关键词: 结核,肺, 中医证候, 体层摄影术,X线计算机, 空洞, 疾病特征, 数据说明,统计, 因素分析,统计学

Abstract:

Objective To explore the correlation between different TCM syndromes of pulmonary tuberculosis and chest CT cavity characteristics, to provide objective evidence for pulmonary tuberculosis TCM syndrome differentiation. Methods A total of 173 new tuberculosis patients diagnosed in the department of tuberculosis, Shanghai Public Health Clinical Center from January 2019 to August 2019 were included. TCM medical history, clinical manifestations, tongue pulse and other information of the patients were collected for TCM syndrome identifying. Senventy-one patients were proved to be having tuberculous cavities by chest CT. Correlation between TCM syndrome types and the characteristics of tuberculosis cavities was analyzed. Chi-square test or Fisher’s exact test were used for univariate analysis. Multi-nomial logistic regression analysis was used for multivariate analysis, P<0.05 was considered statistically significant. Results Among the 173 patients, 89 cases (51.45%) were diagnosed by TCM as having pulmonary Yin deficiency (PYD) syndrome, 38 cases (21.96%) having hyperactivity of fire due to Yin deficiency (HFYD) syndrome, 37 cases (21.39%) having deficiency of Qi and Yin (DQY) syndrome, and 9 cases (5.20%) having deficiency of Yin and Yang (DYY) syndrome. Senventy-one patients with tuberculous cavities included 31 cases (43.66%) with PYD, 22 cases (30.99%) with HFYD, 15 cases (21.13%) with DQY, and 3 cases (4.22%) with DYY; Univariate analysis showed that patients with DQY had the highest incidence of exudation around the cavity, significantly higher than that of patients with PYD (χ²=4.870 P=0.027); For patients with syndrome of PYD,HFYD and DQY: median numbers of cavities were 2.00 (1.00,5.00),4.50 (1.00,8.25), 3.50 (1.75,8.50),(Z=2.952,P=0.229);Median volume of cavities were 1884.00 (435.50,5569.50), 7969.50 (2958.25,29710.00) and 3250.00 (1162.00,8492.00)mm ³,(Z=10.534,P=0.005); Median areas of cavities were 420.50 (191.75,753.00),888.00 (487.00,2283.00),572.00 (190.50,1264.50)mm², (Z=6.822, P=0.033); Median thickness of cavity walls were 3.00 (1.25, 4.00), 4.00 (3.13, 5.88) and 3.50 (2.50, 5.00)mm respectively, (Z=10.436, P=0.005).The volume, area and wall thickness of cavities in patients with HFYD were significantly higher than those with FYD (Z values were -17.017,-13.792 and -16.695, respectively; P values are 0.004, 0.027 and 0.004, respectively). Comparing shapes of cavities in different patients, the incidence of thin-walled cavities in PYD patients (74.19%, 23/31) was significantly higher than that in HFYD patients (31.82%, 7/22) for which difference was statistically significant (χ²=9.407, P=0.004).Multivariate analysis showed that exudation around cavity was an independent factor affecting the TCM classification of pulmonary tuberculosis syndromes (OR=0.238, 95%CI:0.076-0.741; P=0.013). Conclusion There are differences in characteristics of CT cavities between different TCM syndromes of pulmonary tuberculosis. In the stage of PYD of pulmonary tuberculosis, cavities were mainly thin-walled cavities, when they progressed to HFYD, cavity areas appeared to expand, and cavity walls gradually thickened. Exudation is more likely to occur around the cavity in DQY patients.

Key words: Tuberculosis,pulmonary, Chinese medicine syndromes, Tomography,X-ray computed, Cavity, Disease attributes, Data interpretation,statistical, Factor analysis,statistical