涪陵城区冬春季COPD急性加重期的中医证候分布特征

Distribution Characteristics of Traditional Chinese Medicine Syndromes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) during Winter and Spring in Fuling District

摘要: 目的：探讨重庆涪陵城区在冬春季节期间，慢性阻塞性肺疾病急性加重期患者的中医证候分布规律及特征，为本地区该病的辨证论治及季节性防治提供临床依据。方法：选取2024年1月~2025年3月涪陵人民医院收治的AECOPD患者700例，记录患者的一般资料及中医四诊信息。依据相关中医诊疗共识将证候分为风寒束肺、外寒内饮、痰热壅肺、痰湿阻肺、肺虚、肺脾气虚、肺肾气虚、肺肾气阴两虚、血瘀、痰蒙神窍等主要证型，由两名副高及以上职称的中医专家进行辨证分型指导。采用描述性统计学方法分析各证型的分布特征。结果：本研究共纳入700例AECOPD患者，男性占73%，平均年龄(73.15 ± 11)岁，60岁以上者占84.57%，平均病程(12.02 ± 10)年。中医证候分布分析显示，痰热壅肺证(306例，43.71%)与痰湿阻肺证(149例，21.29%)为主要证型，二者合计占比64.99%。其余证型依次为肺脾气虚证(9.71%)、肺肾气阴两虚证(7.29%)、肺肾气虚证(5.86%)、风寒束肺证(4.14%)、血瘀证(3.43%)、外寒内饮证(2.57%)、肺虚证(1.57%)及痰蒙神窍证(0.43%)。影响因素分析发现，高龄是本病的主要人群特征；气候因素中，低温与肺脾气虚、痰瘀阻肺证相关，而干燥与气阴两虚、痰热瘀肺证相关(P < 0.05)；有粉尘职业暴露史的患者更易出现肺脾气虚与痰热壅肺证。结论：涪陵城区冬春季节慢性阻塞性肺疾病急性加重期的中医证候分布具有明显特征，以痰浊阻肺和痰热壅肺为主要证型，可能与本地区冬春季节气候潮湿寒冷的特点有关。临床诊疗中应重视化痰、清热法的运用，并针对不同证型制定个体化的防治策略。

Abstract: Objective: To explore the distribution and characteristics of Traditional Chinese Medicine (TCM) syndromes in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in the urban area of Fuling, Chongqing during the winter and spring seasons, and to provide clinical evidence for the diagnosis and treatment of this disease and seasonal prevention and treatment in this region. Method: 700 patients with AECOPD admitted to Fuling People’s Hospital from January 2024 to March 2025 were selected, and their general information and traditional Chinese medicine diagnosis information were recorded. According to the consensus of relevant traditional Chinese medicine diagnosis and treatment, the syndrome is divided into main types such as wind cold binding the lungs, external cold and internal drink, phlegm heat obstructing the lungs, phlegm dampness obstructing the lungs, lung deficiency, lung spleen qi deficiency, lung kidney qi deficiency, lung kidney qi yin deficiency, blood stasis, and phlegm blocking the divine orifice Use descriptive statistical methods to analyze the distribution characteristics of each syndrome type. Result: A total of 700 AECOPD patients were included in this study, with 73% being male and an average age of (73.15 ± 11) years. 84.57% were over 60 years old and had an average disease course of (12.02 ± 10) years. The distribution analysis of traditional Chinese medicine syndromes shows that phlegm heat obstructing the lungs syndrome (306 cases, 43.71%) and phlegm dampness obstructing the lungs syndrome (149 cases, 21.29%) are the main syndrome types, accounting for a total of 64.99%. The remaining syndrome types are, in order, lung spleen qi deficiency syndrome (9.71%), lung kidney qi yin deficiency syndrome (7.29%), lung kidney qi deficiency syndrome (5.86%), wind cold bundle lung syndrome (4.14%), blood stasis syndrome (3.43%), external cold and internal drinking syndrome (2.57%), lung deficiency syndrome (1.57%), and phlegm obscuring the divine orifice syndrome (0.43%). Analysis of influencing factors revealed that advanced age is the main demographic characteristic of this disease; Among climatic factors, low temperature is associated with lung spleen qi deficiency and phlegm blood stasis obstructing lung syndrome, while dryness is associated with qi yin deficiency and phlegm heat blood stasis lung syndrome (P < 0.05); Patients with a history of occupational exposure to dust are more likely to develop lung spleen qi deficiency and phlegm heat obstructing the lungs. Conclusion: The distribution of traditional Chinese medicine syndromes in the acute exacerbation stage of chronic obstructive pulmonary disease in the winter and spring seasons of Fuling urban area has obvious characteristics, with phlegm turbidity obstructing the lungs and phlegm heat obstructing the lungs as the main syndrome types, which may be related to the humid and cold climate in the local winter and spring seasons. In clinical diagnosis and treatment, attention should be paid to the use of phlegm-resolving and heat-clearing methods, and individualized prevention and treatment strategies should be developed for different syndrome types.