| BackgroundIn recent years,the amount of chest X-ray and chest CT examination has increased since the COVID-19.With the continuous improvement of the accuracy of imaging diagnosis,the detection rate of pulmonary nodules has also become higher and higher,which has brought greater economic burden and mental pressure to patients.The etiology and pathogenesis of pulmonary nodules are not clear,and it is still relatively difficult and complex to judge whether pulmonary nodules are benign clinically.For the treatment of pulmonary nodules,the existing relevant guidelines recommend that there is generally no applicable medical treatment.There are few reports on clinical research of pulmonary nodules in traditional Chinese medicine,and there is also a lack of relevant industry consensus on the TCM disease name,pathogenesis,symptom classification,treatment methods and principles of pulmonary nodules.Previous clinical studies have found that traditional Chinese medicine has a certain clinical effect in the treatment of pulmonary nodules,and can improve the symptoms of patients to a certain extent.Therefore,the intervention of traditional Chinese medicine on early pulmonary nodules can reverse its development trend,slow down its growth rate,and reduce the incidence of lung cancer in the early stage of the disease.This research relies on the national regional(specialized)TCM diagnosis and treatment center construction(TCM lung disease)project of China Japan Friendship Hospital(Code:2019-zx-004)and the project of the "elite plan" talent cultivation project of China Japan Friendship Hospital(Code:zrjy2021-gg06),which has a good research platform and team cooperation ability.Objective(1)To study the prevalence of pulmonary nodules,explore the relevant factors affecting the prevalence of pulmonary nodules,and provide data support and theoretical support for the exploration of "nodule constitution";(2)To explore the medication law of Professor Zhang in the treatment of pulmonary nodules,summarize his clinical experience in the treatment of pulmonary nodules,and provide the basis for the follow-up clinical research;(3)To summarize the clinical characteristics of outpatients with pulmonary nodules,and observe the clinical effect of Yiqi Sanjie Wenhua method on pulmonary nodules of qi deficiency and phlegm coagulation type.Methods(1)Study 1:the cross-sectional study method was used to collect the physical examination data of healthy people who were examined in the physical examination center of a third-class hospital in Beijing from December 2020 to may 2021,and to summarize the clinical epidemiological characteristics of pulmonary nodules and related influencing factors.(2)Study 2:the data mining research method was used to collect the prescription information of pulmonary nodule patients who visited Professor Zhang’s outpatient clinic from January 2018 to December 2020,input it into the "Chinese Medicine Inheritance assistance system(v2.5)" and use the software’s own functions for statistical analysis.(3)Study 3:135 outpatients with pulmonary nodules were enrolled in a non randomized controlled study.The patients who used Chinese medicine were included in the Chinese medicine group,and the patients who were followed up were included in the control group.The patients in both groups received CT Reexamination and follow-up for 12 weeks.The Chinese medicine group took Chinese medicine orally for 12 weeks,and the control group did not receive drug intervention.Results(1)Study 1:① the detection rate of pulmonary nodules increased significantly with the increase of age.The risk of pulmonary nodules increased by 3.9%for each year of age[OR=1.039,95%CI(1.034-1.043)].The total detection rate of female was higher than that of male;In terms of age and sex,the detection rate of pulmonary nodules in women decreased slowly with age,while the trend of detection rate of pulmonary nodules in men was opposite.② The proportion of TPS A(male)and CYFRA21-1 increased in the pulmonary nodule group was significantly higher than that in the non pulmonary nodule group.③ The detection rates of liver cysts(20.6%vs 16.5%),renal cysts(16.2%vs 11.8%),gallstones(7.5%vs 4.6%),thyroid nodules(20.6%vs 16.5%)and breast nodules(38.1%vs 35.1%)in the group with pulmonary nodules were significantly higher than those in the group without pulmonary nodules.The risk of detecting pulmonary nodules in the group with gallbladder stones was 1.363 times higher than that in the group without gallbladder stones[OR=1.363.95%CI(1.177-1.579)],The risk of detecting lung nodules in the population with thyroid nodules was 1.720 times higher than that in the population without thyroid nodules[OR=1.720,95%CI(1.600-1.849)],and the risk of detecting lung nodules in the population with breast nodules was 1.186 times higher than that in the population without breast nodules[OR=1.186,95%CI(1.050-1.340)].④ The proportion of patients with previous history of hypertension,hyperlipidemia,diabetes and coronary heart disease in the pulmonary nodule group was significantly higher than that in the non pulmonary nodule group.⑤ The proportion of non-smokers(no smoking history)in the pulmonary nodule group was lower than that in the non pulmonary nodule group(73.6%vs 75.3%).⑥ The total detection rate of pulmonary nodules was 52.18%.The detection rate of a single pulmonary nodule(solitary pulmonary nodule)is higher than that of multiple nodules(number of nodules≤10).The largest pulmonary nodule diameter is less than 5mm,accounting for 68.9%,and the largest pulmonary nodule diameter is 5-10mm,accounting for 30.4%;The largest pulmonary nodule diameter>10mm was the least,accounting for 0.7%.The diameter of pulmonary nodules was correlated with age and sex.(2)Study 2:a total of 221 prescriptions were included,involving 171 Chinese herbal medicines.There were 15 Chinese herbal medicines with a frequency of≥50.Among them,raw Astragalus appeared the most frequently,203 times,followed by Cinnamon Twig,Fritillaria thunbergii,Prunella vulgaris,tangerine peel,turmeric,raw keel,raw oyster,and arrowhead mushroom.According to the frequency of use,the drug properties are distributed as warm,cold,flat,cool and hot;The medicinal taste is bitter,pungent,sweet,sour(astringent)and salty.The meridians of these drugs involve 12 meridians.The top three are spleen meridians,liver meridians and lung meridians.The top 9 Chinese medicines that are used frequently are raw Astragalus membranaceus,Guizhi,Fritillaria,Prunella vulgaris,tangerine peel,turmeric,raw dragon bone,raw oyster and arrowhead mushroom.Professor Zhang named the prescription composed of these 9 herbs as Yiqi Sanjie Wenhua formula,which is used as the basic formula for routine treatment of pulmonary nodules.(3)Study 3:① there was no statistical difference in gender,age,BMI,smoking history,drinking history,environmental high-risk occupational exposure history,family history of lung cancer,previous tumor history and history of combined lung diseases between the two groups,and the baseline was the same.②Among the largest nodule diameters of outpatient pulmonary nodule patients,the largest is 21mm，the smallest is 2mm,and the largest nodule diameter ranges from 5 to 10mm,accounting for 79.26%;The largest nodules were pure ground glass nodules,accounting for 86.67%;The largest nodules were located in the upper lobe of the right lung,followed by the upper lobe of the left lung,the lower lobe of the right lung,the lower lobe of the left lung,and the middle lobe of the right lung;The number of nodules was mainly multiple,accounting for 57.3%;The morphology was mainly regular,accounting for 63.70%;The boundary is mainly clear,accounting for 69.93%.③ The constitution of the patients with pulmonary nodules in the outpatient department was mainly biased(87/135),less moderate(48/135),and more concurrent constitution.④ There was no statistical difference in the maximum diameter of nodules between the two groups before and after the follow-up.However,the TCM syndrome scores,SDS scores and Bai scores of the two groups before and after the follow-up were statistically significant.The physical changes of the Chinese medicine group before and after the treatment were statistically significant.Conclusion(1)Study 1:① the detection rate of pulmonary nodules in adults increased significantly with age,and the total detection rate in women was higher than that in men.The proportion of female pulmonary nodule detection rate decreased slowly with age(from 56.1%to 41.6%).The trend of male pulmonary nodule detection rate was opposite(from 43.9%to 58.4%);Age may be an independent risk factor for pulmonary nodules in physical examination population.②The proportion of patients with pulmonary nodules with elevated blood pressure and the proportion of patients with previous hypertension were significantly higher than those without pulmonary nodules.Blood pressure may be an influencing factor of pulmonary nodules.③Combined detection of multiple tumor markers is helpful for early detection of malignant tumors.④ The detection of gallbladder stones,thyroid nodules and breast nodules may be independent risk factors for the detection of lung nodules.The "nodule constitution" can be explored from the constitution theory of traditional Chinese medicine and the theory of Sanjiao.⑤ Smoking has certain influence on the detection rate of pulmonary nodules.⑥The total detection rate of pulmonary nodules in the adult physical examination population is high,and the nodules above 5mm are mainly solitary nodules.Clinical follow-up observation should be focused on the nodules above 5mm,and the prognosis and prognosis should be paid attention to.(2)Study 2:Professor Zhang Shunan believes that the pulmonary nodules belong to the category of syndrome volume of TCM.The pulmonary nodules are fixed and will not change significantly in the short term,which conforms to the characteristics of syndrome volume.The pathogenesis of this disease is based on the deficiency of Qi,blood stasis and phlegm,and the deficiency of Qi is mainly due to the deficiency of lung and spleen.The treatment should take into account both the specimen and the specimen.The method of Tonifying the Qi of the lung and spleen is to strengthen the health,and the method of promoting blood circulation and dispersing the knot is to eliminate the evil.Therefore,the method of Supplementing Qi,activating blood circulation and dispersing the knot is adopted to treat the pulmonary nodule in order to improve the clinical symptoms of the patient.(3)Study 3:the constitution of patients with pulmonary nodules in outpatient clinics is mainly biased,and most patients have mild to moderate depression and anxiety.The addition and subtraction of Yiqi Sanjie Wenhua decoction can improve the clinical symptoms,relieve the depression and anxiety of patients,and improve their physique.In clinical practice,we should actively carry out traditional Chinese medicine intervention and pay attention to psychological counseling of patients with pulmonary nodules. |
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