| ObjectiveTo explore the distribution characteristics and regularity of TCM clinical syndromes in 168 patients with pulmonary nodules,to study in depth the age,gender,occupation,smoking history,course of disease,chronic lung disease history,family tumor History,lung nodule size,lung nodule type,whether there is a difference in the distribution of lung nodule clinical syndromes,establish a database of traditional Chinese medicine syndromes of lung nodules,provide an objective for clinical treatment of lung nodules The basis of syndrome differentiation,with a view to enlighten the clinical syndrome differentiation and treatment,legislative medication,disease prevention and treatment.MethodsThrough the method of cross-sectional analysis and research,168 patients who met the respiratory department of Dongzhimen Hospitall of Beijing University of Traditional Chinese Medicine and the respiratory clinic and physical examination center of the International Department from January 2019 to January 2020 were screened.Doctors cooperate to complete the collection of TCM syndromes and the information of the four clinics,and summarize the collected clinical data into a TCM database;use system clustering to cluster analysis of the syndromes of lung nodules and summarize the basic syndromes Then,chi-square test,PearsonX2 test,non-parametric test,comparison between groups and other test methods were used to analyze the regular relationship between disease-related factors and the distribution of TCM syndromes.Results1.Among the 168 patients,22 questionnaires that did not meet the criteria for inclusion and incomplete data were excluded,and the remaining 146 valid cases,including 64 male patients and 82 female patients;the minimum age of onset was 27 years old and 71-85 years old Of patients accounted for the most(47.95%);mental workers accounted for 60.96%,manual workers totaled 57(39.04%);a total of 64 patients had no history of smoking,and the most patients with smoking history of 10 to 50 years,36.99%;the course of pulmonary nodules varies from 1 to 10 years,and the number of patients with a course of less than 1 year is close to more than half(44.52%);76 patients are accompanied by a history of chronic lung disease,including chronic bronchitis and bronchiectasis Syndrome,chronic obstructive pulmonary disease(stable period),bronchial asthma(remission period),interstitial pneumonia,tuberculosis,of which 27.63%of patients had chronic bronchitis;46 patients out of 146 patients The family has carried a history of cancer,and the family has a history of 31 patients with lung cancer,accounting for 21.23%;in the history of statistics,the previous history of hypertension,coronary heart disease,diabetes,hyperlipidemia The proportion of patients is the most,and the proportion overlaps more than nearly 80%;there are 46 patients with isolated pulmonary nodules,accounting for 31.51%,and more than half of patients with multiple pulmonary nodules(68.49%);according to pulmonary nodules From the perspective of nodule size classification,the majority of patients with small pulmonary nodules with diameters of 5 to 8 mm accounted for 49.32%.From the perspective of the type of pulmonary nodules,it can be seen that the number of cases of pure ground glass pulmonary nodules accounts for 48.63%of the total sample size.2.In this study,a total of 83 syndrome items with significance of dialectical analysis were included in the scale for descriptive statistics.The frequency of representative syndrome items with a frequency of more than 20%was:sputum mucus(73.97%),fatigue(weakness)55.48%),white sputum(52.74%),low sputum production(49.32%),wheezing after activity(49.32%),yellow complexion(41.10%),pale lips(40.41%),chest tightness(35.62%),Insomnia(34.93%),easy sputum production(34.25%),mild coughing(33.56%),difficult sputum production(32.88%),tingling in the flank(29.45%),decreased appetite(28.77%),shortness of breath(28.08%),high sputum production(27.40%),yellow sputum(26.03%),spontaneous sweating(26.03%),dizziness(20.55%),bitter mouth(20.55%),greasy moss(78.08%),Yellow fur(58.90%),pale tongue(45.21%),red tongue(43.15%),pulse string(53.42%),pulse slip(46.58%),pulse astringency(45.89%),pulse fineness(38.36%).3.The systematic clustering method was used to statistically analyze the symptoms of traditional Chinese medicine.The six basic syndrome types of pulmonary nodules in clinic are:Qi deficiency syndrome,Yin deficiency syndrome,blood deficiency syndrome,Qi stagnation syndrome,phlegm syndrome 1.Blood stasis syndrome;refer to the basis of TCM syndrome differentiation,based on data analysis and expert guidance,combined with the basic pathogenesis of pulmonary nodules,take phlegm-dampness syndrome and blood stasis syndrome as the basic syndrome in the compound syndrome,and then The four syndrome types were counted and counted,and the clinical syndrome types of 146 patients were:Qi deficiency phlegm and blood stasis syndrome(34.93%),Yin deficiency phlegm and blood stasis syndrome(29.45%),Qi stagnation phlegm and blood stasis syndrome(19.18%)and Blood deficiency phlegm and blood stasis syndrome(16.44%).4.The clinical TCM syndrome types of lung nodules were not statistically different in age(P=0.457),occupation(P=0.149),and family tumor history(P=0.121)(P value>0.05).5.Pulmonary nodules TCM syndrome type and gender(P=0,001),smoking history(P=0.042),course of disease(P=0.009),history of chronic lung disease(P=0.033),lung nodule size(P=0.038).The types of lung nodules(P=0.016)are correlated and have a certain distribution rule(P values are all<0.05).6.The course of disease is related to the clinical syndrome type of pulmonary nodules(X2=2.382,P=0.042,P<0.05).Treating the medical history as one-way ordered data,and then using the Mann-Whitney U method to compare between groups,with the extension of the course of disease,the proportion of qi deficiency phlegm and yin deficiency phlegm and blood stasis type gradually increased,and compared with other There are obvious statistical differences between the two syndromes;further explore the relationship between disease progression and pulmonary nodularity,consider the disease progression as an ordered variable,and compare the group with the false and empirical syndrome(P=0.001).As the course of disease increases,the proportion of pulmonary nodules distributed in the empirical evidence gradually increases.7.There is a correlation between the type of lung nodule and the TCM syndrome type(X2=5.797,P=0.016,P<0.05).The Man-Whitney U method was used to compare the different syndrome types.The results showed:Patients with solid pulmonary nodules are mainly qi stagnation and phlegm stasis type(45.45%),pGGN patients are mainly qi deficiency phlegm stasis type(43.66%),and the main syndrome type of mGGN patients with the highest malignant risk is yin deficiency phlegm stasis type(50.00%).Conclusion1.The research data shows that the clinical syndromes of traditional Chinese medicine for pulmonary nodules can be summarized into six basic syndromes:Qi deficiency syndrome,Yin deficiency syndrome,blood deficiency syndrome,Qi stagnation syndrome,phlegm dampness syndrome,blood stasis syndrome.The basic pathogenesis of the sham and nodule is false and true,so the phlegm-dampness syndrome and the blood stasis syndrome are only used as the basic syndrome type;the patients' TCM syndromes are counted and finally summarized into four compound syndrome types:Qi deficiency Phlegm and blood stasis syndrome>Yin deficiency,phlegm and blood stasis syndrome>Qi stagnation and phlegm and blood stasis syndrome>Blood deficiency and phlegm and blood stasis syndrome.2.Among all the factors that affect the progression of pulmonary nodules,the correlation between gender,disease course,smoking history,family tumor history,lung disease history and syndrome distribution is statistically significant,and there are certain rules in syndrome distribution.With the gradual extension of the course of the disease and smoking history,the symptom manifestation changed from virtual and physical inclusions to empirical evidence,suggesting that the disease gradually progressed,which required the attention of clinicians and timely follow-up diagnosis and treatment strategies for patients.3.The size and type of lung nodules also have a certain pattern in the pattern distribution.With the gradual increase of the diameter of the lung nodules,the proportion of yin deficiency and phlegm and blood stasis type gradually increased.It can be seen that chronic disease consumes gas and hurts the yin,which is extremely detrimental to the lungs;the types and syndrome types of lung nodules The regularity shows:solid lung nodules are mainly qi stagnation and phlegm stasis,pGGN is mainly qi deficiency phlegm stasis,mGGN main syndrome is yin deficiency phlegm stasis type,which can be seen,in addition to grasping the basics of lung nodules In addition to the syndrome type and pathogenesis,the judgment of combined syndrome is also conducive to the accurate diagnosis and treatment of pulmonary nodules in clinic. |
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