目的:分析支气管扩张症稳定期患者中医体质和临床特征的关系,探索影响支气管扩张症急性加重的风险因素.方法:选择2018年1月-2019年2月天津中医药大学第一附属医院呼吸科/感染疾病科符合支气管扩张症诊断标准且经治疗,症状改善的住院患者,制订信息采集表和中医体质调查表,出院1个月后电话随访,纳入符合稳定期诊断标准的患者,并在门诊完成血炎症指标及肺功能检查,之后通过电话随访,每月1次,确定患者6个月内支气管扩张症是否急性加重,采用Cox风险比例模型分析支气管扩张症急性加重的风险因素.结果:本研究筛选期纳入病例106例,剔除20例,最终纳入病例86例,随访终点急性加重50例,男女比例为1:1.68,结果显示气虚质29例,阴虚质23例,痰湿质21例,气郁质13例,各体质间性别、年龄、体质量指数、吸烟史、病程、既往1年内加重次数、呼吸困难指数评分(Modified Medical Research Council,mMRC)、血炎症指标、肺功能分级、高分辨率CT(High Resolution CT,HRCT)表现类型、累及肺叶数和合并症差异均无统计学意义,Cox单因素分析显示,患者既往1年加重次数≥2次、第一秒用力呼气量(Forced Expiratory Volume in First Second,FEV1％)＜50％、呼吸困难指数评分＞2级、累及肺叶≥3叶、合并慢性阻塞性肺疾病慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)与支气管扩张症急性加重相关;Cox多因素分析显示,累及肺叶≥3叶[风险比(HR)=1.949,95％置信区间(CI)(1.019,3.739),P=0.025]是影响支气管扩张症急性加重的独立风险因素.结论:支气管扩张症稳定期患者各中医体质的临床特征有差异,累及肺叶≥3叶是支气管扩张症急性加重的独立风险因素.
Analysis of TCM constitution characteristics and risk factors of acute exacerbation in stable period of bronchiectasis
Objective:To analyze the relationship between traditional Chinese medicine constitution and clinical characteristics of patients with stable bronchiectasis,and to explore the risk factors affecting the acute exacerbation of bronchiectasis.Method:Inpatients meeting the diagnostic criteria for bronchiectasis and whose symptoms improved after treatment were selected from the Respiratory/Infectious Diseases Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to February 2019.Information collection form and TCM constitution questionnaire were developed.Patients meeting the diagnostic criteria for stable period were included in the telephone follow-up one month after discharge.Blood inflammation indicators and pulmonary function tests were completed in the outpatient department,and then the patients were followed up by telephone once a month to determine whether the patients had acute exacerbation of bronchiectasis within 6 months.Cox risk ratio model was used to analyze the risk factors of acute exacerbation of bronchiectasis.Result:During the screening period of this study,106 cases were included,20 cases were excluded,and 86 cases were ultimately included.The follow-up endpoint was acute exacerbation in 50 cases,with a male to female ratio of 1:1.68.The results showed that there were 29 cases of Qi(气)deficiency,23 cases of Yin(阴)deficiency,21 cases of phlegm dampness,and 13 cases of Qi stagnation.There was no significant difference in gender,age,BMI,smoking history,course of disease,number of exacerbations in the past 1 year,mMRC score,blood inflammation index,pulmonary function grade,HRCT manifestation type,number of involved lung lobe,and comorbidities among different physical conditions.Cox univariate analysis showed that patients had exacerbations≥2 times in the past year,FEVl％＜50％,mMRC score＞2 levels,involvement of ≥ 3 lobes in the lung,and comorbidities with COPD were associated with acute exacerbation of bronchiectasis;Cox multivariate analysis showed that involvement of ≥ 3 lobes of the lung[HR=1.949,95％CI(1.019,3.739)P=0.025]was an independent risk factor for acute exacerbation of bronchiectasis.Conclusion:There are differences in the clinical characteristics of various traditional Chinese medicine constitutions among patients with stable stage bronchiectasis,and involving≥3 lobes of the lung is an independent risk factor for acute exacerbation of bronchiectasis.
BronchiectasisAcute exacerbationTraditional Chinese medicine constitutionRisk factor
万方数据
维普
