2型糖尿病合并老年肺炎的证候规律研究

【作者】 沈益谦；

【导师】 郝瑞福；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的本研究拟通过对于2型糖尿病合并老年肺炎的中医证候研究,探索本病的证候诊断规范化,症状、舌脉、证候分布规律,从而找出本病的关键病机,并进一步通过临床观察检验芪银三两三方治疗2型糖尿病合并老年社区获得性肺炎的疗效。方法本研究分为两个临床研究部分：首先,通过对179例2型糖尿病合并老年肺炎患者进行现况调查,利用中医证候信息调查表,收集临床症状及四诊信息,比对证候要素诊断标准,经统计分析,探索本病的症状、舌脉、证候要素、证型等的分布规律。其次,采用病例随机对照研究的方法,检验芪银三两三方治疗2型糖尿病合并老年社区获得性肺炎的疗效。结果1.179例2型糖尿病合并老年肺炎的证候特点研究：发病季节以春、冬季为最多见；症状分析：发热情况普遍存在,但多数热势不高,为中等度热,多在37.3-38℃之间；以咳嗽痰少、夜间咳甚为常见。其中以痰黄、痰粘难咯为常见。大便干,口渴欲饮,纳差,喘憋及气短乏力是消渴病基础上风温肺热病的主要伴随症状；舌象：舌质暗、苔黄腻较多见；脉象以弦脉系最常见,其次为滑脉、细脉。中医证候分析：按单证出现的频率统计,以痰热壅肺、气阴两虚证出现较高；其次是痰湿犯肺、风热犯肺、肺燥津伤、肺胃热盛；而热闭心包相对较少。复合证侯往往是在气阴两虚基础上出现痰热证、痰湿证、血瘀证等邪实证候。病位证素出现频率依次为：肺、脾、肾、肝、心。病性证素出现频率依次为：火热、气虚、阴虚、痰湿、血瘀、气滞、阳虚、血虚、燥。2.芪银三两三方治疗2型糖尿病合并老年社区获得性肺炎的临床观察：治疗7d后：治疗组有效率(68.3%)与对照组有效率(58.3%)比较,差异具有统计学意义(P<0.05)；治疗14d后：治疗组有效率(88.3%)与对照组有效率(71.7%)比较,差异具有统计学意义(P<0.05)。提示治疗7d及14d后治疗组疗效均优于对照组；治疗组发热、咳嗽、咯痰三种症状治疗前后积分差值与对照组比较,差异具有统计学意义(P<0.05)；胸闷痛症状积分差值比较差异无统计学意义(P>0.05)。提示治疗组对于发热、咳嗽、咯痰的改善程度优于对照组,但对于胸闷痛的改善程度无差异；治疗组证候评分改善率(93.4%)优于对照组(76.9%),两组差异具有统计学意义。结论1.2型糖尿病合并老年肺炎的病位证素出现频率依次为：肺、脾、肾、肝、心；病性证候要素按分布频率高到低为：痰热、气虚、阴虚、血瘀；最常见证型为：痰热瘀阻、气阴两虚。2.芪银三两三方治疗2型糖尿病合并老年社区获得性肺炎有效,且在改善主要症状及中医证候积分改善方面效果突出。更多还原

【Abstract】 ObjectiveIn this study, we tried to explore the distribution law of symptoms, tongue and pulse, syndrome elements of the Type 2 diabetic patients with senile pneumonia, so as to find out the key pathogenesis of this disease, and try to improve the standardization of the syndromes diagnosis.And further more, to verify the effects of type 2 diabetes with senile community-acquired pneumonia treated with Qiyin-Sanliangsan Fomula through a clinical study.MethodsThis study is divided into two clinical parts:1.A TCM syndrome information questionnaire was used to Collect the clinical symptoms and the four diagnostic information of 179 cases of the Type 2 diabetic patients with senile pneumonia. We compare the informations with the diagnosis standards of syndrome elements. After statistical analysis of those datas, we can summarize the distribution law of the symptoms, tongue and pulse manifestation, syndrome type and the syndrome elements of this disease.2.Through an randomized controlled clinical study of 60 cases of Type 2 diabetic patients with senile community-acquired pneumonia to verify the effects of Qiyin-Sanliangsan Fomula in treating type 2 diabetes with senile community-acquired pneumonia.Results1.Syndromes study based on the 179 cases of Type 2 diabetes with senile pneumonia:(1) The highest incidence season was in spring and winter. (2) Symptoms analysis:Fever often existed, but the level of fever was usally not high.The temperature was mostly between 37.3℃and 38℃; There was not much sputum while coughing, and cough was often getting worse at night. Yellow sputum was often seen, meanwhile, the sputum was viscosity and was difficult to come out. And other symptoms, such as dry stool, thirst, lack of appetite, wheezing, shortness of breath and fatigue were the main concomitant symptoms. Tongue manifestation:Dark tongue and yellow greasy moss were the most tongue manifestation.Pulse manifestation:Wiry pulse was the most common one, followed by slippery pulse and thread pulse.(3)TCM Syndrome analysis:The most common independent syndromes were Phlegm and heat obstructing the lung, and Insufficiency of both Qi and Yin, which followed by phlegm-damp obstructing the lung, Wind-heat attack the lung, Dryness of the lung fluid, exuberant heat of both the lung and the stomach, and Heat closure of pericardium was relatively less common. The most common composite syndromes were Phlegm-heat, Phlegm-damp and Blood stasis on the basis of Insufficiency of both Qi and Yin. The occurrence frequency of disease location were as follows:lung, spleen, kidney, liver, heart.The occurrence frequency of syndrome factor of disease nature were as follows: fire heat, qi deficiency, phlegm damp, blood stasis, qi stagnation, yang deficiency, blood deficiency, dry.2.Clinical observation in 60 cases of type 2 diabetes with senile community-acquired pneumonia treated by Qiyin-Sanliangsan Fomula:7 days after treatment:the difference of efficiency between treatment group (68.3%) and control group (58.3%) was statistically significant (P<0.05);14 days after treatment:the difference of efficiency between treatment group (88.3%) and control group (71.7%) was statistically significant (P<0.05) too.It shows that the efficiency of treatment group are better than the control group both in 7days and 14days treatment. After treatment, the symptom scores of heat, cough and expectoration significantly decreased, with a significant difference in the decrease of these three symptoms scores between the two groups (P<0.05);The symptom scores of chest pain was no significant difference (P>0.05).It shows that the improvement of treatment group was larger than the control group on the symptoms of fever, cough, expectoration. But there was no difference in the improvement of chest pain;The improvement rate of syndrome scores of the treatment group (93.4%) was better than the control group (76.9%), and the differences between these two groups was statistically significant.Conclusion1.The occurrence frequency of disease location from high to low were as follows:lung, spleen, kidney, liver, heart.The occurrence frequency of syndrome factor of disease nature from high to low were as follows:Phlegm heat, Qi deficiency, Yin deficiency, Blood stasis;The most common Syndrome type was:phlegm-heat stasis along with blood stasis, and Qi and Yin deficiency.2.Qiyin-Sanliangsan Fomula was effective in treatment of type 2 diabetes with senile community-acquired pneumonia, and it was prominent in improving the main symptoms and in the improvement rate of syndrome scores.更多还原