葉鋼福

[摘要] 目的 分析中醫(yī)體質(zhì)在肺結(jié)節(jié)早期診治中的應(yīng)用效果。 方法 該研究采取整群抽樣方法抽取2015年4月—2016年4月，該院呼吸科住院及門診確診72例肺結(jié)節(jié)，納入觀察組;2013年1月—2015年3月，抽取該院住院及門診確診了192例早期肺結(jié)節(jié)，納入對照組。觀察組中采用影像聯(lián)合體質(zhì)辨識診斷良性肺結(jié)節(jié)而進行保守治療的患者41例，按照確診順序分組，分為常規(guī)組（n=20）、干預組（n=21），分別采用常規(guī)治療以及在此基礎(chǔ)上聯(lián)合體質(zhì)管理治療。結(jié)果 觀察組72例對象，其中惡性21例、良性51例，惡性結(jié)節(jié)的對象氣虛、陽虛、陰虛體質(zhì)占比28.57%低于良性對象56.86%，差異有統(tǒng)計學意義（χ2=4.766、P=0.029<0.05）。觀察組聯(lián)合體質(zhì)分析診斷診斷特異度、陽性預測值、符合率分別為98.04%、95.00%、95.83%，高于對照組86.03%、71.64%、85.94%，差異有統(tǒng)計學意義（χ2=5.601、4.747、5.091，P=0.018、0.029、0.024<0.05）。治療后，干預組CRP（7.11±2.48）mg/L低于常規(guī)組（9.27±1.81）mg/L、ALB（46.56±1.97）g/L高于常規(guī)組（44.24±3.12）g/L，干預組結(jié)節(jié)吸收消失率42.86%、病理體質(zhì)轉(zhuǎn)為平和體質(zhì)率38.10%高于常規(guī)組5.00%、0.00%，差異有統(tǒng)計學意義（t/χ2=3.172、2.862、7.961、9.466，P=0.003、0.007、0.005、0.002<0.05）。結(jié)論 在肺結(jié)節(jié)早期診治中的應(yīng)用中醫(yī)體質(zhì)分析，可以降低假陽性率;對于良性保守治療的對象，進行體質(zhì)管理，可以提升療效，加速結(jié)節(jié)吸收消失。

[關(guān)鍵詞] 肺結(jié)節(jié);體質(zhì);管理;治療

[中圖分類號] R259? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-0742（2019）05（b）-0153-03

[Abstract] Objective To analyze the application effect of TCM constitution in the early diagnosis and treatment of pulmonary nodules. Methods The study adopted a cluster sampling method， from April 2015 to April 2016， 72 cases of pulmonary nodules were diagnosed in the hospital for admission and outpatients in our hospital. From January 2013 to March 2015， 192 cases of early pulmonary nodules were diagnosed in the hospital and outpatient clinics， and were included in the control group. 41 patients in the observation group who underwent conservative treatment with benign pulmonary nodules by imaging combined with physical identification were divided into the normal group （n=20） and the intervention group （n=21） according to the order of diagnosis. On this basis， combined with physical management treatment. Results Of the 72 patients in the observation group， 21 were malignant and 51 were benign. The proportion of qi deficiency， yang deficiency and yin deficiency was 28.57%， which was lower than that of benign subjects of 56.86%， the difference was statistically significant （χ2=4.766， P=0.029<0.05）. The diagnostic specificity， positive predictive value and coincidence rate of the observation group combined with physical analysis were 98.04%， 95.00%， and 95.83%， respectively， which were higher than the control group （86.03%， 71.64%， and 85.94%）. The difference was statistically significant （χ2=5.601， 4.747， 5.091， P=0.018， 0.029， 0.024<0.05）. After treatment， the intervention group had a lower CRP （7.11±2.48） mg/L than the conventional group （9.27±1.81） mg/L and ALB （46.56±1.97） g/L， which was higher than the conventional group （44.24±3.12） g/L. The disappearance rate of nodules was 42.86%， the pathological constitution was flat and the body mass rate was 38.10% higher than that of the conventional group （5.00%， 0.00%）， and the difference was statistically significant （t/χ2=3.172， 2.862， 7.961， 9.466， P=0.003， 0.007， 0.005，0.002<0.05）. Conclusion The application of TCM constitution analysis in the early diagnosis and treatment of pulmonary nodules can reduce the false positive rate. For the benign conservative treatment， physical management can improve the curative effect and accelerate the disappearance of nodule absorption.