832例老年肺结核患者共病谱及核心中医证候的关联研究

doi:10.19982/j.issn.1000-6621.20260160

摘要/Abstract

摘要：

目的: 描绘老年肺结核患者共病谱特征,探讨其与核心中医证候的关联,并分析不同年龄、性别分层下的异同,为病证结合的个体化诊疗提供依据。方法: 采用回顾性分析方法,纳入2022年1月至2024年10月于浙江中医药大学附属丽水中医院住院的832例老年肺结核患者作为研究对象,通过电子病历系统收集人口学资料、中医证候及共病信息。分析共病谱分布及气阴两虚证、阴阳两虚证两种核心证候与共病的关联,并按年龄(60~69岁,70~79岁,≥80岁)和性别进行分层分析。结果: 832例研究对象中,共病患病率为64.66%(538/832),共病谱前3位依次为高血压[32.57%(271/832)]、呼吸系统疾病[29.57%(246/832)]和糖尿病[25.00%(208/832)],≥3种共病者占21.75%(181/832)。中医证候以气阴两虚证[39.30%(327/832)]和阴阳两虚证[25.36%(211/832)]为核心。与阴阳两虚证者相比,气阴两虚证患者合并糖尿病的比例更高[44.65%(146/327)对比28.44%(60/211);OR=2.030,95%CI: 1.400~2.944],合并呼吸系统疾病的比例也更高[44.65%(146/327)对比26.54%(56/211);OR=2.230,95%CI: 1.532~3.247];而合并慢性肾脏病的比例[3.67%(12/327)对比22.27%(47/211);OR=0.133,95%CI: 0.069~0.257]及恶性肿瘤的比例[6.73%(22/327)对比17.06%(36/211);OR=0.351,95%CI: 0.199~0.619]均明显低于阴阳两虚证者,且多病共存(≥3种)比例也更低[25.69%(84/327)对比34.12%(72/211);OR=0.667,95%CI: 0.460~0.968]。结论: 老年肺结核患者共病负担沉重,核心中医证候与特定共病存在明确关联,提示临床应依据“证-病”交互特征实施分层个体化干预。

关键词: 结核,肺, 老年人, 共病现象, 中医证候, 统计学分布

Abstract:

Objective: To characterize the comorbidity spectrum of elderly patients with pulmonary tuberculosis, explore its association with core traditional Chinese medicine (TCM) syndromes, and analyze differences across age and gender strata, so as to provide evidence for syndrome-disease integrated individualized management. Methods: A retrospective analysis was conducted. A total of 832 elderly patients with pulmonary tuberculosis hospitalized at Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from January 2022 to October 2024 were enrolled. Demographic data, TCM syndromes, and comorbidities were collected via electronic medical records. The distribution of comorbidities and their associations with two core syndromes—qi-yin deficiency syndrome and yin-yang deficiency syndrome—were analyzed. Stratified analyses were performed by age (60-69 years, 70-79 years, ≥80 years) and gender. Results: Among the 832 patients, the overall comorbidity prevalence was 64.66% (538/832). The top three comorbidities were hypertension (32.57% (271/832)), respiratory diseases (29.57% (246/832)), and diabetes mellitus (25.00% (208/832)). Patients with ≥3 comorbidities accounted for 21.75% (181/832). The core TCM syndromes were qi-yin deficiency syndrome (39.30% (327/832)) and yin-yang deficiency syndrome (25.36% (211/832)). Compared with patients with yin-yang deficiency syndrome, those with qi-yin deficiency syndrome had higher rates of diabetes mellitus (44.65% (146/327) vs. 28.44% (60/211); OR=2.030, 95%CI: 1.400-2.944) and respiratory diseases (44.65% (146/327) vs. 26.54% (56/211); OR=2.230, 95%CI: 1.532-3.247). In contrast, they had lower rates of chronic kidney disease (3.67% (12/327) vs. 22.27% (47/211); OR=0.133, 95%CI: 0.069-0.257), malignancy (6.73% (22/327) vs. 17.06% (36/211); OR=0.351, 95%CI: 0.199-0.619), and multimorbidity (≥3 conditions)(25.69% (84/327) vs. 34.12% (72/211); OR=0.667, 95%CI: 0.460-0.968). Conclusion: Elderly patients with pulmonary tuberculosis carry a heavy comorbidity burden. Core TCM syndromes are distinctly associated with specific comorbidities, suggesting that stratified and individualized interventions should be implemented based on syndrome-disease interactions.

Key words: Tuberculosis, pulmonary, Aged, Comorbidity, Traditional Chinese medicine syndrome, Statistical distributions

中图分类号:

R521

丰银平, 罗水荣, 刘忠达, 张尊敬. 832例老年肺结核患者共病谱及核心中医证候的关联研究[J]. 中国防痨杂志, 2026, 48(7): 1038-1043. doi: 10.19982/j.issn.1000-6621.20260160

Feng Yinping, Luo Shuirong, Liu Zhongda, Zhang Zunjing. An association study of the comorbidity spectrum and core traditional Chinese medicine syndromes in 832 elderly patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(7): 1038-1043. doi: 10.19982/j.issn.1000-6621.20260160

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年龄组(岁)	肺阴亏虚证	阴虚火旺证	气阴两虚证	阴阳两虚证	肺脾气虚证	肺肾阴虚证	痰热壅肺证	痰瘀阻肺证	合计
60~69	39(10.92)	21(5.88)	147(41.18)	81(22.69)	24(6.72)	13(3.64)	14(3.92)	18(5.05)	357(42.91)
70~79	24(8.39)	28(9.79)	101(35.31)	75(26.22)	21(7.34)	9(3.15)	15(5.24)	13(4.56)	286(34.37)
≥80	17(8.99)	12(6.35)	79(41.80)	55(29.10)	2(1.06)	9(4.76)	7(3.70)	8(4.24)	189(22.72)
合计	80(9.62)	61(7.33)	327(39.30)	211(25.36)	47(5.65)	31(3.73)	36(4.33)	39(4.68)	832(100.00)

性别	肺阴亏虚证	阴虚火旺证	气阴两虚证	阴阳两虚证	肺脾气虚证	肺肾阴虚证	痰热壅肺证	痰瘀阻肺证	合计
男性	55(8.97)	43(7.01)	246(40.13)	156(25.45)	28(4.57)	26(4.24)	30(4.89)	29(4.74)	613(73.68)
女性	25(11.42)	18(8.22)	81(36.99)	55(25.11)	19(8.68)	5(2.28)	6(2.74)	10(4.56)	219(26.32)
合计	80(9.62)	61(7.33)	327(39.30)	211(25.36)	47(5.65)	31(3.73)	36(4.33)	39(4.68)	832(100.00)

项目	60~69岁组 (357例)	70~79岁组 (286例)	≥80岁组 (189例)	合计 (832例)	χ²值	P值
共病类型
高血压	95(26.61)	95(33.22)	81(42.86)	271(32.57)	14.934	<0.01
呼吸系统疾病	114(31.93)	85(29.72)	47(24.87)	246(29.57)	2.967	0.227
糖尿病	87(24.37)	69(24.13)	52(27.51)	208(25.00)	0.829	0.661
心血管疾病	82(22.97)	61(21.33)	53(28.04)	196(23.56)	2.969	0.227
消化系统疾病	45(12.61)	37(12.94)	22(11.64)	104(12.50)	0.181	0.913
恶性肿瘤	33(9.24)	30(10.49)	15(7.94)	78(9.38)	0.886	0.642
慢性肾脏病	26(7.28)	20(6.99)	21(11.11)	67(8.05)	3.107	0.211
脑血管疾病	22(6.16)	18(6.29)	16(8.47)	56(6.73)	1.177	0.555
风湿免疫系统疾病	13(3.64)	14(4.90)	6(3.17)	33(3.97)	1.058	0.589
共病数量
≥1种共病	226(63.31)	184(64.34)	128(67.72)	538(64.66)	1.077	0.584
无共病	131(36.69)	102(35.66)	61(32.28)	294(35.34)	1.077	0.584
多重共病(≥3种)	74(20.73)	66(23.08)	41(21.69)	181(21.75)	0.515	0.773

项目	男性组(613例)	女性组(219例)	合计(832例)	χ²值	P值
共病类型
高血压	195(31.81)	76(34.70)	271(32.57)	0.615	0.433
呼吸系统疾病	190(31.00)	56(25.57)	246(29.57)	2.280	0.131
糖尿病	149(24.31)	59(26.94)	208(25.00)	0.597	0.440
心血管疾病	147(23.98)	49(22.37)	196(23.56)	0.231	0.631
消化系统疾病	83(13.54)	21(9.59)	104(12.50)	2.303	0.129
恶性肿瘤	62(10.11)	16(7.31)	78(9.38)	1.498	0.221
慢性肾脏病	45(7.34)	22(10.05)	67(8.05)	1.594	0.207
脑血管疾病	44(7.18)	12(5.48)	56(6.73)	0.741	0.389
风湿免疫系统疾病	29(4.73)	4(1.83)	33(3.97)	3.573	0.059
共病数量
≥1种共病	401(65.42)	137(62.56)	538(64.66)	0.577	0.447
无共病	212(34.58)	82(37.44)	294(35.34)	0.577	0.447
多重共病(≥3种)	133(21.70)	48(21.92)	181(21.75)	0.005	0.946

共病类型	例数	构成比(%)
仅1种共病
呼吸系统疾病	84	38.53
心血管疾病	35	16.06
糖尿病	30	13.76
高血压	29	13.30
恶性肿瘤	23	10.55
其他	17	7.80
合并	218	100.00
2种共病(139例)
高血压+呼吸系统疾病	42	30.22
糖尿病+心血管疾病	16	11.51
高血压+慢性肾脏病	15	10.79
高血压+恶性肿瘤	11	7.91
其他	55	39.57
合计	139	100.00