Correlation Analysis Of TCM Syndromes Of COPD Combined With PH And Clinical Observation Of Jiedu Quyu Decoction

1.BackgroundChronic obstructive pulmonary disease(COPD)is a common and frequently-occurring disease of the respiratory system.The prevalence and mortality rate increase year by year,which not only seriously affects the quality of life and life expectancy of patients,but also imposes a huge burden on families and society.With the deepening of research,it is not only limited to simple COPD,but also related research on COPD comorbidity diseases.It can not only produce diseases such as spontaneous pneumothorax and chronic respiratory failure,but also other diseases.Systemic comorbidity,as a typical representative of chronic pulmonary heart disease in the circulatory system,and pulmonary hypertension(PH)is an inevitable part of COPD progression to chronic pulmonary heart disease.When COPD develops PH Chronic pulmonary heart disease is likely to occur as a typical circulatory complication,and often suggests a poor prognosis,so the prevention and treatment of COPD combined with PH is urgent.2.Clinical research2.1 Objective2.1.1 Through the clinical investigation of TCM syndromes of COPD patients with PH,the distribution of syndromes was analyzed,and the correlation between each syndrome type and clinical detection indicators was discussed.2.1.2 Verifying the efficacy of Jie Du Qu Yu decoction in improving the activity endurance of COPD patients with PH.2.2 Methods2.2.1 The subjects were from July 2017 to March 2019.The ward and outpatient clinic of Xiyuan Hospital of China Academy of Chinese Medical Sciences met the diagnosis of COPD combined with PH.A total of 160 cases were collected,of which 7 cases were excluded due to incomplete data.In 153 cases,through the collection of the four diagnostic data of the enrolled patients,the TCM syndrome classification was carried out and the main inspection index database was established to analyze the different TCM syndromes in pulmonary systolic blood pressure,blood gas index,lung function,blood routine,biochemistry,NT-proBNP.Differences in coagulation indicators,etc.2.2.2 Patients who met the diagnosis of COPD combined with PH and TCM syndrome differentiation were classified as treatment group and control group.The treatment group was given oral detoxification granules on the basis of conventional western medicine treatment,once a day,twice.The rats in the control group were given conventional treatment with Western medicine for 30 vdays.Observe and compare the differences between the two groups in the 6-minute walking distance(6MWD),the BORG dyspnea grading index,the pulmonary hypertension functional grading,the quality of life assessment test(CAT),the dyspnea scale(mMRC),and the TCM symptom scores.And record whether there is any adverse reaction.2.3 Results2.3.1 Correlation between TCM Syndromes in COPD Patients with PH2.3.1.1 Distribution of TCM Syndromes in COPD Patients with PHThrough the TCM dialectical classification of the patients enrolled,the most common symptoms of drug phlegm syndrome(68 cases,accounting for 44.4%),followed by lung and kidney deficiency syndrome(31 cases,accounting for 20.2%)>phlegm-heat syndrome(24 cases,accounting for 15.7%)>qi deficiency and blood stasis syndrome(14 cases,accounting for 9.2%)>phlegm and stasis syndrome(11 cases,accounting for 7.2%)>lung and spleen deficiency syndrome(5 cases,accounting for 3.3%).2.3.1.2 Gender distribution of COPD patients with PH in each syndrome typeAmong the enrolled patients,91 were males,accounting for 59.5%,and 62 females,accounting for 40.5%.The gender composition ratio of each syndrome type was in turn;44 males in the drug abuse syndrome,accounting for 64.7%,24 females,accounting for 35.3%;13 males in the syndrome of phlegm and heat,accounting for 54.2%,and 11 females,accounting for 45.8%5 males in the obstructive pulmonary syndrome,accounting for 45.5%,6 females,accounting for 54.5%;8 males with qi deficiency and blood stasis syndrome,accounting for 57.2%,and 6 females,accounting for 42.8%;lung and kidney Among the two syndromes,18 were males,accounting for 58.0%,and 13 were females,accounting for 42%.Among the syndromes of lung and spleen deficiency,4 were males,accounting for 80%,and 1 females,accounting for 20%.By comparison between groups,P=0.490>0.05,indicating that there was no statistical difference in gender composition ratio among the six syndrome types.2.3.1.3 Age distribution of COPD patients with PH in each syndromeThe youngest patients were 49 years old,the largest was 85 years old,and the average age was(75.13±8.30)years old.The average age of males was(74.60±8.71)years old,and the average age of females was(75.90±7.68)years old.By comparison between groups,P=0.168>0.05,indicating that there were no statistical differences in age between the six syndrome types.2.3.1.4 Correlation analysis of pulmonary systolic pressure in patients with COPD combined with PH syndromeThe minimum pulmonary artery pressure in the enrolled patients was 40 mmHg,the maximum was 115 mmHg,and the average was(51.35±12.65)mmHg.The systolic blood pressure distribution of each syndrome was as follows:57 cases of mild poison syndrome,10 cases of moderate,1 case of severe;18 cases of mild heat and lung syndrome,6 cases of moderate,and 0 cases of severe;Mild in 9 cases,moderate in 1 case,severe in 1 case;qi deficiency and blood stasis syndrome was mild in 11 cases,moderate in 3 cases,severe in 0 cases;lung and kidney deficiency syndrome was mild in 26 cases,moderate in 5 cases,severe in 0 cases The lung and spleen deficiency syndrome was mild in 4 cases,moderate in 1 case,and severe in 0 cases.Analysis of variance showed that the six syndromes had pulmonary artery pressure,P=0.149>0.05,indicating that there were no statistical differences in pulmonary artery pressure between the six syndrome types.2.3.1.5 Correlation analysis of lung function and blood gas index in patients with COPD combined with PHThe mean FEV1%of lung function index was(48.76±16.92)%,the average value of FEV1/FVC was(56.87±10.31)%,the mean value of blood gas analysis was(7.385±0.077),and the average value of PC02 was(45.44±).15.54)mmHg,the average value of P02 is(76.71 ± 23.04)mmHg.Analysis of variance showed that the six syndrome types had P>0.05 in lung function index and blood gas analysis,indicating that there were no statistical differences in lung function and blood gas index among the six syndrome types.2.3.1.6 Analysis of blood routine correlation of various syndromes of COPD combined with PH patientsThe mean WBC in the blood routine indicators of the enrolled patients was(7.05±3.17)*10^9/L,the average RBC was(4.17±0.79)*10^12/L,and the average HGB was(126.98±23.92)g/The average value of L and HCT was(0.377±0.073)L/L,and the average value of PDW was(12,14±2.90)fl.According to the analysis of variance,6 kinds of TCM syndromes in WBC,P=0.000<0.05,statistically significant,indicating that there are significant differences in WBC among the six syndrome types;P>,HGB,HCT,PDW are all P>0.05,indicating that there are no differences in the six syndrome types in terms of RBC,HGB,HCT,and PDW.2.3.1.7 Correlation analysis of biochemistry,NT-proBNP and coagulation in patients with COPD combined with PHThe mean value of ALB in the enrolled patients was(36.16±7.04)g/L,the average value of Hs-CRP was(32.94±50.13)mg/L,and the average value of NT-proBNP was(2137.25±3537.87)pg/ml,D-The average value of Di was(2.27±7.79)mg/L,and the average value of Fbg was(3.62±1.41)g/L.After analysis of variance,it was found that the six TCM syndromes were P<0.05 in Hs-CRP and Fbg,indicating that there were differences in Hs-CRP and Fbg among the six syndromes;in terms of ALB,NT-proBNP and D-Di All P>0.05,indicating that there are no differences in the six syndrome types in ALB,NT-proBNP and D-Di.2.3.2 Clinical observation of Jie Du Qu Yu decoction in the treatment of COPD combined with PH2.3.2.1 Analysis of general data of treatment group and control group After statistical analysis,there was no significant difference in age,gender,duration of disease,smoking status,blood pressure,etc.between the two groups(P>0.05),indicating that the two groups were comparable.2.3.2.2 analysis of pre-treatment indicators in the treatment group and the control groupAfter statistical analysis,there were no significant differences between the two groups in pulmonary systolic pressure,pulmonary function index,blood gas index,WHO pulmonary hypertension function grading,dyspnea mMRC rating,Borg index,6MWD,CAT score,and TCM syndrome score.(P>0.05),indicating that the two groups are comparable.2.3.2.3 Analysis of post-treatment indicators of treatment group and control groupAfter statistical analysis,the treatment group was significantly improved in terms of 6MWD,BORG dyspnea grading index,CAT score,TCM symptom scores,etc.(P<0.01),and in 6MWD,BORG dyspnea grading index,TCM symptom scores,etc.Compared with the control group(P<0.05),there was no improvement in the classification of WHO pulmonary hypertension function before treatment(P>0.05).In the mMRC group,the treatment group improved before treatment(P<0.05),and the control group did not improve.(P>0.05);there were no obvious abnormal changes in hematuria,liver and kidney function,and electrocardiogram after treatment.3.Conclusion3.1 In the study of COPD and PH patients with syndromes,the most common types of poisonous phlegm syndrome were as follows:lung and kidney deficiency syndrome,phlegm heat and lung,qi deficiency and blood stasis syndrome,phlegm and blood stasis syndrome,and lung and spleen deficiency syndrome.3.2 The levels of WBC and Hs-CRP in patients with COPD combined with PH and phlegm and heat syndrome were relatively higher.The levels of Fbg in drug phlegm and phlegm syndrome were relatively higher,which may be related to acute attacks and hemodynamic changes.3.3 Compared with traditional western medicine,Jie Du Qu Yu decoction can effectively improve clinical symptoms,increase activity endurance,improve quality of life,and has no obvious adverse reactions,and has good clinical efficacy.