611例肺结节患者的中医证候特征与证素组合规律分析OA

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%),quintuple-nature 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.