【作者】 朱玉龙；

【导师】 李风森；

【作者基本信息】 新疆医科大学 ， 中医内科学， 2010， 硕士

【摘要】 目的：通过对特发性肺间质纤维化患者的中医证型、凝血功能、血液流变学、D-2聚体等指标进行深入的观察和检测,总结并分析肺间质纤维化患者中医证型分布特点及其与血液流变学、凝血功能和D-2聚体的相关性,为该病的证.治研究提供思路。方法：采用问卷调查表形式,收集120例特发性肺间质纤维化患者为病例组,128例正常人为对照组,对临床表现(四诊合参)进行记录,并检测其凝血功能、血液流变学、D—2聚体等指标。对所收集的数据以统计学处理,以P<0.05作为有统计学意义的标准。结果：1.120例特发性肺间质纤维化患者中男性80例、女性40例,男女比例为2：1。年龄38-89(68.30±10.15)岁,汉族101例,少数民族19例,病史1-8(3.94±1.47)年。中医诊断肺痿90例、肺痹12例、咳嗽10例、喘证8例。2.120例病患中挟感发作期患者51例,其中阴虚燥热伤肺型40例,痰瘀阻肺型7例,痰热壅肺型2例,气虚风寒犯肺型2例,慢性迁延期46例,其中男性27例(58.70%),女性19例(41.30%)。其中气阴两虚瘀喘型39例,气阴两虚痰喘型7例。重症多变期23例,其中男性20例(86.96%),女性3例(13.04%).其中阴阳两虚型14例,阳虚水泛型9例。三期均提示男性发病率高于女性,但三期之间性别分布无显著性差异。3.病例组全血粘度1、全血粘度5、全血粘度30、全血粘度200、血浆黏度、红细胞压积数值均高于对照组(均为P<0.01)。全血粘度1、全血粘度200、血浆粘度、红细胞压积与挟感发作期、慢性迁延期、重症多变期分期呈正相关,全血粘度1、全血粘度5、红细胞压积与阴虚燥热伤肺型、气阴两虚瘀喘型、阴阳两虚型此三个证型呈正相关。4.病例组凝血酶原时间PT、凝血酶时间测定TT和活化部分凝血酶原时间均低于对照组(均为P<0.01),FIB高于对照组(P<0.01),病例组D-二聚体阳性数和对照组的阳性率相比,差异具有统计学意义(P<0.01)。PT、TT与挟感发作期、慢性迁延期、重症多变期分期呈负相关,FIB、D-二聚体与分期呈正相关；PT、TT与阴虚燥热伤肺型、气阴两虚瘀喘型、阴阳两虚型呈负相关,FIB与此三个证型呈正相关；而D-二聚体与分期及此三型都呈正相关。结论：特发性肺间质纤维化的中医诊断以肺痿为主,主要证型为阴虚燥热伤肺型,气阴两虚瘀喘型；该病呈现高血凝,高粘滞变化特点,即“瘀”是特发性肺间质纤维化的主要发病特点之一；高龄和男性是危险因素；“气阴两虚”为本,“瘀”为标是其主要病机,因此,治疗时应该注意益气养阴活血序贯始终。更多还原

【Abstract】 Objective:Revealed to patients in our hospital in Urumqi, represented by idiopathic pulmonary fibrosis TCM Distribution and blood rheology, coagulation, and D-2 polymer, as well as the correlation between the two, theevidence of disease-entry point for governance research and ideas.Method:Questionnaire forms were used to collect 120 cases of idiopathic pulmonary fibrosis patients as case group and 128 cases of normal control group, the clinical performance (combination of all) were recorded, and to detect its coagulation, Hemorheology, D-2 polymer were measured.The collected data to statistical analysis to P<0.05 as statistically significant criteria.Result:1.120 patients with idiopathic pulmonary fibrosis patients, male 80 cases,40 cases of female to female ratio was 2:1.Age 38-89 (68.30±10.15) years old, Han 101 patients,19 cases of ethnic minorities, history 1-8 (3.94±1.47) years.TCM diagnosis Feiwei 90 cases,12 cases of lung paralysis, cough in 10 cases,8 cases of asthma card.2.120 cases of patients who rely on 51 patients a sense of attack, in which the lung yin deficiency heat injury 40 cases,7 cases of type of lung phlegm, phlegm obstruct the lung in 2 cases,2 cases Qi Fanfei cold, chronic PERSISTING46 cases including 27 males (58.70%),19 females (41.30%). myasthenia varied in 23 cases, including 20 males (86.96%),3 females (13.04%). three men were prompted to diseasethan women, but gender distribution between three were no significant differences 3. Whole blood viscosity of patients 1,5, whole blood viscosity, whole blood viscosity 30,200 whole blood viscosity, plasma viscosity and hematocrit values were higher (all P<0.01).And whole blood viscosity 1,200 whole blood viscosity, plasma viscosity, hematocrit was correlated with the stage, while only plasma viscosity, hematocrit was associated with syndromes.4.Patient group prothrombin time PT, thrombin time TT and the determination of activated partial thromboplastin time were lower than the control group (all P<0.01), FIB control group (P<0.01), D- polymer case groupPOSITIVE number and positive rate than the control group, the difference was statistically significant (P<0.01).PT, TT was negatively correlated with the stage, FIB was positively correlated with the stage; only FIB was positively correlated with the syndrome; and D-polymer and staging classification were tested positive.Conclusion:Idiopathic pulmonary fibrosis diagnosis in Chinese medicine mainly to Fei Wei, the main deficiency syndrome heat injury to the lung type, Qi and Yin Deficiency stasis type.diopathic pulmonary fibrosis showed high HA, high-viscosity change of the characteristics of "stasis" is idiopathic pulmonary fibrosis one of the main disease characteristics. I senior citizens, men with idiopathic pulmonary fibrosis risk factors. "Yin Deficiency" oriented, "stasis" as the objective is to idiopathic pulmonary fibrosis of the main pathogenesis, treatment should be noted that sequential always nourishing blood.更多还原