases of deficiency syndrome,older than 65 years were 54 patients.There was a statistical significance between age and the distribution of asthenic and sthenic syndromes(?2=4.413,P=0.036).This study also found "composite syndrome of Qi-asthenic of lung-spleen"(41 cases,48.2%)was the most common in all composite syndrome.The Logistic regression analysis revealed that the symptoms of shortness of breath(OR=0.000,P=0.000),fatigue(OR=0,004,P=0.000),loose stool(OR=0.028,P=0.015)were of statistical significances for the clinical diagnosis of "composite syndrome of Qi-asthenic of lung-spleen".2.In this research,the relationship between the main symptoms(fever,cough,sputum,gasp/chock)and inflammatory markers was analyzed.The results were followed:2.1 Analysis of variance(ANOVA)revealed that the severity of fever had main effect on inflammatory parameters,including WBC count(F3,123=2.814,P=0.042),neutrophilic granulocyte(NEUT)count(F3,123=4.217,P=0.007),NEUT percentage(F3,123=3.983,P=0.010),the ratio of NEUT and lymphocyte(LYMPH)(F3,123=5.983,P=0.001),CRP(F3,123=4.727,P=0.004),ESR(F3,123=5.596,P=0.001)and Pre-Alb(F3,123=5.3155 P=0.002).However,it seemed that LYMPH count(F3,123=0.613,P=0.608),PCT(F;3,123=0.081,P=0.970)and D-dimer(F3,123=1.124,P=0.342)remained unaffected by fever severity.Also,ANOVA revealed that age,as a factor,had a main effect on inflammatory parameters,including WBC count(F2,123=5.042,P=0.008),NEUT count(F2,123=5.731,P=0.004),NEUT percentage(F2,123=4.913,P=0.009),the ratio of NEUT and LYMPH(F2,123=4.813,P=0.010),ESR(F2,123==5.610,P=0.005)and Pre-Alb(F2,123=5.914,P=0.004),but did not have an effect on LYMPH count(F2,123=0.388:P=0.697),CRP(F2,123=1.668,P=0.193),PCT(F2,123=0.916,P=0.403)and D-dimer(F2,123=1.925,P=0.150).Furthermore,this study found that there still was a fever severity-age interaction effect on inflammatory parameters including WBC count(F6,123=3.278,P=0.005),NEUT count(F6,123=3.389,P=0.004)and(F6,123=2.470,P=0.027).2.2 There was a correlation between the cough severity and LYMPH and PCT(P<0.05),but there was not a correlation between the cough severity and the count of WBC,the count of NEUT?CRP?ESR?D-dimer?Pre-Alb(P>0.05).2.3 The amount of sputum had a strong relation with CRP,PCT and the fever severity(P<0.05),but there was not a correlation between inflammatory parameters and sputum smear and the color of sputum(P>0.05).2.4 The severity of symptoms of gasp/chock had a relation with LYMPH count and CRP(P<0.05),but not with WBC count,NEUT count,the ratio of NEUT and LYMPH,Pre-Alb,ESR,PCT,D-dimer(P>0.05).3.In this study,98 patients were examined by FENO.After statistical analysis,it turned out that there was not a correlation between the level of FENO and WBC count,NEUT count,the ratio of NEUT and LYMPH,Pre-Alb,ESR,PCT,CRP and D-dimer(P>0.05).But,analysis of one way ANOVA revealed that the level of FENO was correlated with cough,red tongue and repid pulse(P<0.05).4.In addition to the above results,the ordinal logistic regression showed that patients who did not have a symptom of shortness breathing on admission might have a shorter duration of hospitalization than that of patients with severe shortness breathing(OR=0.000,P=0.000).Male patients would spend less days in hospital than that of female patients(OR=0.3 69,P=0.005),as well as younger patients(versus those older than 79 years,OR=0.382,P=0.028).The level of D-dimer checked on admission would predict the duration of hospitalization,the regression equation is Y(days)= 9.996+0.350*D-dimer,the standardized coefficient is 0.225.CONCLUSION:1.The interaction of "sputum" and "heat" is the key factor of lung heat disease of wind-warm of phlegm-heat accumulated type.Age is very important for the manifestation of composite syndrome.Patients older than 65 years are likely to be diagnosed with asthenic syndrome,mostly composite with "Qi-asthenic of lung-spleen".Also,the symptoms of shortness breathing,fatigue and loose stool are valuable for the diagnosis of composite syndrome with "Qi-asthenic of lung-spleen".This is consistent with the diagnosis of"Qi-asthenic of lung-spleen".2.The correlation between clinical symptoms,signs and inflammatory parameters2.1 There are correlations between fever severity and WBC count,NEUT count,NEUT percentage,the ratio of NEUT and LYMPH,CRP,ESR,and Pre-Alb,and the WBC count of patients in different age is affected by the fever severity.2.2 There is a correlation between the cough severity and LYMPH count and PCT.2.3 The amount of sputum has a strong relation with the fever severity,CRP and PCT.The fever severity and the level of CRP and PCT are higher in patients with small amount of sputum,and that without sputum as well,suggesting that there were more evil resided in the body.Nevertheless,there was not a correlation between yellow sputum and inflammatory parameters as well as sputum smear.The nature of inflammatory could not deduced by the color of sputum,neither for the prediction of the type of bacterial infection.2.4 The severity of gasp/chocking has a correlation with LYMPH count and CRP.The level of serum CRP is predictable for the severity of gasp/chocking.3.There is not a correlation between the level of FENO and inflammatory parameters of pneumonia.But there is a correlation between FENO and the symptoms of cough,red tongue and rapid pulse,indicating that the level of FENO will be affected by excessive heat evil staying inside the body.4.The duration of hospitalization is affected by factors including age,gender,the level of serum D-dimer and the symptom of shortness breathing.Elder female patients(>79 years old)with moderate or severe shortness breathing and high level of serum D-dimer are at risk of long hospital stay.