| Objective:By utilizing modern mathematical statistics methods,combining with the GOLD classification and taking TCM syndrome factors as the breakthrough point,explore the distribution characteristics of TCM Syndrome factors of AECOPD complicated with microecological imbalance of intestinal flora,and rediscover the pathogenetic essence of AECOPD complicated with microecological imbalance of intestinal flora.In the meanwhile,probe the correlation between microecological imbalance of intestinal flora and the acute attack frequency of COPD,which will provide a new idea for using the theory of"treating the lung from the intestine " to prevent and treat AECOPD combined with microecological imbalance of intestinal flora.Method:Through the prospective study method,the clinical information(including demographic data,the four diagnostic information,the differentiation of symptoms by experience,lung function classification,physical and chemical examination results,etc.)of the AECOPD patients in Dongzhimen hospital from January 2019 to January 2020 was investigated by means of questionnaire.According to whether merges the microecological imbalance of intestinal flora or not,it was divided into the observed group and the control group,Then,establish the clinical information database,use the software of Excel and SPSS22.0 to sort and summarize the clinical information and make statistical analysis,standardize the TCM syndromes,and extract the factors of TCM syndromes,to sum up the distribution characteristics of TCM syndromes factors of AECOPD complicated with microecological imbalance of intestinal flora in different pulmonary function grades and different comprehensive evaluation grades.Besides,explore the relationship between the microecological imbalance of intestinal flora and the frequency of acute exacerbation of COPD.Results:1.By comparing the demographic data(sex,age,BMI),course of disease,season of disease,exposure to risk factors,smoking index,other lung diseases,laboratory indexes(blood routine,liver and kidney function,blood coagulation,IL-6),specific examination(pulmonary function,pulmonary function classification,mMRC,CAT score,frequency of acute exacerbation,comprehensive evaluation),there was no statistically significant difference between the two groups,indicating that the two groups had the same baseline and were comparable.It is worth being noticed that SPO2 was significantly lower in the observed group than in the control group between the two groups of arterial blood gas analysis.However,comparing the PaO2 of the two groups,P=0.068,which is close to 0.05,and the observed group has a potential trend lower than the control group.2.Through collating the information of the four diagnostic information and TCM syndromes in the two groups,it was found that the two groups were mainly cough,expectoration and asthma,and the symptoms of the whole body and tongue and pulse were roughly the same,but the stool in the observed group was more dry and blocked,and that in the control group was more normal.Moreover,there were many types of TCM syndromes in the two groups.but they were mainly composed of deficiency and excess.After reducing the dimension,the two groups were mainly composed of phlegm-heat obstructing lung,lung-qi deficiency,spleen-qi deficiency,kidney-qi deficiency,and blood stasis.In addition,the proportion of positive syndrome(phlegm-heat obstructing lung)gradually decreased in both groups,and the proportion of deficiency syndrome(deficiency of lung-qi,deficiency of spleen-qi,deficiency of kidney-qi)and combined syndrome(blood stasis)gradually increased,whether in accordance with grade I to grade IV of lung function or in accordance with group B to group D of comprehensive evaluation.But the rule in the observed group was more obvious,indicating that the patients in the observed group were more seriously ill than the control group.The microecological imbalance of the intestinal flora may further lead to the exacerbation of AECOPD.3.Combined with the classification of GOLD,a statistical analysis of the two groups of TCM syndrome factors revealed that the emphysematic factors of the two groups were mainly lung,spleen,and kidney,and the lungs accounted for 100%,involving heart,liver and large intestine,etc.The pathogenic factors are mainly phlegm,qi deficiency,heat(fire),and it can also see blood stasis,yin deficiency,etc.However,the degree of qi deficiency,blood stasis and yin deficiency in the observed group was higher than that in the control group.That is,the condition of the observed group was heavier than that of the control group.In other words,microecological imbalance of intestinal flora is most likely the cause of the aggravation of AECOPD patients.4.According to the classification of pulmonary function,the distribution of the emphysematic factors is as follows:In the observed group,lung and spleen were the main factors in grade ?,lung and kidney were the main factors in grade ?,lung,kidney and spleen were the main factors in grade ?,and the heart can also be seen in grade ?,and the proportion of the kidney in grade ? to ? gradually increased,and all levels have the disease location "large intestine".That is,lung function ? is most related to the lung and Spleen,?and IV is most related to the lung and kidney,just reflects the disease development process from lung to spleen,and then to kidney.In the control group:grade ??grade ? are mainly lung,spleen and kidney.Grade ? appears the location large intestine,while grade ? and grade ? can also see location heart,liver and surface.The distribution of pathogenic factors is as follows:In grade ? and ?,phlegm and qi deficiency were the main factors in the observed group,while phlegm and heat(fire)were the main factors in the control group.Though in grade ?,qi deficiency and phlegm were the main factors in two groups,but the degree of qi deficiency and phlegm in the observed group was higher than that in the control group.5.According to the comprehensive evaluation classification,the distribution of emphysematic factors is as follows:from group B?group D,the two groups are mainly lung,spleen,kidney,and also see heart,liver,large intestine and so on.However,the proportion of kidney in group D in the observed group was greater than that in group B,while the proportion of kidney in the control group was smaller than that in group B,highlighting the role of kidney in the development of the disease in the observed group.The distribution of pathogenic factors is as follows:from group B?group D,both groups are mainly phlegm,qi deficiency,heat(fire),blood stasis,and yin deficiency.Except for heat(fire),the proportion of disease-causing factors in group D is greater than group B,especially Blood stasis;compared with group B,the degree of qi deficiency in the control group was significantly reduced,and the degree of yin deficiency was significantly increased.Conclusion:1.Patients of AECOPD combined with microecological imbalance of intestinal flora are mainly elderly people,more men than women,longer disease course,higher lung function grade and comprehensive evaluation grade,which may be related to the body's natural aging and the excessive exposure to harmful substances.It often occurs in summer and winter,especially in summer;and more than half of people have a history of smoking.The average smoking index suggests that it is severe.In the laboratory examination,the SpO2 comparison between the two groups is statistically different,and the observed group was lower than the control group;and the PaO2 of the observed group has a potential trend lower than that of the control group.So the SpO2 can be used as an inspection indicator of the microecological imbalance of intestinal flora in AECOPD,and the PaO2 can be referenced as its potential inspection index.Furthermore,there was no obvious correlation between the imbalance of intestinal microflora during the acute exacerbation of COPD and the frequency of acute exacerbation of COPD.2.There are many kinds of TCM syndromes in AECOPD patients complicated with microecological imbalance of intestinal flora.Through the way of reducing dimension,it is found that the single syndrome type is mainly phlegm-heat obstructing lung,lung-qi deficiency,spleen-qi deficiency and kidney-qi deficiency,with blood stasis.In addition,whether it is grade ?? ? of pulmonary function or group B? D of comprehensive evaluation,the proportion of positive syndrome is gradually decreased,while the proportion of deficiency syndrome and combined syndrome are gradually increased.3.In AECOPD complicated with microecological imbalance of intestinal flora,the main emphysematic factors are lung,spleen and kidney.With the decline of lung function,grade II is most related to lung and spleen,and grade ? and ? are most related to lung and kidney.In comprehensive evaluation,the emphysematic factors of group B and group D are mainly lung,kidney and spleen,and highlight the role of the kidney,reflecting the development of the disease from lung to spleen,and then to kidney.4.The pathogenic factors of AECOPD complicated with microecological imbalance of intestinal flora were mainly Phlegm,qi deficiency,heat(fire),and blood stasis and yin deficiency can also be seen.From grade II to grade IV of the pulmonary function,blood stasis runs through all the time.Phlegm,qi deficiency and heat(frre)always occupy the main position,and the proponion of yin deficdiency also increases gradually.In the comprehensive evaluation,the main pathogenic factors in group B and D were phlegm,qi deficiency,heat(fire),blood stasis and yin deficiency,highlighting the role of blood stasis.5.The main pathogenic feature of AECOPD combined with microbiological imbalance of intestinal flora is deficiency in origin and excess in superficiality.Deficiency in origin is the deficiency of lung,spleen and kidney;excess in superficiality is the phlegm and blood stasis.Deficiency of of lung,spleen and kidney qi is the basic pathogenesis,and deficiency,phlegm and stasis are the key links in the occurrence and development of the disease. |
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