慢阻肺急性加重期合并症中医证候及病情关联的横断面研究
Journal: Frontiers of Chinese Medicine Research DOI: 10.32629/fcmr.v8i2.20944
Abstract
慢性阻塞性肺疾病急性加重(AECOPD)是导致患者预后不良的关键事件,常合并多种疾病,但合并症对其中医证候特征的影响尚不明确。本研究旨在系统探讨合并症对AECOPD患者中医证候分布及与病情严重程度关联性的影响。采用横断面调查,纳入300例AECOPD患者,收集人口学、合并症、病情严重程度(CAT、EXACT-PRO评分)及中医四诊信息。运用卡方检验、方差分析及多因素回归比较组间差异,并采用系统聚类和Apriori关联规则进行数据挖掘。结果显示,伴有合并症组(n=210)的CAT评分(24.5±6.2vs.18.3±5.1,P<0.001)、EXACT-PRO评分(45.8±10.7vs.35.2±9.4,P<0.001)及中重度急性加重比例(76.2%vs.51.1%,P<0.001)均显著高于无合并症组(n=90)。中医证候分布差异显著：无合并症组以痰热内蕴(42.2%)等邪实证为主,而合并症组则以肺肾气阴两虚兼痰瘀互阻(38.1%)等虚实夹杂证为主,且证候复杂程度(以复合证型数量计)与急性加重严重程度呈正相关(r=0.67,P<0.001)。聚类分析识别出四个临床亚型(如气虚痰瘀型伴心血管病,占比28.6%),关联规则挖掘出强关联(如“心血管疾病+舌质紫暗→痰瘀互阻证”,支持度18.3%,置信度82%)。多因素分析证实心血管疾病(OR=2.45,95%CI:1.52-3.95)、焦虑/抑郁(OR=1.98,95%CI:1.21-3.24)及心肾阳虚等证型(OR=3.12,95%CI:1.85-5.26)是急性加重严重的独立危险因素。结论：合并症是塑造AECOPD期中医证候由实转虚、由单一变复杂的关键因素,并与病情严重程度密切相关。基于“合并症-证型”的风险分层模型有助于实现个体化中西医结合诊疗。未来需多中心前瞻性研究验证,并整合多组学数据深入探索其生物学机制。
Keywords
慢性阻塞性肺疾病急性加重；合并症；中医证候；数据挖掘；病情严重程度
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