The Effect Of Comorbidities On TCM Syndromes In Patients With Stable COPD

In recent years,complications are widely concerned in the prevention and treatment of COPD,in addition to the stability of the maintenance of treatment,self-management,lung rehabilitation,comprehensive nursing.Studies show that different COPD patients show different characteristics,including different characteristics of complications.Comorbidityalso affects the development of COPD.It is urgent to carry out extensive research on epidemiology,risk factors,pathogenesis and diagnosis and treatment of COPD complication,and provide a basis for improving the evaluation of COPD outcome.In this study,a questionnaire survey was conducted to collect data on clinical epidemiology and TCM Syndromes of COPD patients who met the inclusion criteria.A combination of statistical methods,cluster analysis and association rules was used to explore the influence of complications on TCM syndromes in patients with stable COPD.The paper includes two parts:literature review and clinical research.Literature reviewIt mainly includes:the influence of complications on pulmonary function in patients with COPD.COPD in Chinese medicine.In the effect of complication on pulmonary function in patients with chronic obstructive pulmonary disease(COPD),the effect of different complications on the pulmonary function of COPD patients was briefly reviewed.In the Chinese medicine study of COPD,the etiology,pathogenesis,syndrome,syndrome differentiation and treatment of chronic obstructive pulmonary disease with different complications were briefly reviewed.Clinical researchObjective:Influence of complications on TCM syndromes in patients with stable COPD.Method:538 patients were collected from January 2011 to March 2018 in the Third Affiliated Hospital of Beijing University of Chinese Medicine,Department of respiration of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,the Department of respiration in the Eastern Hospital of Beijing University of Chinese Medicine,the China-Japan Friendship Hospital of Beijing University of Chinese Medicine,China-Japan Friendship Hospital of the Ministry of health,the hospital of the integrated traditional Chinese medicine and Western medicine in Beijing,Daxing District,Shaanxi,including epidemiological data,TCM syndromes and other data.The collected data were entered into the database,and then statistical analysis,cluster analysis and association rules were carried out to investigate the influence of complications on TCM syndromes in patients with stable COPD.Results;(1)the correlation between TCM syndromes and pulmonary function in stable COPD patients with or without complications.?In the stable COPD patients with and without complication,the position of the disease involves the spleen is difference in the classification of lung functions:GOLD1(?2=5.779,P<0.05),GOLD2(?2=10.733,P<0,01),GOLD3(?2=1.372,P>0.05),GOLD4(?2=0.001,P>0.05).In the stable COPD patients with and without complication,the position of the disease involves the kidney is difference in the classification of lung functions:GOLD1(x2=5.779,P<0.05),GOLD2(x2=9.834,P<0.01),GOLD3(x2=0.249,P>0.05),GOLD4(P>0.05).Logistic regression showed that in GOLD2,the position of the disease involves the lung and kidney were different in the stable COPD with and without complication(OR=3.003,95%CI:1.532-5.888).?Basic syndrome:in the stable COPD patients with and without complication,basic syndromes of spleen qi deficiency syndrome are different in different grades of lung function:GOLD1(?2=5.779,P<0.05),GOLD2(x2=9.834,P<0.01),GOLD3(x2=0.249,P>0.05),GOLD4(P>0.05).In the patients with and without complications,the basic syndrome of kidney qi deficiency syndrome is different in different lung function classification:GOLD1(?2=4.160,P<0.05),GOLD2(x2=14.229,P<0.05),GOLD3(?2=1.122,P>0.05),GOLD4(?2=0,P>0.05).In the patients with and without complications,the phlegm syndrome of basic syndrome was different in different pulmonary function classification:GOLD1(?2=30.169,P<0.001),GOLD2(x2=28.907,P<0.001),GOLD3(x2=7.763,P<0.01),GOLD4(?2=0.085,P>0.05).In stable COPD patients with and without complication,basic syndrome phlegm heat syndrome was different in different grades of lung function:GOLD1(P>0.05),GOLD2(P<0.001),GOLD3(P<0.001),GOLD4(P>0.05).In the patients with and without complications,the syndrome of basic syndrome and blood stasis was different in different grades of pulmonary function:GOLD1(P<0.01),GOLD2(x2=9.378,P<0.01),GOLD3(x2=1.423,P>0.05),GOLD4(x2=0.408,P>0.05).Logistic regression showed that in GOLD1,there were differences in lung qi deficiency syndrome,spleen qi deficiency syndrome(OR=0.110,95%CI:0.036-0.342)and lung qi deficiency syndrome,spleen qi deficiency syndrome and phlegm syndrome(OR=57.647,95%CI:7.223-460.102)in stable COPD patients with and without complication.In GOLD2,there are also lung qi deficiency syndrome,kidney qi deficiency syndrome and phlegm syndrome(ORF=12.574,95%CI:2.941-53.762),and there are differences in the patients with stable COPD period with and without complication.In GOLD3,there were lung qi deficiency syndrome,spleen qi deficiency syndrome and phlegm syndrome(OR=0.204,95%CI:0.042-0.978),and there were differences in the patients with stable COPD period with and without complication.?Syndrome:In the stable COPD patients with and without complication,the deficiency of lung and spleen deficiency syndrome was difference in different pulmonary function classification:GOLD1(x2=40.575,P<0.001),GOLD2(x2=49.171,P<0.001).In the patients with and without complications,the lung and kidney qi deficiency syndrome and lung kidney yin deficiency syndrome was different in different lung function grades:GOLD1(P>0.05),GOLD2(P>0.05)and GOLD3(P<0.05).In the patients with and without complications,the lung and kidney qi yin two deficiency syndrome was difference in different pulmonary function classification:GOLD1(P>0.05),GOLD2(x2=7.168,P<0.01),GOLD3(?2=2.636,P>0.05).In the patients with and without complication of COPD,the syndrome of lung qi deficiency phlegm block was diferent in different pulmonary function classification:GOLD l(?2=10.514,P<0.01),GOLD2(x2=0.135,P>0.05),GOLD3(?2=0.454,P>0.05).In stable COPD patients with and without complication,the syndrome of pulmonary spleen qi deficiency and Phlegm Stagnation was different in different pulmonary function classification:GOLD 1(P<0.05),GOLD2(x2=0.028,P>0.05),GOLD3(x2=1.737,P>0.05).In the patients with and without complications of stable COPD,the lung and kidney qi deficiency phlegm block syndrome was different in different lung function grades:GOLD1(P<0.05),GOLD2(x2=5.966,P<0.05),GOLD3(?2=0,P>0.05),GOLD4(P>0.05).In the patients with and without complications of stable COPD,the syndrome of pulmonary and kidney qi deficiency and phlegm stasis was different in different lung function grades:GOLD1(P>0.05),GOLD2(x2=6.329,P<0.05),GOLD3(?2=1.468,P>0.05),GOLD4(?2=0,P>0.05).Logistic regression was used for the syndrome type with frequency of more than 5%.In GOLD1,there were differences in lung qi deficiency syndrome(OR=0.010,95%CI:0.001-0.077),lung kidney qi deficiency syndrome(OR=0.030,95%CI:0.003-0.363),lung kidney yin deficiency syndrome(OR=0.045,95%CI:0.003-0.618)in the patients with and without complication of stable COPD;GOLD2,Pulmonary spleen qi deficiency syndrome(OR=0.002,95%CI:0.000-0.023),lung kidney qi deficiency syndrome(OR=0.051,95%CI:0.012-0.218),lung kidney yin deficiency syndrome(OR=0.0461,95%CI:0.014-0.273),lung Kidney Qi Yin two deficiency syndrome(OR=0.046,95%CI:0.012-0.168),lung qi deficiency phlegm block syndrome(OR=0.143,95%CI:0.032-0.632)in the patients with and without complication of stable COPD.(2)In the stable COPD bronchiectasis patients with and without complications,there did not exhibit the above characteristics in the position of the disease and syndrome,and showed similar characteristics in the basic syndrome;the above characteristics were not shown in the patients with frequent acute exacerbation of the stable COPD with and without complications,the basic syndromes and syndromes showed similar characteristics.(3)Cluster analysis found that the patients were divided into ten categories:?hypertension,gastroesophageal reflux,lung kidney yin deficiency and phlegm obstructing lung syndrome;?coronary heart disease,heart failure,diabetes,lung cancer,osteoporosis,lung kidney qi deficiency phlegm stasis syndrome,lung Kidney qi yin two deficiency phlegm block syndrome,lung Kidney qi yin two deficiency phlegm stasis syndrome mutual obstruction syndrome Lung kidney yin deficiency and phlegm stasis syndrome,GOLD3,GOLD4,female,BMI<18.5kg/m2,mMRC?2,CAT?10,acute aggravation times more than 2;?lung kidney yin deficiency phlegm heat depression lung syndrome,18.5-23.9kg/m2;?bronchiectasis,lung qi deficiency phlegm heat depression lung syndrome,lung kidney qi deficiency phlegm heat depression lung syndrome,BMI more than 25kg/m2;?deficiency of lung Kidney Qi Yin two deficiency Syndrome,lung and kidney qi stagnation of phlegm block syndrome,GOLD2,male,smoking;?Lower extremity arteriosclerosis,spleen kidney yang deficiency syndrome,spleen kidney yang deficiency water drinking syndrome;?obstructive sleep apnea,lung spleen qi deficiency syndrome,lung spleen qi deficiency phlegm block syndrome,lung spleen qi deficiency phlegm stasis syndrome,GOLD1,mMRC0-1,CAT<10,acute aggravation times 0?1 times per year;?arrhythmia,lung and kidney qi deficiency syndrome,heart blood stasis syndrome;?lung and Kidney qi yin two asthenia phlegm heat stagnation syndrome;?anxiety and depression,deficiency of lung kidney yin and stagnation of liver qi.(4)The association rules found that the combination of single syndrome and single syndrome can be found in combination of heart failure,lung Kidney qi yin two deficiency phlegm stasis syndrome/lung kidney yin deficiency and phlegm stasis syndrome;three factors analysis of hypertension,GOLD2,lung kidney qi deficiency and phlegm stasis syndrome;heart failure,GOLD4,lung Kidney qi yin and two deficiency phlegm stasis syndrome combination;four cause The analysis of coronary heart disease,pulmonary and kidney qi deficiency and phlegm stasis syndrome,GOLD2,acute exacerbation of 0?1 times pre year combination,heart failure,lung kidney qi deficiency and phlegm stasis syndrome,GOLD2,acute aggravation times 0?1 times pre year combination,five factors analysis showed bronchiectasis,lung and kidney qi deficiency phlegm heat stagnation of lung syndrome,acute aggravation times 2,mMRC More than 2,CAT>10,hypertension,pulmonary and kidney qi deficiency and phlegm stasis syndrome,GOLD2,male,smoking,six factors analysis showed that heart failure,lung kidney qi deficiency and phlegm stasis syndrome,coronary heart disease,acute aggravation number 0?1 times pre year,mMRC>2,CAT>10 combination;heart failure,lung Kidney qi yin deficiency phlegm stasis mutual obstruction syndrome,acute aggravation times 2 mMRC?2,CAT?10,and the combination of smoking.Conclusion:(1)The presence of complication has an effect on the position of the patients in the stable COPD.The patients with stable COPD may have both lung and kidney disease in the early stage.With the increase of air flow limitation,the proportion of the disease position in the lung and kidney is increasing gradually.(2)The existence of complication has an influence on the basic syndrome in the stable COPD.The patients accompanied by complications can not only show kidney qi deficiency syndrome,phlegm syndrome and blood stasis syndrome in the early stage,but the deficiency of kidney yin and blood stasis gradually increase with the increase of air flow limitation,while spleen qi deficiency syndrome was shown in the patients with stable COPD without complication in the early stage.With the increase of airflow limitation,the proportion of kidney qi deficiency and kidney yin deficiency increased gradually.(3)The existence of complication affects the syndrome of the patients in the stable COPD and makes the syndrome more complex.(4)There did not have difference in the position of the disease at the bronchiectasis and frequent acute exacerbation phenotypes of the stable COPD in the patients with and without complication,and the symptoms were similar to those in the basic syndromes and syndromes,while the basic syndromes and syndromes showed similar characteristics.(5)Cluster analysis can find the syndrome characteristics of partial COPD,complication and pulmonary function,such as COPD combined obstructive sleep apnea,GOLD1,mMRC<2,CAT<10,and acute aggravation times 0?1 times per year with lung spleen qi deficiency syndrome,lung spleen qi deficiency phlegm block syndrome,lung spleen qi deficiency phlegm stasis syndrome mutual obstruction syndrome more common.(6)The syndrome characteristics of COPD,complication and pulmonary function can be found by association rules,such as in patients with COPD with coronary heart disease,lung function GOLD2,acute aggravation times 0?1 times per year,and the syndrome of pulmonary qi deficiency and phlegm stasis syndrome is more common.