Analysis On Clinical Characteristics And Exploration Of Dialectical Types Of Chinese Medicine In Elderly Patients With Chronic Obstructive Pulmonary Disease In Acute Exacerbation Period Complicated With Type 2diabetes Mellitus

Objective:To explore explore the clinical characteristics in elderly patients with chronicobstructive pulmonary disease in acute exacerbation period complicated with type 2diabetes mellitus,and to analyze the dialectical types of Chinese medicine in elderly patients with chronic obstructive pulmonary disease in acute exacerbation period complicated with type 2 diabetes mellitus according to the <Clinical syndrome collection form>,and clinical characteristics.Methods:386 cases of elderly patients with chronic obstructive pulmonary disease in acute exacerbation period treated in Affiliated Hospital of Gansu College of Traditional Chinese Medicine Department of pulmonary disease in elderly patients and department of Hospital of TCM Hospital of Gansu Province Department of pulmonary disease who met the inclusion and exclusion criteria at the same time were selected,and after signing informed consent the 273 cases who were coplicated with type 2 diabetes mellitus were noted as the observation group,and the other 113 cases who were not complicated with type 2 diabetes mellitus were noted as the control group.The clinical data including the factors that may affect the chronic obstructive pulmonary disease in acute exacerbation period complicated with type 2 diabetes mellitus such as gender,age,pulmonary function,arterial blood gas,serum high-sensitivity C reactive protein(hs-CRP) and Homocysteine(Hcy) levels and so on were analyzed respectively by one-way analysis of variance and multivariate Logistic regression analysis methods,in order to make sure there is a certain correlation between the pulmonary function, arterial blood gas,hs-CRP and Hcy and the blood sugar levels.Then the 273 cases in the observation group were recorded with TCM symptoms and single disease frequency and percentage statistics,to provide the basis for dialectical analysis of senile patients with acute exacerbations of chronic obstructive pulmonary disease with TCM syndrome of type 2 diabetes mellitus type.Results:1.The differences in the factors such as age more than or eaqul to 75 years old,smoking history, drinking history,combined with hypertension,combined with hyperlipidemia, AECOPD onset frequency, BMI, course of COPD disease, the severity of AECOPD, FEV1, FEV1/FVC, PaO2, PaCO2, hs-CRP and D-D and Hcy levels difference between the two groups had statistical significance(P<0.05). The differences in the age and fever between the two groups had no statistical significance(P>0.05). The levels ofFEV1, FEV1/FVC, PaO2 in the patients with AECOPD complicated with type 2 diabetes were significantly lower than those in the patients with single AECOPD, while the levels of PaCO2, hs-CRP and D-D and Hcy levels were significantly higher than those in the patients with single AECOPD.2.The independent risk factors of AECOPD patients with type 2 diabetes mellitus according to the degree of risk from high to low order for:PaO2 less than or equal to60mmHg(OR=5.071), FEV1 / FVC less than or equal to 70 percent(OR=4.325),hs CRP more than or equal to 6mg/L(OR=4.296), Hcy more than or equal to 10 mol/L(OR=3.867),D-D more than or equal to 1.24mg/L(OR=3.645), age more than or equal to 75 years(OR=1.675),and the FEV1 more than or equal to 50%(OR=0.732) and the PaCO2 less than or equal to 55 mmHg(OR = 0.756) were the proctive factors for AECOPD with type 2diabetes.3.The FPG and postprandial 2h plasma glucose levles in the observation group were significantly higher than those in control group.The differences between the two groups had statistical significance, and it was suggested that the levels of LPG and postprandial 2h plasma glucose in the patients with AECOPD complicated with type 2 diabetes were significantly higher than those in the patients with single type 2 diabetes.The FPG and postprandial 2H blood glucose levels of average had a certain positive correlation with the FEV1/FVC, PaCO2, hs CRP and D-Dimer(D-D) and Hcy levels,and the FEV1, PaO2 levels were negative relevance with the blood glucose levels, and it was suggested that the occurrence of type 2 diabetes had a certain with AECOPD.4.The Tanreyufei, Feishenqixu, Tanzhuoyongfei syndromes were more common in pat ients with AECOPD, accounting for 53.10%,20.34% and 14.16% respectively, and the Yan gxushuifan and Tanmengshenqiao syndromes were relatively rare, accounting for 10.62%and 1.77% respectively.5.The Tanreyufei,Yinxuresheng syndrome,Feishenqixu, Xueyushuiting syndrome, Tan zhuoyongfei, Shirekunpi syndrome were more common in patients with AECOPD complic ated with type 2 diabetes, accounting for 51.65%, 17.58% and 15.38% respectively.Conclusion:1.The levels of FEV1, FEV1/FVC, PaO2 in the patients with AECOPD complicated with type 2 diabetes are significantly lower than those inthe patients with single AECOPD, while the levels of PaCO2, hs-CRP and D-D and Hcy levels aresignificantly higher than those in the patients with single AECOPD.2.The levels of FPG and postprandial 2h plasma glucose levles are positively relate d to FEV1/FVC, PaCO2, hs CRP, D-D and Hcy levels, which are negatively related to FE V1, PaO2 levels FPG and postprandial 2h plasma glucose in patients with AECOPD co mplicated with type 2 diabetes.3.In patients with AECOPD complicated with type 2 diabetes, the Tanreyufei, Yinxur esheng syndrome,Feishenqixu, Xueyushuiting syndrome, Tanzhuoyongfei, Shirekunpi syn drome are more common, and the rates are respectively 51.65%,17.58% and 15.38%, who can be treated by different types of differentiation in clinic.