1.中国中医科学院西苑医院检验科,北京 100091
2.中国中医科学院西苑医院肺病科,北京 100091
3.河北北方学院医学检验学院,张家口 075000
张鹏,女,30岁,本科,主管技师。研究方向:临床血液与体液诊断学。
李琦,E-mail:yourslq@126.com
扫 描 看 全 文
张鹏,徐佳,刘文娟,等.实验室指标对慢性阻塞性肺疾病急性加重期中医证候的鉴别作用[J].北京中医药,2023,42(2):208-213.
ZHANG Peng,XU Jia,LIU Wen-juan,et al.Differentiation of TCM syndrome in acute exacerbation of COPD by laboratory indexes[J]. Beijing Journal of Traditional Chinese Medicine,2023,42(02):208-213.
张鹏,徐佳,刘文娟,等.实验室指标对慢性阻塞性肺疾病急性加重期中医证候的鉴别作用[J].北京中医药,2023,42(2):208-213. DOI: 10.16025/j.1674-1307.2023.02.020.
ZHANG Peng,XU Jia,LIU Wen-juan,et al.Differentiation of TCM syndrome in acute exacerbation of COPD by laboratory indexes[J]. Beijing Journal of Traditional Chinese Medicine,2023,42(02):208-213. DOI: 10.16025/j.1674-1307.2023.02.020.
目的,2,观察慢性阻塞性肺疾病急性加重期(AECOPD)患者中医证候与检验指标的相关性,并探讨检验指标鉴别证候的诊断价值。,方法,2,收集2018年11月―2020年8月在中国中医科学院西苑医院肺病科就诊符合AECOPD诊断标准的患者1 693例,其中接受血常规、凝血功能及血生化指标检测者分别为642、580、471例。依照中医辨证分型,痰热蕴肺证接受血常规、凝血功能及血生化指标检测者分别为331、306、254例;痰瘀互结证接受血常规、凝血功能及血生化指标检测者分别为116、104、92例;肺脾肾虚证接受血常规、凝血功能及血生化指标检测者分别为195、170、125例。比较AECOPD3种中医证候患者血常规、凝血功能及血生化指标的变化,绘制受试者工作特征(ROC)曲线,评价所观察指标在不同证候中的诊断性能。,结果,2,痰热蕴肺证淋巴细胞计数(Lym#)和总蛋白(TP)高于肺脾肾虚证(,P,<,0.05),肺脾肾虚证红细胞体积分布宽度CV(RDW-CV)、红细胞体积分布宽度SD(RDW-SD)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、B型钠尿肽前体(NT-proBNP)高于痰热蕴肺证(,P,<,0.05);痰瘀互结证红细胞平均体积(MCV)、RDW-SD、D-D、NT-proBNP、尿酸(UA)高于痰热蕴肺证(,P,<,0.05),痰热蕴肺证平均血红蛋白浓度(MCHC)高于痰瘀互结证(,P,<,0.05);痰瘀互结证MCV、UA高于肺脾肾虚证(,P,<,0.05)。在痰热蕴肺证和肺脾肾虚证进行比较时,Lym# + RDW-CV + RDW-SD 、APTT + D-D、TP + NT-proBNP曲线下面积(AUC)分别是0.608、0.585、0.585,灵敏度分别为81.3%、73.5%、78.0%,特异度分别为35.4%、43.5%、37.6%;在痰热蕴肺证和痰瘀互结证进行比较时,MCV + MCHC + RDW-SD、D-D、UA + NT-proBNP的AUC分别是0.606、0.574、0.629,灵敏度分别为73.4%、65.4%、72.8%,特异度分别为46.6%、53.8%、46.7%;在痰瘀互结证和肺脾肾虚证进行比较时,MCV、UA的AUC分别是0.571、0.588,灵敏度分别为30.2%、60.9%,特异度分别为83.6%、56.0%。,结论,2,Lym#、TP、RDW-CV、RDW-SD、APTT、D-D、NT-proBNP、MCV、UA和MCHC等指标在AECOPD患者不同中医证候中有差异,对证候鉴别有一定的诊断价值。
Objective,2,To observe the correlation between different TCM syndrome types and laboratory indexes in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),and explore its differential diagnosis value for different TCM syndrome types.,Methods,2,A collection of 1 693 patients(642 cases received blood routine test,580 cases received coagulation test,471 cases received biochemical test) who met the diagnostic criteria for acute exacerbation of COPD in the Department of Pulmonology,Xiyuan Hospital,China Academy of Chinese Medical Sciences from November 2018 to August 2020,were divided into 3 groups according to syndrome differentiation of TCM,namely,phlegm-heat accumulating in the lung group of 331,306 and 254 cases received blood routine,coagulation and biochemical test,phlegm-blood stasis accumulating group of 116,104 and 92 cases received blood routine,coagulation and biochemical test,and lung,spleen and kidney deficiency group of 195,195 and 125 cases received blood routine,coagulation and biochemical test.The blood routine,coagulation and biochemical indicators in patients with acute exacerbation of COPD of three groups were compared,the receiver's operating characteristic(ROC)curve were drawn,and the diagnostic performance of the observed indicators in different syndromes was evaluated.,Results,2,Lym# and TP in the phlegm-heat accumulating in the lung group were higher than those in the lung-spleen-kidney deficiency group(,P,<,0.05),RDW⁃CV,RDW⁃SD,APTT,D⁃D,NT⁃proBNP in the lung-spleen-kidney deficiency group were higher than those in the phlegm-heat accumulating in the lung group(,P,<,0.05);MCV,RDW⁃SD,D⁃D,NT⁃proBNP and UA in the phlegm-blood stasis accumulating group were higher than those in the phlegm-heat accumulating in the lung group(,P,<,0.05),and the phlegm-heat accumulating in the lung group had higher MCHC than the phlegm-blood stasis accumulating group(,P,<,0.05);MCV and UA of the phlegm-blood stasis accumulating group were higher than those of the lung, spleen and kidney deficiency group(,P,<,0.05).When comparing Lym#+RDW⁃CV+RDW⁃SD,APTT+D⁃D,TP+NT⁃proBNP between the phlegm-heat accumulating in the lung group and the lung,spleen and kidney deficiency group,the AUC were 0.608,0.585,0.585,and the sensitivity was 81.3%,73.5%,78.0%,the specificity was 35.4%,43.5%,37.6%,respectively;MCV+MCHC+RDW⁃SD,D⁃D,UA+NT⁃proBNP were compared in the phlegm-heat accumulating in the lung group and the phlegm-blood stasis accumulating group.At the time,the AUC were 0.606,0.574,0.629,the sensitivity was 73.4%,65.4%,72.8%,and the specificity was 46.6%,53.8%,46.7%,respectively;when comparing the phlegm-blood stasis accumulating group and the lung,spleen and kidney deficiency group,the AUC were 0.571 and 0.588,the sensitivity was 30.2%,60.9%,and the specificity was 83.6% and 56.0%,respectively.,Conclusion,2,Lym#,TP,RDW⁃CV,RDW⁃SD,APTT,D⁃D,NT⁃proBNP,MCV,UA and MCHC have statistical differences among different TCM syndrome types in patients with acute exacerbation of COPD,and have certain differential diagnosis value for different syndromes.
慢性阻塞性肺疾病急性加重期中医证候实验室指标
Acute exacerbation of COPDTCM syndromeslaboratory indexes
MATHERS CD,LONCAR D.Projections of global mortality and burden of disease from 2002 to 2030[J]. PLoS Med,2006,3(11):e442.
任成山,王关嵩,钱桂生.慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J].中华肺部疾病杂志(电子版),2019,12(2):127-141.
SORIANO JB,LAMPRECHT B.Chronic obstructive pulmonary disease: a worldwide problem[J].Med Clin North Am,2012,96(4):671-680.
中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
李建生,李素云,余学庆.慢性阻塞性肺疾病中医诊疗指南(2011版)[J].中医杂志,2012,53(1):80-84.
王永炎,鲁兆麟.中医内科学[M].2版.北京:人民卫生出版社,2011.
王岩,郝铮,洪燕英.检验指标对慢性阻塞性肺疾病中医证型鉴别诊断价值分析[J].北京中医药,2021,40(8):915-917.
邹鹏,蔡海荣,袁康,等.慢性阻塞性肺疾病急性加重期中医证型与客观指标的相关性研究[J].中国中医急症,2018,27(10):1801-1804.
梅彤,涂晓龙.慢性阻塞性肺病虚症患者病程与证型的相关性探讨[J].成都中医药大学学报,2005,28(2):25-26.
黄亚玲,闵婕,李官红,等.慢性阻塞性肺疾病合并症及其炎症机制的临床研究[J].四川大学学报(医学版),2019,50(1):88-92.
彭文照,刘梅,郝小梅.岭南慢性阻塞性肺疾病常见中医证型主要症状分布及不同证型间T淋巴细胞亚群与肺功能指标的差异性初探[J].中华中医药杂志,2019,34(8):3747-3750.
SRENSEN AK,HOLMGAARD DB,MYGIND LH,et al.Neutrophil⁃to⁃lymphocyte ratio,calprotectin and YKL⁃40 in patients with chronic obstructive pulmonary disease: correlations and 5⁃year mortality:a cohort study[J].J Inflamm(Lond),2015,12(1):20.
张鹏,温雪,徐佳,等.检验指标对急性脑梗死中医证型鉴别的作用研究[J].北京中医药,2020,39(12):1307-1310.
崔翔.血浆磷脂、白三烯B4联合B型脑钠肽诊断慢性阻塞性肺疾病急性加重期患者的临床价值研究[J].标记免疫分析与临床,2019,26(1):56-59.
苏成程,章匀,唐艳芬,等.慢性阻塞性肺疾病急性加重期中医证型与营养状况关系研究[J].江苏中医药,2012,44(3):20-21.
0
浏览量
0
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构