摘要
目的回顾性分析抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)肺受累患者的症状、证候分布特点,并探索其病因病机。方法收集2014年5月—2019年10月经笔者所在医院首次确诊为AAV肺受累住院患者的中医四诊信息和辨证资料,进行回顾性分析。结果21例AAV肺受累患者肺系症状出现频率较高的依次为咳嗽(21/21,100%)、咳痰(19/21,90.5%)和短气(17/21,81.0%);肺外症状以发热(13/21,61.9%)、肌肉关节疼痛(12/21,57.1%)、乏力(10/21,47.6%)和纳呆(10/21,47.6%)为主。活动期肌肉关节疼痛发生率(10/13,76.9%)高于稳定期(2/8,25%),差异有统计学意义(P<0.05)。中医证候类型出现频率较高的前5位依次为湿邪侵袭(52.4%)、肺气虚(47.6%)、痰湿内阻(38.1%)、脾气虚(33.3%)和肾气虚(33.3%)。活动期湿证(11/13,84.6%)出现频率高,稳定期血瘀证(4/8,50.0%)出现频率高(P<0.05)。湿邪侵袭证与伯明翰系统性血管炎活动评分(BVAS)、红细胞沉降率(ESR)的升高有关(P<0.05)。病因主要为湿、痰、热和血瘀。基本病机为正虚和标实两方面,肺、脾、肾三脏虚损为本,痰、湿、热、瘀为标。肺、脾、肾是其主要病位。结论AAV肺受累的临床症状复杂多样,虚实夹杂。基本病机为正虚和邪实两方面,肺、脾、肾三脏是其主要病位。
Objective To analyze the TCM syndromes and syndrome characteristics of patients with pulmonary injury of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV),and explore its etiology and pathogenesis.Methods The four-diagnosis information and syndrome differentiation data of the hospitalized patients diagnosed with lung injury due to AAV for the first time,were collected from May 2014 to October 2019,and retrospectively analyzed.Results In this study,the high frequency of pulmonary symptoms was cough(21/21,100%),expectoration(19/21,90.5%)and shortness of breath(17/21,81.0%);the main extrapulmonary symptoms were fever(13/21,61.9%),muscle and joint pain(12/21,57.1%),fatigue(10/21,47.6%)and anorexia(10/21,47.6%).The incidence of muscle and joint pain in the active period(10/13,76.9%)was higher than that in the stable period(2/8,25%),with a statistical difference(P<0.05).The top 5 most high frequent types of syndromes were dampness invasion(52.4%),lung-qi deficiency(47.6%),internal phlegm dampness accumulation(38.1%),spleen-qi deficiency(33.3%)and kidney-qi deficiency(33.3%).The frequency of dampness syndrome(11/13,84.6%)was higher in the active period,and the frequency of blood stasis syndrome(4/8,50.0%)was higher in the stable period(P<0.05).Among them,dampness invasion syndrome was related to the increase of Birmingham Vasculitis Activity Score(BVAS)and erythrocyte sedimentation rate(ESR),and the difference was statistically significant(P<0.05).The main causes were dampness,phlegm,heat and blood stasis.The basic pathogenesis is rightness deficiency and evil excess.The deficiency of lung,spleen and kidney is the root,and phlegm,dampness,heat and blood stasis are the branches.Lung,spleen and kidney are the main regions of the disease.Conclusion The clinical symptoms of lung injury due to AAV are complex and diverse,mixed with deficiency and excess.The basic pathogenesis is deficiency and excess.Lung,spleen and kidney are the mainly affected regions.
作者
李雪
焦以庆
刘建
郭亚丽
王玉光
LI Xue;JIAO Yi-qing;LIU Jian;GUO Ya-li;WANG Yu-guang(Department of Respiratory Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China)
出处
《北京中医药》
2021年第7期685-689,共5页
Beijing Journal of Traditional Chinese Medicine
基金
首都卫生发展科研专项(首发2020-2-2233)。
关键词
抗中性粒细胞胞浆抗体相关性血管炎
肺受累
症状
证候
病因病机
ANCA-associated vasculitis
pulmonary injury
syndromes
syndrome characteristics
etiology and pathogenesis
