Study On The Relationship Between The Limitation Of Airflow And TCM Syndromes And Clinical Features In Patients With Stable Stage Of Bronchiectasis

1.Research backgroundBronchiectasis is a chronic lung disease characterized by dilatation of airways,with injury to the bronchial walls due to recurrent infection and inflammation.When the range of lesions is wide,it can seriously affect the pulmonary function of patients and cause respiratory dysfunction.Bronchiectasis is a common airflow limitation disease besides chronic obstructive pulmonary disease and asthma,and pulmonary function examination in 33%of bronchiectasis patients showed severe airflow limitation.At present,there are few studies on the limitation of airflow in patients with bronchiectasis,but most scholars believe that the limitation of airflow in patients with bronchiectasis can be regarded as one of the signs of severity of the disease.The related research indicated that the patient’s airflow limitation had a long duration,frequent hospitalization,wide range of chest CT lesions,high detection rate of Pseudomonas aeruginosa and poor quality of life.However,there is no clear basis and uniform standard for the evaluation of the severity of bronchiectasis with airflow limitation in the world.Traditional Chinese medicine has a unique advantage in alleviating the symptoms and improving the quality of life in patients with bronchiectasis at stable stage,but it has not been reported on the development of bronchiectasis with the decrease of pulmonary function and the evolution of TCM syndromes.In this study,through collecting the data of patients with bronchiectasis,classification of pulmonary function in patients with stable bronchiectasis,pulmonary function and correlation of the severity of airflow limitation and body mass index,course of disease,acute exacerbation,immune function and inflammatory index,chest CT score,sputum culture,TCM syndrome type,quality of life,comprehensive the clinical characteristics of TCM syndrome and in-depth understanding of airflow limitation in patients with bronchiectasis complicated with evolution,in order to improve the level of understanding and diagnosis of bronchiectasis.2.Clinical research2.1 PurposeThrough cross-sectional investigation of patients with stable bronchiectasis,the correlation of pulmonary function impairment,airflow restriction,disease development and TCM syndrome type evolution was analyzed.2.2 MethodThis study uses the cross-sectional survey method.Included in the study were from August 2017 to March 2018 to visit the China Academy of Chinese Medicine Xiyuan Hospital Respiratory Department outpatient Service,a total of 150 cases of extension of stable patients,as 8 cases were removed without pulmonary function examination,and finally included 142 patients.According to the results of the patient’s lung function test,the relationship between pulmonary function and the duration of patients,acute exacerbation,body mass index(BMI),immune function,inflammatory index,Lung CT score,sputum culture and quality of life was analyzed with FEV1 as percentage of estimated value(FEV1%).Statistical methods:This study applied SPSS20.0 for statistical analysis.For continuous variables,the mean±standard deviation(x±s)is used to denote that the classification data is expressed as a percentage.The measurement data accords with the normal distribution,the analysis of variance and the Kruska-wallisih test are applied to the comparison between groups,and the comparison between the counting data groups is by the card-square test.Spearman correlation analysis was used to analyze the correlation of grade data.The difference of P-value<0.05 was statistically significant.2.3 Result2.3.1 Analysis of general data of patients with stable period of Patients with bronchiectasisIn 142 cases,100 cases were female,42 in males,men and women were 0.42:1,the youngest was 20 years,the largest was 83,and the average age was 58.69± 13.02 years.The average value of pulmonary function FEV1%(62.54 ± 23.33)was%,FEVl/FVC(68.61 ± 14.70).The results of pulmonary function grading were as follows:in 50%FEV1%<80%65 patients(accounted for 45.77%),FEV1%≥80%patients 35 cases(accounted for 24.65%),30%≤FEV1%<50%26 cases(accounting for 18.31%),FEV1%<30%16 cases(accounting for 11.27%).2.3.2 A survey of body mass index in patients with stable period of bronchiectasisThe patient’s BMI was analyzed by data analysis,in which 51 people with low body weight(35.91%),65 people with normal weight(45.77%),overweight 20(14.08%)and obese 6(4.23%).There is a negative correlation between pulmonary function grading and BMI value,that is,the heavier the pulmonary function,the lower the BM1 value.2.3.3 Investigation on correlation between airflow limitation,duration of disease and acute exacerbation in patients with stable period of bronchiectasisThe duration of course and the number of acute exacerbation in 1 years were analyzed by data,and there was no difference between different lung function grading groups.In 1 years,there were differences in the number of acute exacerbation in different lung function grading groups,and the two were positive correlation:the worse the lung function,the more frequent the acute exacerbation.2.3.4 Correlation between airflow limitation and chest CT score,positive detection rate of sputum culture,inflammatory index and SGRQ score in patients with stable period of bronchiectasisAccording to the data analysis,there were statistically differences in chest CT score,positive detection rate of Pseudomonas aeruginosa,C-reactive protein,prealbumin and SGRQ score among different pulmonary function grades,and the severity of airflow limitation in patients with bronchiectasis is related to these aspects.That is,the more severe the air flow,the more likely the patient repeated acute exacerbation,the more significant changes in the chest structure,the higher the detection rate of Pseudomonas aeruginosa,the higher the level of inflammation(CRP elevation,the lower the Prealbumin),the poorer the quality of life of patients.2.3.5 Correlation analysis of airflow limitation and immunoglobulin in patients with stable period of bronchiectasisThe analysis of immunoglobulin data shows that there is a statistical difference between IgA,IgE,IgG and pulmonary function,but there is a correlation between IgG and pulmonary function grading,that is,the worse the lung function,the lower the IgG.2.3.6 Correlation analysis between severity of pulmonary function and TCM syndromes in patients with stable period of bronchiectasisSyndrome and tongue veins of TCM syndromes show that the syndrome type of TCM syndromes is the most mixed,with 80 cases(accounting for 57.75%)and positive patients in 62 cases(accounting for 42.25%).23 cases of phlegm-Heat Yun Lung syndrome(accounted for 16.20%),7 cases of lung and stomach heat sheng syndrome(4.93%),32 cases(accounting for 22.54%),lung and spleen deficiency,phlegm-heat syndrome in 47 cases(33.10%),lung and kidney deficiency,phlegm-Heat Yun Lung syndrome 33 cases(accounting for 23.24%).In patients with stable period,the number of mixed syndromes was the most,with the patients with impaired lung function,the deficiency of lung and spleen,phlegm heat,lung syndrome and lung and kidney deficiency syndrome were found.3.Conclusion3,1 The bronchiectasis patients were found in elderly-women,of whom the average pulmonary function FEV1%(62.54±23.33)%,FEV1/FVC averaged(68.61 ± 14.70)%in patients with stable period,FEV1%in the 50%-80%,followed by FEV1%)80%,30%-50%,FEV1%<30%.3.2 The severity of lung dysfunction in patients with stable period was statistically different from those of body mass index,acute exacerbation,chest CT score,extension severity index and St.George respiration questionnaire.The results are as follows:①The more severe the air flow limitation,the lower the BMI value;② The more severe the air flow limitation,the more frequent the acute aggravation;③The more severe the air flow limitation,the more the chest CT lesion affects the lung lobe and the higher the Reiff score;④The more severe the airflow limitation,the higher the positive detection rate of Pseudomonas aeruginosa in sputum culture;⑤The more severe the air flow limitation,the higher the level of inflammation;⑥The more severe the air flow limitation,the worse the quality of life.3.3 With the increase of the severity of airflow limitation,the patients with stable period of extension syndrome decrease,and the number of mixed syndromes becomes more and more,the two deficiency of lung and spleen,phlegm Heat Yun Lung syndrome patients,accounted for 33.10%,but with the patients with impaired lung function,lung and kidney deficiency syndrome,lung and spleen two deficiency syndrome see more.