Background Community-acquired pneumonia(CAP)is one of the common infectious diseases,especially in elderly patients,with atypical clinical symptoms,which is susceptibility to serious complications,lacks effective treatment measures,and often has a poor prognosis.Objective To investigate the effect of traditional Chinese medicine(TCM)syndrome differentiation therapy on the quality of life and efficacy satisfaction of elderly patients with CAP discharged from hospital(within 1 week).Methods This study was designed as a multicentre,randomized double-blind placebo clinical study.Elderly CAP post-discharge patients admitted to the respiratory departments of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Henan Chest Hospital,Henan People's Hospital,Zhengzhou Hospital of Traditional Chinese Medicine and Zhengzhou People's Hospital from April 2018 to January 2020 were selected as the study subjects and divided into the experimental group and control group by using a central randomized group enrolment model.The patients in the experimental group were treated with corresponding TCM granules based on syndrome differentiation,and the lung-tonifying spleen-invigorating phlegm-reducing formula was given for syndrome of phlegm-dampness due to qi deficiency,and the qi-supplementing yin-nourishing lung-clearing formula was given for qi and yin deficiency and phlegm-heat syndrome.The control group was given a placebo with the same appearance,weight,color,and smell as the Chinese medicine granules.The treatment course was 2 months,and the follow-up was up to 6 months.The quality of life evaluated by the Chinese version of the Quality of Life Rating Scale(SF-36)and efficacy satisfaction evaluated by the Efficacy Satisfaction Questionnaire for CAP(ESQ-CAP)were compared between the two groups before the treatment,1 month after the treatment,2 months after the treatment,3 months after the follow-up,and 6 months after the follow-up.Results Among the 120 subjects included,8 were dislodged and 112 were finally included that met the protocol set,including 54 cases in the experimental group and 58 cases in the control group.There was no significant difference in gender,age,time after discharge,TCM syndrome differentiation,CUBR-65 score,and underlying diseases between the two groups before treatment(P>0.05).The main effects of the group were significant on SF-36 physiological function domain score(Fgroup=5.057,Pgroup=0.027),general health domain score(Fgroup=7.286,Pgroup=0.008),and role limitations due to emotional problems domain score(Fgroup=6.858,Pgroup=0.010).Comparison between the two groups showed that SF-36 physical function domain score of the experimental group was higher than that of the control group at 2 months of treatment,3 months of follow-up,and 6 months of follow-up(P<0.05);SF-36 general health status domain and role limitations due to emotional problems domain scores of the experimental group were higher than those of the control group at 1 and 2 months of treatment,3 and 6 months of follow-up(P<0.05);the SF-36 domain score for role limitations due to mental health was higher than that of the control group(P<0.05)at 3 and 6 months of follow-up.The main effect of group on ESQ-CAP daily living and ability domain score(Fgroup=16.218,Pgroup<0.001),convenience domain score(Fgroup=25.013,Pgroup<0.001),and ESQ-CAP total score(Fgroup=13.843,Pgroup<0.001)was significant.The ESQ-CAP daily living and ability domain scores were higher in the experimental group than the control group at 2 months of treatment,3 and 6 months of follow-up(P<0.05).At 1 and 2 months of treatment and 3 and 6 months of follow-up,ESQ-CAP convenience domain score and ESQ-CAP total score were higher in the experimental group than in the control group(P<0.05).At 3 months of follow-up,the ESQ-CAP overall efficacy domain score was higher in the experimental group than the control group(P<0.05).Conclusion The TCM syndrome differentiation therapy scheme can improve the quality of life and efficacy satisfaction of elderly patients with CAP after discharge.

OBJECTIVE:To construct the risk prediction model of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and verify its effectiveness based on deep learning and back propagation algorithm neural network (BP neural network).METHODS:Based on the relevant data of 1 326 patients with chronic obstructive pulmonary disease (COPD) in the team's previous clinical study, the acute exacerbation, and its risk factors during the stable period and 6 months of follow-up were recorded and analyzed. Combined with previous clinical research data and expert questionnaire results, the independent risk factors of AECOPD after screening and optimization by multivariate Logistic regression including gender, body mass index (BMI) classification, number of acute exacerbation, duration of acute exacerbation and forced expiratory volume in one second (FEV1) were used to build the BP neural network by Python 3.6 programming language and Tensorflow 1.12 deep learning framework. The patients were randomly selected according to the ratio of 4:1 to generate the training group and the test group, of which, the training group had 1 061 sample data while the test group had 265 pieces of sample data. The training group was used to establish the prediction model of neural network, and the test group was used for back-substitution test. When using the training group data to construct the neural network model, the training group was randomly divided into training set and verification set according to the ratio of 4:1. There were 849 training samples in the training set and 212 verification samples in the verification set. The optimal model was screened by adjusting the parameters of the neural network and combining the area under the receiver operator characteristic curve (AUC), and the sample data of the test group was substituted into the model for verification.RESULTS:The independent risk factors including gender, BMI classification, number of acute exacerbation, duration of acute exacerbation and FEV1 were collected from the team's previous clinical research, and the AECOPD risk prediction model was constructed based on deep learning and BP neural network. After 10 000 training sessions, the accuracy of the AECOPD risk prediction model in the validation set of the training group was 83.09%. When the number of training times reached 8 000, the accuracy basically tended to be stable and the prediction ability reached the upper limit. The AECOPD risk prediction model trained for 10 000 times was used to predict the risk of the validation set data, and the receiver operator characteristic curve (ROC curve) analysis showed that the AUC was 0.803. When using this model to predict the risk of the data of the test group, the accuracy rate was 81.69%.CONCLUSION:The risk prediction model based on deep learning and BP neural network has a medium level of prediction efficiency for acute exacerbation within 6 months in COPD patients, which can evaluate the risk of AECOPD and assist the clinic in making accurate treatment decisions.

慢性阻塞性肺疾病( COPD)是以气流受限为特征呈进行性发展的疾病,居全球死亡原因第4 位, 2020年居全球死亡原因第3位,造成严重经济和社会负担〔1～4〕. 2007年中国40岁以上人群COPD患病率为8. 2％ 〔5〕,2014～2015年中国40岁以上人群COPD患病率为13. 6％,较2007 年增长约1 倍〔6〕.Wang等〔7〕基于2012年6月至2015年5月中国10省5万余名居民调查显示,40岁以上COPD患病率为13. 7％,患病人数近1亿人.

目的:评价中医辨证治疗方案对老年社区获得性肺炎(CAP)患者再住院率、医生报告结局及患者报告结局的影响.方法:采用多中心随机双盲安慰剂对照试验设计,以老年CAP出院后患者为研究对象,120例患者中央随机分为试验组和对照组各60例,试验组辨证给予相应中药颗粒剂,对照组辨证给予相应中药安慰剂,均治疗2个月,随访6个月.主要结局指标为再住院率(肺炎再住院率、全因再住院率),次要结局指标包括肺炎的医生报告结局量表(CAP-CRO)、肺炎患者报告结局量表(CAP-PRO),采用SPSS 23.0进行统计分析.结果:共纳入120例患者,脱落8例,符合方案集112例(试验组54例、对照组58例).①再住院率:试验组治疗2个月及随访3、6个月的肺炎再住院率显著低于对照组(P＜0.05);各时间点的全因再住院率组间比较差异均无统计学意义.②CAP-CRO:疾病症状领域、病情改善综合评价领域和量表总评分不同时间点重复测量方差分析有时间效应和组别效应(P＜0.01),主要体征领域评分有时间效应(P＜0.01).③CAP-PRO:疾病症状领域评分和量表总评分不同时间点重复测量方差分析有时间效应和组别效应(P＜0.01);健康满意度领域评分、疗效满意度领域评分有时间效应(P＜0.01).结论:中医辨证治疗能够降低老年CAP患者肺炎再住院率,改善咳嗽、咳痰、乏力、胸痛等症状,提高临床疗效.

慢性阻塞性肺疾病( COPD )急性加重( AECO-PD)是患者肺功能下降、生存质量恶化、经济负担加重及最终死亡的重要因素,对疾病预后产生严重影响﹝1﹞.AECOPD患者出院后易于反复再住院,出院后6个月内有44％再次住院、超过50％出院后6个月至少再入院1次﹝2﹞.导致AECOPD患者再入院情况的影响因素,主要包括患者个人及既往疾病情况、临床症状、生存质量、肺功能、实验室指标等方面.

慢性阻塞性肺疾病( COPD)以持续气流受限不可逆和呼吸困难为特点,是呼吸系统常见病、多发病,其急性加重期( AECOPD )是患者就诊、住院、致残致死和疾病进展、疾病负担沉重的主要原因,严重危害患者生存质量.

老年CAP是指年龄大于或等于65岁的CAP患者.随着中国人口老龄化的发展,老年CAP病死率和死亡率呈上升趋势,关于老年CAP患者预后的影响因素是多方面的,本文章将围绕个人情况、疾病情况、实验室检查指标、中医辨证治疗4个方面进行总结和探讨.

慢性阻塞性肺疾病(COPD)是一种以持续气流受限为特征的可预防和治疗的疾病.目前COPD多以急性期治疗为主,而忽略了稳定期的治疗.肺康复治疗是COPD稳定期患者非药物治疗的重要方法之一.中医肺康复技术是在中医学、中西医结合理论指导下,吸纳传统康复技术,融合现代康复技术理念、方法和技术所形成的新的康复技术.中医肺康复技术方法多种多样,可在COPD稳定期患者康复过程中根据患者个体差异同病异治,实现个体化治疗.