节点文献
感冒后咳嗽治疗措施与疗效相关因素研究
【作者】 江芳超；
【导师】 李友林；
【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 博士
【摘要】 咳嗽是多种基础病引发的常见的内科疾病症状；属机体清除呼吸道分泌物和有害因子的防御反射；频繁剧烈的咳嗽对患者的工作、生活和社会活动造成严重的影响。当感冒本身急性期症状消失后,咳嗽仍然迁延不愈,临床上称为感冒后咳嗽。除了呼吸道病毒外,其他呼吸道感染亦可能导致此类迁延不愈的咳嗽,有文献统称为感染后咳嗽。目前,对于感冒后咳嗽疗效影响因素的研究较少见,本研究对其进行探讨并初步分析不同治疗措施的疗效。目的总目的采用多中心、开放式、前瞻性、队列研究的方法,通过对感冒后咳嗽主要疗效相关因素的调查,运用多元回归分析方法进行数据挖掘,总结感冒后咳嗽疗效的主要影响因素。并初步比较不同治疗措施对疗效的影响,为制定感冒后咳嗽的临床决策提供依据。具体目的理论研究：通过文献研究和专家共识,总结感冒后咳嗽疗效的可能关联因素,为临床研究提供依据。临床研究：通过临床研究,总结感冒后咳嗽的主要影响因素,并初步比较不同治疗措施对疗效的影响。方法1.理论研究方法1.1文献研究：借鉴系统综述的方法,查阅1989年至2011年5月中国学术期刊网数据库、维普中文科技期刊数据库和万方数据库中咳嗽疗效关联因素的中西医文献,总结咳嗽疗效关联因素。1.2专家共识：采用定性定量研讨厅体系和层次分析法,进行专家共识,.补充文献研究的不足,所得结果与文献研究结果共同做为问卷设计的依据。2.临床研究方法2.1治疗措施与疗效的相关性研究：采用多中心、开放式、前瞻性的设计方法,通过现场问卷调查收集初诊患者信息；通过现场问卷调查和电话随访相结合的方法,收集患者服药后病情变化等相关资料,运用多元回归的方法,将所采集的数据进行挖掘,总结出感冒后咳嗽疾病疗效的主要影响因素,并依据得到的结果分析治疗措施与疗效的相关性,同时进行不同措施的疗效比较。2.2其他因素与疗效的相关性研究：依据得到的结果分析其他因素与疗效的相关性,并分析其对疗效的影响。结果1.理论研究结果1.1文献研究：共获得363篇以中文发表的文章,患者39.813名。文献中涉及的关联因素包括：性别、年龄、病程、病情、血常规、胸片检查结果、咳嗽的中医证候积分、咳嗽的症状等级、患者既往史及痰培养结果等,其中涉及最多的为性别、年龄、病程、病情。1.2专家共识：共识结果：文献研究所得到的相关因素在临床研究条件允许的情况下,应全面收集；同时应考虑到疾病(感冒后咳嗽)严重程度、患者既往病史、家族史、个人过敏史等情况和不同干预措施对疗效的影响。2.临床研究结果2.1完成病例情况及初步分析结果：本研究共完成病例397例,其中男性115例,占28.97%,女性282例,占71.03%；患者平均年龄46.99±15.74岁；平均病程25.62±13.44天。2.2感冒后咳嗽疗效的主要影响因素分析结果：主要影响因素包括治疗措施、年龄、病程和性别。2.3治疗措施对疗效的影响：辨证论治中药汤剂组、中成药组和单纯西药组治疗后与治疗前相比,咳嗽症状及生命质量均得到改善,差异有统计学意义(P<0.05)。因性别对疗效有影响且三组性别有统计学差异(P<0.05),故以性别进行分层分析：治疗后三组女性患者相比(咳嗽症状积分表总分、视觉模拟评分总分和LCQ总分),中药汤剂组改善最明显,差异有统计学意义(这P<0.05)；治疗后三组男性患者相比(咳嗽症状积分表总分、视觉模拟评分总分),中药汤剂组改善最明显,差异有统计学意义(P<0.05)；三组男性LCQ总分相比,差异无统计学意义(P>0.05)。2.4其他因素对疗效的影响：治疗措施为辨证论治中药汤剂时,多元回归结果显示,年龄、病程和性别对感冒后咳嗽疗效有影响。结论1.感冒后咳嗽是临床常见病、多发病,女性患者比例高于男性；感冒后咳嗽可见于任何年龄段,中年患者发生的比例更高。2.治疗措施是药物治疗感冒后咳嗽疗效的最主要影响因素,年龄、病程和性别亦影响感冒后咳嗽的疗效。3.对于感冒后咳嗽患者,辨证论治中药汤剂、中成药和西药均有较好疗效；其中三组相比,辨证论治中药汤剂为最佳治疗手段。4.当治疗措施是辨证论治中药汤剂时,年龄、病程和性别则是感冒后咳嗽疗效的主要影响因素。
【Abstract】 Cough is a common symptom caused by many diseases in internal medicine. The quality of life and social activities in many patients coule be disturbed by frequent and severely cough.When the cold symptoms disappeared after the acute phase itself, cough still in, and it be called postinfectious cough. Many respiratory infections may cause cough in addition to the respiratory virus. At present, postinfectious cough curative effect factors is rare, and we’re wondering the curative effect factors of postinfectious cough and explore the curative effect in different treatment measures.ObjectiveThrough observation of the treatment effect factors in postinfectious cough, the cohort-study method was used, the multiple linear regression analysis was applied to summarize the treatment effect factors and preliminary probe the effect of different treatment measures, so as to provide some references in improving the curative effect of postinfectious cough.Theoretical study:Summarizes the associated curative effect factors of postinfectious cough, and to provide basis for clinical research through the literature research and the expert consensus.Clinical study:Summarizes the main influence factors of postinfectious cough, and compare the effect in different treatment measures.Methods1. The methods of theoretical study:1.1 Literature research:Relevant literature on postinfectious cough in Chinese and Western medicine were reviewed, so as to summarize the treatment effect factors.1.2 Expert consensus:Hall for workshop of metasynthetic engineering and Analytic Hierarchy Process methods were used to add the deficiency of the literature research. The results and literature research results were theorical and practical experience supports for CRF design.2. The methods of clinical study:The multiple-centers, open design, prospective observational, cross-sectional study methods were used. And site questionnaire was applied to collect information of the first clinic patients. Site questionnaire and follow-up phone calls combined to collect information about posttreatment of postinfectious cough.Comparison in the group and comparison among groups before and after treatment, and multiple regression analysis were used for statistical analysis of the collected data to study and summarize the effectiveness in postinfectious cough. Meanwhile we compared the differences of therapeutic efficacy of the three methods in the treatment of postinfectious cough.Results1. The results of theoretical study:1.1 The results of literature research:We obtained 363 articles published in Chinese articles, contained 39.813 patients. The associated factors included gender, age, course, the severity of PIC, routine blood test, X ray, past medical history and sputum cultures results.etc.1.2 The results of expert consensus:We should collect patients information as much as possible.2. The results of clinical study:2.1 A total of 397 cases of patients were observed in the study of effectiveness of postinfectious cough, including 115 males and 282 females; mean age of 46.99±15.74 years; and mean course of 25.62±13.44 days.2.2 Age, course, therapeutic measures and gender were factors related to the therapeutic effect of postinfectious cough.2.3 Cough symptoms and quality of life were improved compared with treatment before in 3 groups, with significant difference (P<0.05). Stratified analysis by gender:After treatment, the female cough symptoms(Cough symptom scores, VAS and total score of LCQ) improved in Chinese traditional medicine group, better than Chinese medicine group and Western medicine group, with significant difference (P<0.05). The male cough symptoms(Cough symptom scores, VAS) improved in Chinese traditional medicine group, better than Chinese medicine group and Western medicine group, with significant difference (P<0.05). The male cough symptoms were not obvious difference in total score of LCQ.2.4 Age, course and gender were factors related to the Chinese traditional medicine of therapeutic effect in postinfectious cough.Conclusions1. Clinically, postinfectious cough is a common syndrome, with a higher incidence in females. Postinfectious cough can be found in all age groups, with the highest incidence in middle-aged group. Most of postinfectious cough duration was less than 8 weeks, it can affect the quality of life of patients in different degrees, especially in female.2. Age, course, therapeutic measures and gender were factors related to the therapeutic effect of postinfectious cough.3. Chinese traditional medicine, Chinese patent medicine and Western medicine had significant effect for treating postinfectious cough, Chinese traditional medicine was the best treatment.4. Age, course and gender were factors related to the Chinese traditional medicine of therapeutic effect in postinfectious cough.