Correlation Analysis Of TCM Syndromes Distribution And Clinical Indicators In COPD Patients Complicated With Chronic Pulmonary Heart Disease During Acute Exacerbation

Objectives:By analyzing the clinical data of the included patients,this paper summarized the correlation between the distribution of Traditional Chinese Medicine（TCM）syndromes and clinical characteristics of patients with chronic obstructive pulmonary disease（COPD）complicated with chronic pulmonary heart disease（CPHD）in the acute exacerbation stage,providing effective theoretical support for the diagnosis and treatment of COPD complicated with CPHD in the future.Method:Clinical data of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）hospitalized in the Respiratory Department of Traditional Chinese Medicine Hospital of Chengdu’s Pidu District during January 1,2021 to December 31,2021 were retrospectively analyzed.According to the screening criteria of cases,the patients were divided into AECOPD group（AE group）and COPD complicated with CPHD acute exacerbation group（AC group）.The differences of general information and laboratory indicators were compared between the two groups.The distribution of TCM syndromes in the two groups was summarized and analyzed.The correlation between general and laboratory indicators,cardiac function grade,pulmonary artery pressure and various TCM syndromes in AC group was analyzed.To investigate the relationship between various indicators,TCM syndromes and pulmonary artery pressure during hospitalization in AC group.Results:（1）A total of 390 patients with AECOPD were enrolled in this study,including 130 patients in AC group.（2）Compared with AE group,the age,COPD duration,the number of acute exacerbations in the previous year,the proportion of previously complicating hypertension and diabetes,the proportion of ventilator treatment during hospitalization,length of hospital stays and hospitalization expenses in AC group were higher.And NT pro-BNP,c Tn I,D-dimer,FIB,neutrophil to lymphocyte ratio（NLR）,hematocrit（HCT）,CRP,PCT,Pa CO₂have higher levels,while ESR,p H value of blood gas analysis and Pa O₂have lower level.（3）The distribution of TCM syndromes in the two groups were arranged in descending order.The AC group was followed by yang deficiency water flooding syndrome,phlegm dampness obstructing lung syndrome,phlegm and heat blocking lung syndrome,cold fluid retained in lung syndrome and phlegm covering mind syndrome.The AE group was followed by phlegm and turbidity obstructing lung syndrome,phlegm and heat blocking lung syndrome,external cold and internal fluid syndrome,wind cold attacking lung syndrome and phlegm covering mind syndrome.（4）Compared with other syndromes in AC group,the hospitalization expenses and NLR of patients with phlegm covering mind syndrome were the highest（P<0.05）.There were also significant differences in cardiac function grade and pulmonary artery pressure levels between this syndrome and other syndromes（P<0.01）.（5）Spearman correlation coefficient analysis was conducted on various indicators of patients in the AC group.The results showed that age,number of acute exacerbations in the previous year,proportion of ventilator treatment during hospitalization,length of hospital stays and hospitalization expenses were positively correlated with pulmonary artery pressure.Meanwhile,pulmonary arterial pressure was positively correlated with NT pro-BNP,c Tn I,D-dimer,FIB,monocyte to high density lipoprotein ratio（MHR）,CRP,PCT,Pa CO₂and cardiac function grade,and negatively correlated with blood gas analysis p H and Pa O₂level（P<0.05）.There was no significant difference in TCM syndromes（P>0.05）.（6）Multiple linear stepwise regression analysis of pulmonary artery pressure in AC group showed that pulmonary artery pressure in this group was most closely related to age,proportion of ventilator treatment,the levels of FIB and cardiac function grade（P<0.01）.After gender correction,the fitting equation was obtained:pulmonary artery pressure=1.111+0.292*age-1.438*gender+11.13*ventilatortherapy+1.919*FIB+4.451*cardiac function grade（R=0.708,R²=0.501）.Conclusion:（1）The AC group was sicker than the AE group.Specifically,patients in the AC group were older,had a longer course of previous COPD,more acute exacerbations and more underlying diseases.In addition,this group of patients had a higher proportion of ventilator treatment,longer hospitalization days,more hospitalization expenses,higher levels of inflammatory indicators and coagulation indicators in blood,higher Pa CO₂level,lower p H and lower Pa O₂level value in blood gas analysis.（2）The TCM syndromes of patients in the AC group and the AE group were different.Patients in the AC group were mainly manifested as yang deficiency water flooding syndrome and phlegm dampness obstructing lung syndrome,while patients in the AE group were mainly manifested as phlegm turbidity obstructing lung syndrome and phlegm heat blocking lung syndrome.（3）The inflammatory indicators,cardiac function grade and pulmonary artery pressure levels of patients with phlegm covering mind syndrome were higher,and the hospitalization expenses was higher,suggesting that patients with this syndrome were more serious.（4）Age,hypoxia,the levels of FIB and cardiac function grade may be important factors affecting pulmonary artery pressure in AECOPD patients complicated with CPHD.