| Objective: This project intends to collect the voice information of patients with pulmonary nodules in clinical practice,analyze the voice characteristics of patients with pulmonary nodules,and explore the correlation between the voice characteristics of patients with pulmonary nodules and TCM syndromes.Patients with pulmonary nodules were followed up,focusing on the distribution of syndrome types and imaging changes.In order to provide an objective basis with TCM characteristics for the acoustic diagnosis of patients with different syndromes of pulmonary nodules.Methods:(1)based on the early stage of the research development of the "PN inquiring information collection table",combined with the literature to analyze the risk factors in patients with pulmonary nodules and summarizing,perfecting and establishing "lung nodules inquiring information collection table",including basic information,special emphasis on the scale,general physician visits,living habits,the lingual pulse condition,physical and chemical indicators,etc.(2)the "pulmonary nodules information acquisition form" was used to collect the information of pulmonary nodules patients,and the smarttcm-1 Chinese medicine life information analysis system was used to collect the voice information of patients with pulmonary nodules.Visits according to the symptoms of "no/yes" the assignment for "0/1," the voice signal by analyzing Praat6.0.34 fundamental pitch,intensity,formant,harmonic to noise ratio,Jitter and Shimmer.At the same time,according to the early stage of the group and east China university of science and technology institute of electrical and mechanical combination of the wavelet packet analysis method,analysis of patients with pulmonary nodules voice frequency wavelet packet energy entropy and shannon entropy.(3)frequency analysis was used to analyze the distribution characteristics of different syndromes,risk factors,living habits and comorbidities of patients with pulmonary nodules.The rank sum test was used to analyze the differences in speech features between patients with pulmonary nodules and those with asthma in remission stage and normal patients,and to analyze the differences in speech features among patients with pulmonary nodules in different syndromes,risk factors,exercise habits and comordities.Canonical correlation was used to analyze the correlation between different dietary habits and phonetic features of pulmonary nodules.According to the prognosis of patients with pulmonary nodules,the distribution of syndrome types in patients with pulmonary nodules with different pathological changes was observed.Results:(1)Diagnosis information of patients with pulmonary nodules:(1)The diagnosis symptoms ranked in the top 10 in frequency according to the order of frequency: weakness,cough,forgetfulness,phlegm in the throat,weakness of waist and knee,chills(tied),irritability,dry mouth,chest tightness and pharyngeal pain.(2)The frequency distribution of TCM syndromes is from high to low: insufficiency of qi and blood(46.18%),phlegm and dampness accumulation syndrome(23.25%),Yin fluid deficiency syndrome(16.89%),qi stagnation syndrome(7.96%)and blood stasis syndrome(5.73%).(3)imaging findings,among 314 patients with pulmonary nodules,the ground glass nodules accounted for 41.40%;Patients with pulmonary nodules meeting the surgical criteria(8mm)accounted for 28.25%,while patients with smaller pulmonary nodules(< 5mm)accounted for 39.17%.Patients with pulmonary nodules located in the right lung accounted for 45.86%,and patients with pulmonary nodules located in the upper lobe of the lung accounted for 58.28%.Patients with solitary pulmonary nodules accounted for 55.41%.(4)Patients with a family history of cancer accounted for 17.52%,which has a family history of lung cancer patients accounted for only 5.41%;Smokers accounted for 17.20% and the majority of them were male,patients with a history of passive smoking accounted for 21.97%,and patients with a history of oil smoke exposure accounted for 45.22%.(5)Life habits,like hot drinks,sweet patients appear more frequently,and prefer preserved products patients less;There were 65 patients with long-term exercise habit,and the number of patients with exercise increased to 127 in the recent three months.41.72% of the patients were accompanied by mood disorders,and they were mainly irritable.(6)Pomorbidity frequency from more to less for thyroid nodules(35.35%),hyperlipidemia(30.89%),breast nodules(20.70%),hypertension(17.83%),diabetes(10.19%),asthma(5.73%).(2)Voice characteristics of patients with pulmonary nodules:(1)compared with normal people,patients with pulmonary nodules and asthma in remission stage showed higher voice wavelet packet energy in 0-500 hz frequency band than normal people.In the frequency range of 7250-8000 hz,patients with asthma remission stage were higher than normal people and patients with pulmonary nodules,with a significant difference(p<0.05).Wavelet packet shannon entropy within 0-1250 hz was significantly higher in patients with pulmonary nodules than in normal people(p<0.05).(2)patients with pulmonary nodules comparison between different TCM syndrome group,qi and blood deficiency syndrome fundamental frequency,the fundamental frequency is high value,low fundamental frequency are higher than phlegm dampness wenjie,Yin fluid lose money the fundamental frequency of high value,low fundamental frequency is higher than the phlegm wet wenjie,the person who first formant than phlegm stasis syndrome wet wenjie syndrome and blood stasis block,and down the second formant stasis syndrome is higher than phlegm wet wenjie,qi and blood deficiency syndrome third formant than blood stasis block,the differences were statistically significant(p<0.05).Wavelet packet energy at 0-250 hz frequency range,Yin fluid loss syndrome is higher than qi stagnation and qi blood deficiency syndrome,1250-1500 hz frequency range qi stagnation syndrome is higher than blood stasis syndrome,1000-1250 hz frequency range between each syndrome has a difference,the difference is statistically significant(p<0.05).The wavelet packet shannon entropy at 250-750 hz and 1000-1250 hz was lower than that of phlegm-dampness accumulation,with a significant difference(p<0.05).(3)Between different risk factors,ground glass nodules in 7750-8000 Hz difference appears on the wavelet packet energy,pulmonary nodule size in the third formant,2000-2500 Hz frequency difference appears on the wavelet packet energy,nodules single status in fundamental frequency,and the differences between the fundamental frequency of high value,family history of cancer in 7500-7750 Hz frequency difference appears on the wavelet packet energy,family history of lung cancer is in the fundamental frequency and base band of high value,low fundamental frequency appear on the differences of passive smoking history in 3000-3250 Hz difference appears on the wavelet packet energy,The difference in the fourth formant and the wavelet packet energy of 1000-1750 hz,2500-2750 hz and 3250-3750 hz was statistically significant(p<0.05),and there was no significant difference in the history of smoking(p>0.05).(4)exercise habits on the voice loudness,the first formant,the second formant and 750-1000 hz,1500-2500 hz,3000-8000 hz each frequency band wavelet packet energy impact,recent movement behavior affects the voice loudness and 1750-2250 hz,3250-3500 hz band wavelet packet energy,have significant differences(p<0.05);There was a pair of canonical correlation between eating habits and phonetic energy characteristics,and the correlation coefficient was 0.70.(5)Patients with pulmonary nodules were sick voice characteristics,the fundamental frequency of lung nodules with hyperlipidemia patients,high fundamental frequency value,frequency band width,frequency perturbation,harmonic noise ratio between 250-500 Hz shannon entropy wavelet significant differences(p<0.05),pulmonary nodules with thyroid nodule is the first and the second formant and 1500-3250 Hz,4000-4500 Hz,5000-5250 Hz in wavelet packet energy difference(p<0.05),patients with diabetes with phonetic features does not appear obvious difference(p>0.05).(3)Imaging examination results of 104 patients were obtained after follow-up of 314 patients with pulmonary nodules,among which 9 patients were pathologically diagnosed as lung cancer.There was no significant difference in TCM syndromes between patients with and without malignant changes(p > 0.05).Conclusion:(1)the symptoms of pulmonary nodules patients are mainly fatigue,followed by cough,which is consistent with the respiratory symptoms of pulmonary nodules,suggesting that medical staffs should pay attention to the symptoms other than respiratory system in clinical practice.TCM syndromes are mainly deficiency of qi and blood and obstruction of phlegm and dampness,with deficiency of qi and blood and phlegm and dampness as the main pathogenesis of pulmonary nodules.(2)In the speech features of patients with pulmonary nodules,acoustic parameters can more obviously reflect the differences in different syndromes,living habits and comorbidities,while wavelet packet energy characteristics can extract the frequency bands containing significant differences in disease types,TCM syndromes,risk factors,living habits and comorbidities.It is suggested that the phonetic features can provide certain basis for the screening of pulmonary sarcoidosis and the differentiation of TCM syndromes. |
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