非结核分枝杆菌肺病中医证候特点研究*

作者：罗敬月1，张立群2，王桂荣1，黄海荣1，邵玲玲1，李 波1，赵丽萍1，鲜馥阳1，梁博文1

单位：1.首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所，北京 101149； 2.广州国家实验室，广东 广州 510005

引用：引用：罗敬月，张立群，王桂荣，黄海荣，邵玲玲，李波，赵丽萍，鲜馥阳，梁博文.非结核分枝杆菌肺病中医证候特点研究[J].中医药导报,2025,31(3):122-126,132.

DOI：10.13862/j.cn43-1446/r.2025.03.020

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摘要：

目的：分析非结核分枝杆菌（NTM）肺病患者的临床特点及中医证候分布规律，以期为临床辨治NTM肺病提供依据。方法：纳入175例NTM肺病患者，采用横断面研究，填写调查问卷，收集患者症状及四诊信息，确定中医证候分型。结果：175例NTM肺病患者，菌种分布以胞内分枝杆菌[37.1%（65/175）]、脓肿分枝杆菌[35.4%（62/175）]、堪萨斯分枝杆菌[10.3%（18/175）]、鸟分枝杆菌[5.7%（10/175）]为主。症状多见日间咳嗽、痰黏稠、乏力、气短。快速生长型组与缓慢生长型组在咳嗽、气短、口干渴、情绪急躁易怒方面比较，差异无统计学意义（P＞0.05）；快速生长型组患者乏力占比高于缓慢生长型组（P＜0.05）。影像学表现方面，快速生长型组患者支气管扩张占比高于缓慢生长型组，空洞占比低于缓慢生长型组，差异均有统计学意义（P＜0.05）。舌形以嫩舌、胖大舌多见，舌色以暗红为主，舌苔以苔薄、苔腻、少苔居多，苔色以苔白、苔黄为主。脉象多见弦脉、细脉、滑脉。中医辨证频率从高到低依次为气阴两虚、痰热郁肺、肺阴亏虚、肺脾气虚等；复合证候居多，多数患者兼夹2种或3种证候。女性多见气阴两虚，男性多见痰热郁肺。青年多见肺脾气虚，中年多见气阴两虚及痰热郁肺，老年以气阴两虚及痰热郁肺。胞内分枝杆菌肺病以痰热郁肺为主要中医辨证，脓肿分枝杆菌肺病以气阴两虚为主要中医辨证。结论：NTM肺病好发于中老年人，女性患病多于男性，菌种多见胞内分枝杆菌、脓肿分枝杆菌，中医辨证以气阴两虚为主，不同性别、年龄段及不同菌种主要中医辨证不同，复合中医辨证多于单一中医辨证，病性本虚标实、虚实夹杂。

关键词：非结核分枝杆菌肺病；证候特点；中医辨证；横断面研究

Abstract：

Objective: To analyze the clinical characteristics and TCM syndromes distribution of patients with non-tuberculous mycobacteria (NTM) pulmonary disease, in order to provide evidence for clinical differentiation and treatment of NTM pulmonary disease. Methods: A total of 175 patients with NTM pulmonary disease were included in this study. A cross-sectional study was carried out and survey questionnaires were filled in order to collect the symptoms and four diagnostic information of the patients, and to determine traditional Chinese medicine syndrome types. Results: The 175 patients with NTM pulmonary disease were mainly Mycobacterium intracellular [37.1%(65/175)], Mycobacterium abscess [35.4%(62/175)], Mycobacterium kansensis [10.3%(18/175)] and Mycobacterium avium [5.7%(10/175)]. The symptoms were daytime cough and thick expectoration, fatigue and short of breath. There were no significant differences in cough, shortness of breath, xerostomia and irritable mood between therapidly growing group and slowly growing group (P>0.05). The proportion of patients with symptoms of fatigue in the rapidly growing group was higher than that in the slowly growing group (P<0.05). In terms of imaging features, the proportion of bronchiectasis in the rapidly growing group was higher than that in the slow growing group, and the proportion of cavity was lower than that in the slowly growing group, and the differences were statistically significant (P<0.05). Tongue shape were mostly tender and plump, tongue color was mostly dark red. The fur were mostly thin, greasy and light, the fur color were mainly white or yellow. Pulse manifestation were mostly stringy, thready and slippery. The proportion of TCM syndromes from high to low were mainly deficiency of both qi and yin, phlegm-heat obstructing lung, deficiency of lung yin, qi deficiency of lung and spleen, and so on. The combined syndromes were in the majority. Most patients had two or three syndromes simultaneously. The syndrome of deficiency of both qi and yin was more common in females. The syndrome of phlegm-heat obstructing lung was more common in males. The syndrome of qi deficiency of lung and spleen was more common in young people. The syndromes of deficiency of both qi and yin, and phlegm-heat obstructing lung were more common in middle-aged people. The syndromes of elderly people were mainly deficiency of both qi and yin, and phlegm-heat obstructing lung. The main syndrome of Mycobacterium intracellular pulmonary disease was phlegm-heat obstructing lung, and the main syndrome of Mycobacterium abscess pulmonarydisease was deficiency of both qi and yin. Conclusion: NTM pulmonary disease is more common in middle-aged and elderly people, and the incidence of female is higher than that of male. Mycobacterium intracellular and Mycobacterium abscess are the major strains. Deficiency of both qi and yin is the major TCM syndrome. The main TCM syndrome types are different in patients with different gender, age andstrains. The combined syndromes are more than single syndromes. Disease nature is deficiency in origin and excess in superficiality, intermingled deficiency and excess.

Key words：non-tuberculous mycobacterium pulmonary disease; TCM syndrome characteristics; TCM differentiation; cross-sectional research

发布时间：2025-12-15

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