Abstract:

Objective To explore the correlation between the age, course of disease and pulmonary X-ray manifestation of multidrug-resistant pulmonary tuberculosis (MDR-PTB) patients and traditional Chinese medicine (TCM) syndrome elements, in order to guide TCM treatments. Methods All of 740 valid cases of MDR-PTB patients were surveyed ranging from 18 tuberculosis-designated hospitals, including Shanghai Pulmonary Hospital affiliated to Tongji University, Beijing Chest Hospital affiliated to Capital Medical University and the 8th Medical Center of Chinese PLA General Hospital, etc. Those patients were diagnosed between January, 2013 and December, 2015 and their course of diseases were all less than 6 months. As some patients’ clinical characteristics, such as age, course of disease, cavity and focal involvement, were insufficient, 615 cases were finally adopted. The survey questionnaire containing personal information of patients (name, gender, age, etc) was used, information also related to clinical treatments (previous symptoms, current symptoms, course of disease, cavity and focal involvement) and medical diagnosis. All the data was discussed and recognized by the panel participated in Drug-Resistant Tuberculosis of TCM Project during 12th-Five-Year Plan for Infectious Disease. One thousand pieces of questionnaire were offered, and 850 pieces returned back with information filled, while 740 pieces were eventually recognized as valid. The valid rate achieved 87.06%. SPSS 21.0 was used to analyze the data, in order to explored the correlation between different types of syndrome elements and these study objects mentioned above and their distribution. Results In this study, 5 types of TCM syndrome elements could be concluded according to their frequency: Yin deficiency (55.1% (339/615)), Qi deficiency (54.0% (332/615)), phlegm-turbidity (26.7% (164/615)), hyperactive fire (26.3% (162/615)), and Yang deficiency (15.0% (92/615)). The median age (M(Q₁,Q₃)) of patients developed with Qi deficiency, Yin deficiency and Yang deficiency were 40.0 (28.0,51.0), 40.0 (28.0,50.0) and 45.0 (28.0,53.0), respectively; all of them were significantly older than those of patients without the three TCM syndrome elements mentioned above (34.0 (25.0,47.0), 34.0 (26.0,48.0) and 36.0 (26.0,49.0), respectively) (Z=8.944, P=0.003; Z=8.043, P=0.005; Z=5.185, P=0.023). Furthermore, with their age grows, these patients were likely to suffer with severer Qi deficiency (lighter ones 38.0 (28.0, 51.0); severer ones 45.0 (29.0, 53.0)) (Z=6.350, P=0.042). Both the courses of disease of patients with Qi deficiency and Yang deficiency (averaged 24.0 (8.0, 60.0) and 28.0 (11.0,68.0) months, respectively) and their diameters of biggest cavity (averaged 1.5 (0.0, 3.0) and 1.5 (0.0, 3.0) cm, respectively) were significantly longer than those of patients without Qi and Yang deficiency (courses of disease: 18.0 (5.0, 39.8) and 18.0 (6.0, 48.0) months, respectively; diameters of biggest cavity: 1.3 (0.0,2.4) and 1.5 (0.0, 2.6) cm, respectively) (Z=8.642, P=0.003; Z=17.954, P<0.001; Z=4.191, P=0.041; Z=6.709, P=0.010). Additionally, patients with longer course of disease tend to suffer with severer Qi deficiency and hyperactive fire (lighter ones 27.0 (8.5, 59.0) months, severer ones 28.0 (11.0, 72.0) months; lighter ones 12.5 (5.3, 39.3) months, severer ones 26.0 (12.0, 60.0) months)(Z=12.725, P=0.002; Z=6.997, P=0.030). As to the rates of cavity, patients with hyperactive fire (79.6% (129/162)) were much higher than those without the syndrome elements (70.0% (317/453)) (Z=4.869, P=0.031). Conclusion MDR-PTB patients with Yin deficiency are the majority. It is helpful to guide TCM treatment by discerning and analyzing the correlation between clinical characteristics, such as age, course of disease and occurance rate of cavity as well as its biggest diameter, and the TCM syndrome elements.

Key words: Tuberculosis,pulmonary, Tuberculosis,multidrug-resistant, Disease attributes, Medicine,Chinese traditional, Traditional Chinese medicine synbrome elements