611 例肺结节患者的中医证候特征与证素组合规律分析

Analysis of Traditional Chinese Medicine Syndrome Characteristics and Syndrome Element Combination Patterns in 611 Patients with Pulmonary Nodules

摘要:

目的：分析肺结节患者的中医证候特征及证素分布组合规律，为阐明核心病机及证治提供依据。方法：收集611例肺结节患者的临床数据，分析病位病性证素的分布特征、组合规律、系统聚类及关联规则。结果：患者男女比例为1∶1.38，年龄以51～60岁、31～40岁高发；影像学特征以多发性（71.19%）、小结节（60.07%）、磨玻璃密度（73.32%） 为主，多位于右肺上叶（28.64%）。高频证候为咳嗽（49.10%）、脉滑（48.77%）、苔白（47.79%）、舌淡（47.46%）、舌红（41.24%） 等。证素分布： 病位以肺（54.17%）、脾（22.91%）、肝（22.42%） 为主；病性以痰（45.83%）、气滞（43.86%）、血瘀（32.90%）、阴虚（32.73%）为主。病位组合：单病位237例（肺为主，71.73%），双病位108例（肺-肝为主，31.48%），三病位73例（肺-脾-胃为主，21.92%），四病位及以上26 例（以肺-脾-肝-胃为主）。病性组合：单病性91 例（痰为主，36.36%），双病性90例（气滞-血瘀为主，22.22%），三病性86例（痰-气滞-血瘀为主，19.77%），四病性69例（痰-气滞-血瘀-湿为主，10.14%），五病性44例（痰-阴虚-热-气虚-血虚为主，13.64%），虚实夹杂证247例占比最高。关联规则获得肝-气滞（置信度0.89）、肺-痰（支持度0.46） 等10对核心组合（P＜0.001）。聚类分析分为痰浊阻肺、肝郁气滞（化火、阴虚、血瘀）、脾肾阳虚（气血两虚） 三类。主要证型有肝郁脾虚证、气滞痰凝证、痰瘀互结证、气虚痰凝证、脾肾阳虚证、气阴两虚证。结论：肺结节属本虚标实之证，病机以肺脾肾虚为本，以肝郁气滞、痰凝血瘀、痹阻肺络为标，兼见气郁化火伤阴。

Abstract:

Abstract： Objective： To analyze the distribution of the traditional Chinese medicine （TCM） syndrome characteristics and combination patterns of syndrome elements in patients with pulmonary nodules， thus providing a basis for elucidating the core pathogenesis and guiding syndrome-based treatment. Methods ： Clinical data from 611 patients with pulmonary nodules were collected to analyze the distribution characteristics， combination patterns， systematic clustering， and association rules of syndrome elements related to disease location and disease nature. Results ： The male-to-female ratio was 1：1.38， with the highest incidence in the age groups of 51-60 years and 31-40 years. Imaging features were predominantly multiple nodules （71.19%）， small nodules （60.07%）， and ground-glass opacities （73.32%）， most commonly located in the right upper lobe （28.64%）. High-frequency TCM syndromes included cough （49.10%）， slippery pulse （48.77%）， white tongue coating （47.79%）， pale tongue （47.46%）， and red tongue （41.24%）. Distribution of syndrome elements： the main disease locations were lung （54.17%）， spleen （22.91%）， and liver （22.42%）； the main disease natures were phlegm （45.83%）， qi stagnation （43.86%）， blood stasis （32.90%） ， and yin deficiency （32.73%）. Combinations of disease locations ： single-location in 237 cases （lung predominant， 71.73%）， dual-location in 108 cases （lung-liver predominant， 31.48%）， triple-location in 73 cases （lung-spleen-stomach predominant，21.92%），and quadruple or more locations in 26 cases （lung-spleen-liver-stomach predominant）. Combinations of disease natures： single-nature in 91 cases （phlegm predominant， 36.36%）， dual-nature in 90 cases （qi stagnation-blood stasis predominant， 22.22%）， triple-nature in 86 cases （phlegm-qi stagnation-blood stasis predominant， 19.77%）， quadruple-nature in 69 cases （phlegm-qi stagnation-blood stasis-dampness predominant， 10.14%）， quintuplenature in 44 cases （phlegm-yin deficiency-heat-qi deficiency-blood deficiency predominant，13.64%）. Intermingled deficiency and excess syndrome accounted for the highest proportion （247 cases）. Association rule analysis yielded 10 core combinations，including liver-qi stagnation （confidence 0.89） and lung-phlegm （support 0.46） （P＜0.001）. Cluster analysis identified three categories： phlegm turbidity obstructing the lung； liver depression and qi stagnation （with fire transformation， yin deficiency， blood stasis）； and spleen-kidney yang deficiency （with deficiency of qi and blood）. The main syndrome types were liver depression and spleen deficiency， qi stagnation and phlegm coagulation， phlegm blended with blood stasis， qi deficiency and phlegm coagulation， spleen-kidney yang deficiency，and deficiency of qi and yin. Conclusion：Pulmonary nodules represent a syndrome of deficiency in origin and excess in superficiality. The pathogenesis is rooted in deficiency of the lung， spleen， and kidney， with manifestations including liver depression and qi stagnation， phlegm coagulation and blood stasis， obstruction of the lung collaterals，as well as qi constraint transforming into fire and injuring yin.