【作者】 胡旭贞；

【导师】 池逊；

【作者基本信息】 广州中医药大学 ， 中医呼吸内科学， 2006， 硕士

【摘要】 研究背景 COPD是老年人的常见病和多发病。随着人们平均寿命的延长和人口老龄化趋势的日渐显著，COPD以其患病人数多、复发率高、死亡率高、治疗棘手、社会经济负担重等特点，已逐渐成为困扰诸多医家和患者的重要的公共卫生问题。目前对于本病西医尚缺乏有效的特异性治疗药物。中国传统医学认为本病属“肺胀”范畴，治疗上有独到的优势，但由于中医药传统诊疗方法侧重于宏观性、整体性和直观性，所以中医证候诊断的确立具有一定的主观性和模糊性，临床上缺乏公认客观的辨证分期分型标准，因此中药对其的综合疗效优势不能得到公认，且制约了对其的进一步研究。因此探讨COPD急性加重期中医证型的分布规律及动态演变规律，确立统一、规范、量化、客观的辨证标准，从而为中医药辨证论治提供临床依据具有重大意义。 研究目的 运用临床流行病学的方法，统计分析COPD急性加重期中医证候(症状及证型)的分布规律，探讨COPD急性加重期客观、动态且能被国内外学者所接受和采纳的中医宏观辨证标准及分级标准，为中医药辨证论治提供临床依据，并为该病的中医分型量化诊断和中医疗效评价提供相对规范的初步标准。 研究方法 1．文献调研、临床观察收集古今相关文献，对国家行业标准、规范教材及著作、有关文献中COPD急性加重期的证候分类进行证候信息的采集、整理、归纳，并参考权威标准和专家咨询论证，统计分析其证候分布，构建COPD急性加重期中医证候调查表，并进一步临床病例试用对该调查表做初步论证。按正式调查表分别在广东省中医院及广东省人民医院开展临床调研。 2．统计学方法数据分析在SPSS13.0统计分析软件包上进行。COPD急性加重期临床资料分布研究及中医证型、症状的分布研究采用描述性统计方法；临床病例证候分型分析采用样品聚类分析，并进行证型下的四诊指标频数的描述性分析，采取频数归一划权重，正态性检验、百分位数法进行证候诊断阈值及分级标准计算。 研究结果 1．文献研究COPD急性加重期中医证候分布特点：气喘、咳嗽、咳痰、胸闷所占频数最多，其构成比波动于3.4％～11.2％之间，为本病的四大主症；其次为水肿、紫绀、心悸三症，其构成比波动于1.3％～1.4％之间，与上述四症共同构成COPD急性加重期的七大证候特征。舌暗红或舌淡暗、苔黄腻或苔白腻，脉滑、脉数、脉细、脉弦等为本病的主要舌脉象，其构成比波动于3.9％～9.5％之间。 2．临床研究COPD急性加重期患者的基本特点：本病好发于中老年男性、低学历(小更多还原

【Abstract】 BackgroundCOPD is the common diseases of older persons. With the extended life expectancy and the ageing of the population trends are significant, COPD has gradually become the important public health issue which afflicts many doctors and patients because of its characteristics of high morbidity, relapse rate, mortality rate, and its treatment difficulty, heavy socio-economic burden, e. t.c. So far there have been no effective and specificit treatments of Western medicine for the disease. While there are exceptional advantages of Traditional Chinese Medicine (TCM) treatments for COPD, which is named "lung-distention" by TCM. But the integrated efficacy of TCM treatments for COPD has been not recognized, and its further studies are constrained. The reason is that the macro, holistic and visualization of TCM diagnosis and treatment methods lead to a certain subjectivity and ambiguity of syndromes diagnosis establishment, which result in the lack of accepted and objective differential diagnosis standards. Therefore it is important to explore syndromes distribution and dynamic evolution laws of Acute Exacerbations of COPD, and establish uniform, standardized, quantitative, objective standard, which can provide clinical basis for Selection of treatment based on the differential diagnosis. ObjectiveUsing clinical epidemiological methods to count up and analyze syndromes distribution of Acute Exacerbations of COPD, and explore objective, dynamic and acceptive differential diagnosis standards and classification standards, which can provide both clinical basis for Selection of treatment based on the differential diagnosis and canonical primary standards for TCM sub-type quantification diagnosis and efficacy evaluation.更多还原