The Study Of Traditional Chinese Medicine Excessive Pattern From Chronic Obstructive Pulmonary Disease With Acute Exacerbation Of Chronic Pulmonary Heart Disease Based On GOLD2017

Objective:To explore the relationship between TCM empirical excessive patterns and clinical manifestation of COPD with acute exacerbation of CPHD in high altitude areas based on the comprehensive evaluation of ABCD grouping based on GOLD2017 report.Method:The datas of 482 inpatients with COPD complicated with acute exacerbation of CPHD in the Department of Pulmonary Diseases of Qinghai Hospital of Traditional Chinese Medicine from December 2016 to November 2017 and from October 2020 to September 2021 were collected for TCM pattern differentiation and ABCD grouping based on GOLD2017.Dichotomous Logistic regression was used to analyze the correlation between each excessive pattern and clinical manifestation and all laboratory indicators collected.Results:There were positively correlated between phlegm obstructing lung pattern and age[OR=1.051,95%CI（1.006,1.098）,P=0.026],MCHC[OR=1.032,95%CI（1.003,1.062）,P=0.028],CD₃⁺CD₄⁺T cell [OR=1.820,95%CI（1.384,2.394）,P<0.001],CD₃⁺CD₈⁺T cell[OR=1.400,95%CI（1.081,1.813）,P=0.011],Ig M level[OR=2.047,95%CI（1.019,4.112）,P=0.044];were negative correlation relationship with m MRC score [OR=0.590,95%CI（0.362,0.962）,P=0.034],Hb[OR=0.952,95%CI（0.937,0.967）,P<0.001],Pa CO2[OR=0.914,95%CI（0.853,0.980）,P=0.011],PLT[OR=0.994,95%CI（0.989,0.999）,P=0.031],CD₃⁺T cell[OR=0.638,95%CI（0.490,0.831）,P=0.001],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell [OR=1.400,95%CI（1.081,1.813）,P=0.011].There was a positive correlation between pattern of turbid phlegm obstructing lung and CD₃⁺T cell level[OR=1.280,95%CI（1.180,1.389）,P<0.001];Han nationality patients were more likely to differentiate the pattern of turbid phlegm obstructing lung than other nationalities[OR=0.574,95%CI（0.349,0.942）,P= 0.028],and there were a negative correlation with times of acute exacerbations[OR=0.756,95%CI（0.603,0.948）,P= 0.015],Hb[OR=0.969,95%CI（0.959,0.979）,P<0.001],BNP[OR=0.999376,95%CI（0.998892,0.999885）,P=0.015],CD₃⁺CD₈⁺T cell[OR=0.435,95%CI（0.354,0.535）,P<0.001 ],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell[OR=0.001,95%CI（1.51×10-4,0.008）,P<0.001],Ig M level[OR=0.356,95%CI（0.194,0.654）,P=0.001].There were positively correlated between the pattern of phlegm-heat obstructing lung and PCT[OR=15.555,95%CI（2.928,82.626）,P= 0.001],CD₃⁺T cell[OR=1.355,95%CI（1.239,1.482）,P< 0.001],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell[OR=47.366,95%CI（10.706,209.569）,P< 0.001],Ig A level[OR=2.242,95%CI（1.512,3.324）,P< 0.001],patients with medical imageology changes were more likely to differentiate phlegm-heat obstruction lung pattern than those without medical imageology changes[OR=1.898,95%CI（1.186,3.306）,P< 0.001];other causes such as air pollution are more likely to lead to the pattern differentiation of phlegm-heat obstructing lung[OR=0.687,95%CI（0.507,0.931）,P= 0.015],and there were a negative correlation with cardiac function classification[OR=0.362,95%CI（0.208,0.630）,P< 0.001],Lym#[OR=0.366,95%CI（0.233,0.574）,P< 0.001],Hb[OR=0.975,95%CI（0.963,0.987）,P< 0.001],TT[OR=0.662,95%CI（0.487,0.901）,P= 0.009],CD₃⁺CD₄⁺T cell[OR=0.617,95%CI（0.537,0.707）,P< 0.001],Ig G level[OR=0.689,95%CI（0.566,0.839）,P< 0.001].There were positively correlated between the pattern of phlegm and stasis blocking lung and Hb[OR=1.067,95%CI（1.053,1.081）,P< 0.001],D-D[OR=1.463,95%CI（1.015,2.110）,P= 0.041],CD₃⁺T cell[OR=1.065,95%CI（1.016,1.116）,P= 0.008],C4 level[OR=2.240×103,95%CI（25.017,2.006×105）,P= 0.001],female were more likely to differentiate phlegm and stasis blocking lung pattern than male[OR= 4.002,95%CI（2.156,7.428）,P < 0.001];and there were a negative correlation with cardiac function classification [OR=0.469,95%CI（0.291,0.755）,P= 0.002],CRP level [OR=0.985,95%CI（0.974,0.996）,P= 0.006].There were positively correlated between Wet phlegm and blood stasis heat patterns and HCO₃^-[OR=1.068,95%CI（1.000170,1.140）,P= 0.049],Hb[OR=1.026,95%CI（1.014,1.039）,P< 0.001],PLT[OR=1.007,95%CI（1.001,1.013）,P= 0.020],CRP[OR=1.009,95%CI（1.000237,1.018）,P= 0.044],PG level[OR=1.015,95%CI（1.001,1.029）,P= 0.034],Non-han patients were more likely to differentiate Wet phlegm and blood stasis heat patterns than Han patients [OR=1.583,95%CI（1.087,2.304）,P= 0.017];and there were a negative correlation with PH[OR=2.000×10-6,95%CI（6.098×10-10,0.004）,P= 0.001],LVEF[OR=0.965,95%CI（0.933,0.998）,P= 0.038],C3 level[OR=1.583,95%CI（1.087,2.304）,P= 0.017].There was a positive correlation between shuiyinningxin pattern and grading of cardiac function [OR= 9.040×108,95%CI（0.000,-）,P= 0.990],but there was no statistical significance.In group B,there were positively correlated between phlegm obstructing lung pattern was associated with Pa O2 [OR=1.045,95%CI（1.009,1.082）,P= 0.013],CD₃⁺CD₄⁺T cell[OR=2.609,95%CI（1.486,4.580）,P= 0.001],CD₃⁺CD₈⁺T cell level [OR=2.399,95%CI（1.372,4.194）,P= 0.002];and there were a negative correlation with m MRC score[OR=0.126,95%CI（0.028,0.557）,P= 0.006],RBC[OR=0.179,95%CI（0.071,0.451）,P< 0.001],MCH[OR=0.790,95%CI（0.646,0.965）,P= 0.021],CD₃⁺T cell[OR=0.501,95%CI（0.284,0.884）,P= 0.017],C4 level[OR=2.990×10-4,95%CI（9.567×10-8,0.936）,P= 0.048].In group B,there was a positive correlation between pattern of turbid phlegm obstructing lung and CD₃⁺CD₄⁺T cell level[OR=1.659,95%CI（1.197,2.301）,P= 0.0027];and there were a negative correlation with the times of acute exacerbation[OR=0.219,95%CI（0.070,0.686）,P= 0.009],days of acute exacerbation [OR=0.875,95%CI（0.784,0.977）,P= 0.017],Hb[OR=0.978,95%CI（0.958,0.998）,P= 0.030],CD₃⁺T cell[OR=0.612,95%CI（0.495,0.757）,P< 0.001],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell[OR=0.011,95%CI（2.400×10-4,0.495）,P= 0.020],Ig M level[OR=0.418,95%CI（0.181,0.965）,P= 0.041],With the BNP[OR=0.999397,95%CI（0.998756,1.000037）,P= 0.065]was negatively correlated,but the difference was not statistically significant.There were positively correlated between pattern of phlegm-heat obstructing lung and course of disease in group B[OR=1.157,95%CI（1.028,1.303）,P= 0.016],PH[OR= 8.710×1027,95%CI（3.392×1011,2.237×1044）,P= 0.001],D-D[OR=9.049,95%CI（1.747,46.865）,P= 0.009],CD₃⁺[OR=1.667,95%CI（1.172,2.371）,P= 0.004],Ig A level[OR=4.106,95%CI（1.633,10.326）,P= 0.003];Non-han patients were more likely to differentiate the pattern of phlegm-heat obstructing lung than han patients [OR=6.093,95%CI（1.365,27.201）,P= 0.018],patients with medical imageology changes were more likely to differentiate the pattern of phlegm-heat obstructing lung[OR=4.790,95%CI（1.171,19.595）,P= 0.029];Males were more likely to differentiate the pattern of phlegm-heat obstructing lung than females [OR= 0.019,95%CI（0.001,0.311）,P= 0.006],and there were a negative correlation with Sa O2[OR=0.909,95%CI（0.846,0.976）,P= 0.009],MCH[OR=0.510,95%CI（0.332,0.781）,P= 0.002],TT[OR=0.072,95%CI（0.017,0.299）,P< 0.001],CD₃⁺CD₈⁺T cell [OR =0.386,95%CI（0.225,0.663）,P= 0.001],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell level [OR= 5.392×10-10,95%CI（9.127×10-15,3.200×10-5）,P< 0.001],and there was a negatively correlated with WBC[OR=0.563,95%CI（0.315,1.010）,P= 0.054],but the difference was not statistically significant.There were positively correlated between the pattern of phlegm and stasis blocking lung and the times of acute exacerbation[OR=2.678,95% CI（1.059,6.774）,P= 0.038],days of acute exacerbation[OR=1.278,95%CI（1.147,1.424）,P< 0.001],RBC[OR=11.232,95%CI（3.300,38.233）,P< 0.001],MCH[OR=1.471,95%CI（1.144,1.892）,P= 0.003],CD₃⁺CD₈⁺T cell[OR=1.247,95%CI（1.084,1.436）,P= 0.002],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell[OR= 370.766,95%CI（16.115,8.530×103）,P< 0.001];female is more likely to differentiate the pattern of phlegm and stasis blocking lung than male[OR=9.722,95%CI（1.864,50.714）,P= 0.007];and there was a negatively correlated with cardiac function classification[OR=0.215,95%CI（0.049,0.945）,P= 0.042],Ig M level[OR= 0.062,95%CI（0.008,0.512）,P= 0.010].There was a positive correlation between wet phlegm and blood stasis heat patterns and RBC level in group B[OR=3.108,95%CI（1.783,5.419）,P< 0.001];and there was a negatively correlated with LVEF[OR=0.953,95%CI（0.913,0.994）,P= 0.026].In group B,there was a positive correlation between the pattern of shuiyinningxin and the grading of cardiac function[OR=1.405×109,95%CI（0.000,-）,P= 0.994],but the difference was not statistically significant.In group D,phlegm obstructing lung pattern and Pa CO2[OR=0.814,95%CI（0.700,0.946）,P= 0.007],Hb[OR=0.920,95%CI（0.880,0.962）,P< 0.001],PCT[OR=1.679×10-11,95%CI（7.072×10-21,0.040）,P= 0.024],CD₃⁺CD₈⁺T cell level[OR=0.751,95%CI（0.624,0.904）,P= 0.003]showed a negative correlation;compared with non-Han nationality patients,han nationality patients were more likely to differentiate the pattern of phlegm obstructing lung[OR=0.025,95%CI（0.002,0.282）,P= 0.003].The pattern of turbid phlegm obstructing lung in group D was positively correlated with CD₃⁺CD₄⁺T cell [OR=1.144,95%CI（1.060,1.233）,P< 0.001],Ig G level[OR=1.672,95%CI（1.291,2.165）,P< 0.001];Male patients were more likely to differentiate the pattern of urbid phlegm obstructing lung than female patients [OR=0.287,95%CI（0.097,0.850）,P= 0.024],han patients were more likely to differentiate the pattern of urbid phlegm obstructing lung[OR=0.170,95%CI（0.037,0.769）,P= 0.021];and there was a negatively correlated with Hb[OR=0.942,95%CI（0.918,0.966）,P < 0.001],Ig A[OR=0.561,95%CI（0.326,0.967）,P= 0.037],Ig M level[OR=0.140,95%CI（0.027,0.715）,P= 0.018].In group D,pattern of phlegm-heat obstructing lung were a positively associated with PCT [OR=1.155×107,95%CI（27.511,4.853×1012）,P= 0.014],PG[OR=1.083,95%CI（1.001,1.172）,P= 0.048],CD₃⁺CD₈⁺T cell[OR=2.500,95%CI（1.348,4.638）,P= 0.004],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell level[OR=4.396×105,95%CI（93.839,2.060×109）,P= 0.003];Males were more likely to differentiate the pattern of phlegm-heat obstructing lung than females [OR=0.001,95%CI（2.000×10-6,0.258）,P= 0.016];and there was a negatively correlated with days of acute exacerbation[OR=0.329,95%CI（0.148,0.733）,P= 0.007],m MRC[OR=0.001,95%CI（6.000×10-6,0.231）,P= 0.012],Hb[OR=0.897,95%CI（0.822,0.978）,P= 0.014],TT[OR=0.109,95%CI（0.017,0.676）,P= 0.017],CD₃⁺CD₄⁺T cell level[OR=0.701,95%CI（0.533,0.923）,P= 0.011].In group D,the pattern of phlegm and stasis blocking lung was positively correlated with times of acute exacerbation[OR=184.781,95% CI（0.016,2.140×106）,P= 0.274],PH[OR=2.709×1072,95%CI（1.051×10-64,6.986×10208）,P= 0.298],Hb[OR=5.099,95%CI（0.184,141.701）,P= 0.337],CD₃⁺CD₄⁺T cell[OR=13.489,95%CI（0.073,2.478×104）,P= 0.328],women were more likely to differentiate the pattern of phlegm and stasis blocking lung than men[OR=6.976×1024,95%CI（3.842×10-27,1.267×1076）,P= 0.342];and there was a negatively correlated with days of acute exacerbation[OR= 0.016,95%CI（0.300×10-5,73.193）,P= 0.335],grade of cardiac function[OR=1.191×10-8,95%CI（5.212×10-23,2.719×106）,P= 0.279],Pa O2[OR=0.287,95%CI（0.024,3.387）,P= 0.321],Pa CO2[OR=0.362,95%CI（0.037,3.580）,P= 0.385],MCHC[OR=0.219,95% CI（0.011,4.357）,P= 0.319],PT[OR=0.161,95%CI（0.004,6.972）,P= 0.342],TR:Vmax[OR=0.001,95%CI（1.232×10-9,604.324）,P= 0.304],CD₃⁺CD₄⁺/CD₃⁺CD₈⁺T cell level [OR=1.789×10-37,95%CI（5.977×10-112,5.351×1037）,P= 0.334],but the differences were not statistically significant.Wet phlegm and blood stasis heat patterns in group D was positively correlated with days of acute exacerbation[OR=1.055,95%CI（1.012,1.099）,P= 0.012],Hb[OR=1.040,95%CI（1.019,1.061）,P< 0.001],PG leve [OR=1.027,95%CI（1.006,1.049）,P= 0.013];and there was a negatively correlated with TT[OR=0.708,95%CI（0.504,0.996）,P= 0.047].In group D,there was a positive correlation between the pattern of shuiyinningxin and the grading of cardiac function[OR=1.364×109,95%CI（0.000,-）,P= 0.995],but the difference was not statistically significant.Conclusions:1.The symptoms of dyspnea in patients with Phlegm obstructing lung pattern are mild,the "stasis" is not obvious,and the infection is not serious.Although the CD₃⁺CD₄⁺T cells and CD₃⁺CD₈⁺T cells level is elevated by hyperirritability,the immune function of the body is in a coordinated state.2.The overall clinical symptoms of patients with pattern of turbid phlegm obstructing lung are mild,with fewer acute exacerbations,insignificant water and sodium retention,and coordinated immune function.3.The patients with pattern of phlegm-heat obstructing lung have expressed certain signs on medical imageology,which are closely related to bacterial infection and mobilize the activities of humoral immunity and cellular immunity,but the overall immune function of the body remains in balance.4.Female patients are more likely to express the pattern of phlegm and stasis blocking lung than male patients,and the "stasis" is obvious.5.The "stasis" is obvious on the wet phlegm and blood stasis heat pattern,and the cardiopulmonary function is poor.