Chronic Obstructive Pulmonary Disease With Acute Exacerbation-prone Phenotype In Patients Syndromes Of The

1.BackgroundIn recent years, with chronic obstructive pulmonary disease (COPD) study unceasingly thorough, it is found that there is a large difference in risk factors, pathogenesis, clinical symptom, imaging manifestations and acute exacerbation frequency among COPD patients.Simply based on the severity of airflow limitation in COPD diagnosis and evaluation there are obvious limitations and may not reflect phenotypic heterogeneity.Meanwhile, more and more scholars recognized phenotypes to better reflect the heterogeneity of COPD,and phenotype is the direction of future research in COPD. COPD phenotype is a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death).The patients of COPD with frequent acute exacerbations phenotype may constitute a distinct phenotype.Research shows that, this phenotype can predict the tendency of the acute exacerbation of COPD in patients.However, there is currently no relevant study on correlation between TCM syndromes and phenotypes of COPD.2.clinical researchObjective:Through questionnaires on the patients of COPD with frequent acute exacerbations phenotype, study on their characteristics of TCM syndromes, provide a basis for effective control of their acute exacerbation frequency, and improve their quality of life and the prognosis.Method:The198cases of COPD patients who had been to Wangjing Hospital for treatment from January2009to December2013were selected.Formulate the questionnaire,record patients of General information, history, symptoms, tongue pulse, and lung features. Use SPSS19.0software for factoranalysis and clustering,and combine TCM theory and the clinical actual to classify their TCM syndrome.Results:l.The proportion of men and women in198patients of COPD with frequent acute exacerbations phenotype is2.19:1,the distribution of age is at49-86years old,the annual average of acute exacerbation frequency is2.69times, average course is (17.2±8.4) years.2.The top of15symptoms and signs, which appear more frequently, are dyspnea, expectoration, cough, poor appetite, ill wind, insomnia, fatigue, weakness, chest tightness, lip cyanosis, complexion chlorosis, constipation, bloating, dry mouth, frequent urination.3.These patients could be divided into5types.First,Qi deficiency of lung and spleen,includes expectoration, dilute phlegm, face chlorosis, bloating, diarrhea, tongue pale, white greasy tongue, weak pulse.Second,Qi deficiency of lung and kidney, internal resistance of the phlegm and blood stasis,includes dyspnea, expectoration, yellow and viscosity sputum, frequent urination, yellow greasy tongue, purple tongue,uneven pulse.Third,deficiency of both Qi and Yin,includes cough with less sputum, sweating, ill wind, dry mouth, constipation, insomnia, tongue with thin coating,thready rapid pulse.Fourth,Qi deficiency of lung and kidney,includes cough with white sputum,waist knee limp,thin tongue,thin pulse.Fifth,Qi-deficiency and blood-stasis syndrome,includes Chest tightness, expectoration, tired, palpitations, thirsty not for drink, poor appetite,cyanotic mouth and lip,dark tongue,intermittent pulse.Conclusion:TCM syndrome of COPD patients with frequent acute exacerbations phenotype is deficiency in origin, phlegm and blood stasis will also affect the disease,which is mainly in the lung, spleen, kidney. Qi deficiency of lung and spleen,Qi deficiency of lung and kidney, deficiency of both Qi and Yin, Qi deficiency of lung,kidney and Qi-deficiency and blood-stasis syndrome may be their main TCM syndrome.