Study On The Clinical Characteristics And Medication Rules Of Hospitalized Patients With Sjogren's Syndrome Complicated With Interstitial Pulmonary Diseas

ObjectiveSjogren’s syndrome accompanied by lung interstitial disease(SS-ILD)has a high incidence,a protracted duration,and a poor prognosis,all of which have a negative impact on patients’ quality of life.Its pathophysiology is unknown,current clinical research is poor,early diagnostic criteria are lacking,and therapeutic options are restricted.The overall idea and the differentiation and treatment of syndromes are the main characteristics of traditional Chinese medicine,which have significant benefits in the diagnosis and treatment of this condition,although few research have published the TCM syndrome characteristics and medication regulations.This retrospective study was conducted to investigate the clinical differences between patients with SS-ILD and patients without pulmonary interstitial disease(SS-NILD),as well as different TCM syndrome types of SS-ILD,as well as the characteristics of traditional Chinese and western medicine and inpatient prescription compatibility.It is believed that the findings of this study will serve as a solid foundation for providing objective theoretical support for the early identification and clinical treatment of SS-ILD.Methods1 Aims to gather clinical data from inpatients with SS-ILD and SS-NILD who meet the inclusion criteria at the Guang’anmen Hospital Chinese Academy of Traditional Chinese Medical Science’s from January 2010 to December 2021.2 Patients’ basic information,clinical symptoms,tongue and pulse of traditional Chinese medicine,laboratory examination,SS-ILD-related examination,diagnosis and treatment plan,prescription of traditional Chinese medicine,and so on are all recorded and included.3 SPSS 22.0 software was used for statistical analysis to analyze the differences between SS-ILD and SS-NILD in general conditions,clinical aspects,laboratory exams,and so on.4 To analyze differences in general condition,clinical characteristics,and laboratory examination of SS-ILD patients with distinct syndrome kinds and summarize TCM syndrome rules.5 To summarize the characteristics of integrated traditional Chinese and western medicine diagnosis and treatment in the SS-ILD and SS-NILD groups.6 Using the data mining module of an ancient and modern medical record cloud platform system to summarize the medication characteristics of patients in the SS-ILD group’s first diagnosis prescription.Results1 Comparison of SS-ILD and SS-NILD discrepancies1.1 Situation in generalA total of 299 patients were included,including the SS-ILD(n=87)and SS-NILD(n=212)groups.The male-to-female ratio was roughly 1:29,and the average age in the quartile was 61 years old.The age and likelihood of smoking and drinking histories were higher in the SS-ILD group than in the SS-NILD group,although there was no significant difference in age and illness course.1.2 Clinical characteristicsThe most common complaints in the SS-ILD group were dry mouth,dry eyes,joint pain,joint swelling,and cough,while the SS-NILD group complained of dry mouth,dry eyes,joint pain,joint swelling,and weariness.The risk of dry eye,Raynaud phenomenon,joint swelling,cough,and expectoration was higher in the SS-ILD group than in the SS-NILD group.Both groups experienced dry mouth,dry eyes,joint pain,weariness,and chest tightness.The likelihood of joint swelling,shortness of breath,coughing,and expectoration was higher in the SS-ILD group than in the SS-NILD group.Dark/purple/blood stasis,tongue body cracks,and no/eexfoliation of the tongue coating were the most prevalent tongue pictures in the SS-ILD group.The most prevalent tongue images in the SS-NILD group were dark/purple/blood stasis,tongue body crack,yellow,and greasy tongue coating.No or minor tongue coating exfoliation was more common in the SS-ILD group.Veinlets,slippery pulses,buried pulses,and string pulses were the most common pulses in both groups.Weak pulses were more common in the SS-ILD group,but there was no statistically significant difference in other pulse parameters.1.3 Laboratory testingThe average PaO2 value in the SS-ILD group was lower than in the SS-NILD group,but the average levels of ESR,CRP,and RF positive rate in the SS-NILD group were greater.The normal blood test,liver and renal function,and PaCO2 levels did not differ significantly.The average values of the ink absorption test and saliva flow rate were lower than the normal range in both groups,and there was no significant difference in the binocular ink absorption test,saliva flow rate,or salivary gland ultrasound score.The PFTs of SS-ILD patients revealed primarily mild obstructive and restrictive ventilatory dysfunction,as well as mild diffusion dysfunction.Pleural thickening,nodular shadow,ground glass shadow,grid shadow,and cord-like changes were the most common manifestations of chest HRCT.1.4 Syndrome Type DistributionThe distribution frequency of TCM syndrome types in SS patients from high to low is:yin deficiency internal heat syndrome;qi-yin deficiency syndrome;dryness and blood stasis syndrome;dryness-dampness syndrome;yin deficiency fluid deficiency syndrome;qi-yin deficiency syndrome;and dryness-blood stasis syndrome.The proportion of ILD in patients with yin deficiency syndrome,qi-yin deficiency syndrome,and dryness-stasis syndrome is higher than that of yin deficiency syndrome and dryness-dampness syndrome,and the difference is statistically significant.1.5 SS-ILD correlation studyThe binary logistic regression model included smoking history,chief complaint of dry eyes,chief complaint of cough,no or exfoliation of tongue coating,weak pulse,and qi and yin deficiency.According to the findings of the regression analysis,SS-ILD was positively correlated with smoking history,the chief complaint of cough,the absence or exfoliation of tongue coating,a weak pulse,and deficiency of both qi and yin syndromes,and negatively correlated with the chief complaint of dry eye.2 The regularity of SS-ILD TCM syndromes.2.1 Situation in generalThere was no significant difference in sex,age,age of onset,disease course,or smoking history between patients with different SS-ILD syndrome types.Patients with dryness-dampness syndrome were more likely than those with yin deficiency internal heat syndrome and dryness and blood stasis syndrome to have a drinking history;the difference was statistically significant.2.2 Clinical manifestations.Different syndrome types in SS-ILD patients were statistically significant in terms of dry mouth,joint swelling,joint pain,and other chief complaint symptoms,as well as cough,Raynaud phenomenon,joint swelling,and other symptoms,but not in terms of other chief complaints and symptoms,ILD special signs,and tongue and pulse differences.2.3 Laboratory testingBUN levels were higher in SS-ILD individuals with Yin deficiency internal heat syndrome than in other syndrome types,and the difference was statistically significant.Other blood tests,including liver and kidney function,blood gas analysis,inflammation,and immunology,revealed no significant differences between patients with various syndrome types,as did salivary gland ultrasound scores.The ESR and CRP of each syndrome type’s SS-ILD individuals were higher than the normal reference range.ESR levels were higher in Yin and Jin deficiency syndromes,dryness and blood stasis syndromes,and qi-yin deficiency syndrome,and CRP levels were higher in dryness-dampness syndrome,dryness-blood stasis syndrome,and qi-yin deficiency syndrome.3 Characteristics of the integrated traditional Chinese and western medicine treatment planBailing capsules,Tripterygium wilfordii polyglycoside tablets,Kunxian capsules,total glucosides of paeony capsules,Simiao pills,total glucosides of paeony capsules,Simiao pills,and a total of four kinds of glucocorticoids were chosen from the two groups.Prednisone acetate pills and prednisolone acetate tablets were frequently used.Thirteen immunosuppressants were chosen in total.Tripterygium wilfordii polyglycosides tablets,hydroxychloroquine sulfate tablets,and leflunomide tablets were the most commonly used medicines.Topiramate citrate tablets were chosen as the most frequently used of four types of biological formulations.In terms of patent Chinese medicine,the SS-ILD group primarily used Cordyceps sinensis preparation,whereas the SS-NILD group primarily used Tripterygium wilfordii preparation.Immunosuppressants were primarily used in both groups in terms of joint use of western medicine.4 Analysis of the Law of SS-ILD Prescription Drug UseA total of 79 prescriptions were written,217 traditional Chinese remedies were used,and licorice,angelica,Radix Astragali,Poria,Atractylodes macrocephala,yam,tangerine peel,Platycodon grandiflorum,Salvia miltiorrhiza,honeysuckle,Radix Rehmanniae,and Radix Paeoniae Rubra were frequently used.The medicinal properties are primarily flat,warm,and cold,with a sweet,bitter,and pungent flavor,while the lung dominates the meridian,followed by the liver,spleen,and stomach,the heart,and the kidney.According to correlation research,the most common drug pairs were angelica-licorice,astragalus-licorice,licorice-angelica,and licorice-astragalus.17 traditional Chinese medicines with frequencies of 20 were divided into four groups based on the longest distance of 5.5:Radix Paeoniae Rubra,Glycyrrhiza uralensis,Angelica sinensis,Radix Paeoniae Rubra,Radix Paeoniae Rubra,Radix Paeoniae Rubra,Group 2 includes Platycodon grandiflorum,Trichosanthes,Radix Rehmanniae,Radix Salviae Miltiorrhizae,and Radix Salviae Miltiorrhizae.Tangerine peel,Pinellia,Radix Astragali,Flos Lonicerae comprise Group 3.Radix Rehmanniae,Atractylodes macrocephala,Radix Ophiopogonis,Poria cocos,Radix Scutellariae comprise Group 4.Licorice,Radix Astragali,Angelica sinensis,Poria cocos,Atractylodes macrocephala,Salvia miltiorrhiza,Radix Rehmanniae,yam,Platycodon grandiflorum,Achyranthes bidentata,Radix Paeoniae Rubra,Radix Rehmanniae,Gentiana macrophylla,Radix Ophiopogonis.Conclusions1 The majority of SS hospitalized patients were middle-aged and elderly,with a female predominance.2 The probability of advanced age,smoking and drinking history,joint swelling,Raynaud phenomenon,cough,and expectoration,positive ESR,CRP,and RF,and the TCM syndrome type of yin deficiency of lung dryness,qi and yin deficiency,and combination of dryness and blood stasis was higher in the SS-ILD group than in the SS-NILD group.3 PFTs revealed mild obstructive or restrictive ventilation disorder and mild diffusion dysfunction in patients with SS-ILD,while chest HRCT revealed pleural thickening,nodular shadow,ground glass shadow,grid shadow,and cord-like changes.4 When SS patients have a smoking history,a chief complaint of cough,tongue coating,no exfoliation,a weak pulse,and a deficiency of both qi and yin,the likelihood of ILD increases,and the likelihood of ILD without xerophthalmia increases.5 Among SS-ILD patients,the drinking history of dryness-dampness syndrome is the most common,followed by yin deficiency internal heat syndrome and dryness and blood stasis syndrome;the main complaint of yin deficiency and fluid deficiency syndrome is dry mouth,and the most common symptom of dryness and blood stasis syndrome is joint swelling;dryness and blood stasis syndrome is the most common cause of joint swelling,and yin deficiency internal heat syndrome is the most common cause of cough;the serum BUN of yin deficiency internal heat syndrome is higher than that of other syndromes.6 Characteristics of integrated traditional Chinese and western medicine treatment:in the application of proprietary Chinese medicine,Cordyceps sinensis was the main preparation in SS-ILD patients and Tripterygium wilfordii in SS-NILD patients;western medicine aimed at anti-inflammation and regulating immunity,primarily using immunosuppressants,sometimes combined with middle-effect corticosteroids;and biological agents require further popularization and application.7 SS-ILD prescriptions are mostly made up of energizing spleen and qi,nourishing yin and clearing heat,nourishing blood and activating blood,and returning to the lung,liver,and spleen meridians.The main prescription is Bazhen decoction mixed with Yangyin Qingfei decoction,which is strongly related to the etiology of deficiency and excess.