谢纬中西医结合治疗抗合成酶综合征相关性间质性肺炎1例
Interstitial lung disease related to antisynthetase syndrome was treated by Xie Wei chief physician utilizing the therapeutic regimen of traditional Chinese medicine and western medicine: A case report
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1.广州中医药大学第四临床医学院,广东深圳 518033
2.深圳市中医院呼吸与危重症医学科,广东深圳 518033
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陈珠妮, 叶景焕, 杨林, 等. 谢纬中西医结合治疗抗合成酶综合征相关性间质性肺炎1例[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36540219&Fpath=home&index=0
CHEN Zhuni, YE Jinghuan, YANG Lin, et al. Interstitial lung disease related to antisynthetase syndrome was treated by Xie Wei chief physician utilizing the therapeutic regimen of traditional Chinese medicine and western medicine: A case report[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36540219&Fpath=home&index=0
陈珠妮, 叶景焕, 杨林, 等. 谢纬中西医结合治疗抗合成酶综合征相关性间质性肺炎1例[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36540219&Fpath=home&index=0 DOI:
CHEN Zhuni, YE Jinghuan, YANG Lin, et al. Interstitial lung disease related to antisynthetase syndrome was treated by Xie Wei chief physician utilizing the therapeutic regimen of traditional Chinese medicine and western medicine: A case report[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36540219&Fpath=home&index=0 DOI:
病史摘要,2,患者胡某,女,54岁,因“咳嗽、气喘2月余,加重伴发热4天” 2021年9月24日于深圳市中医院呼吸与危重症医学科住院治疗,查胸部CT示:双肺弥漫性间质性炎症,血抗SSA/Ro52抗体 阳性(++)。特发性炎性肌病谱1(17项):EJ抗体+、Ro52抗体+++,电子支气管镜肺活检(TBLB)病理:组织改变符合结缔组织相关性间质性肺炎(非特异型间质性肺炎伴机化性肺炎),经住院抗感染、抗炎平喘、抑制免疫、免疫调节及中药辨证施治等治疗18天,咳嗽气喘稍改善,无发热,仍活动后气喘,2021年10月5日复查胸部CT:双肺间质性炎症较前稍吸收。为求进一步中西医治疗,遂求治于谢纬主任医师。首诊四诊信息:精神一般,咳嗽,偶咳白粘痰,活动后或弯腰时气喘明显,胸闷乏力,口干,无发热恶寒,自汗出,不思饮食,睡眠一般,大便溏,小便可。舌质暗红,苔黄腻,脉弦细滑。中医诊断 肺痿(肺脾气虚,痰瘀阻肺证)。西医诊断 抗合成酶综合征(EJ抗体+、Ro52抗体+)相关性间质性肺炎。干预措施 谢纬主任医师总结“肺痿”的基本病机为“气虚痰结络瘀”,以“补脾益肺,益气涤痰,宣肺逐瘀,通络平喘”为基本大法,结合四诊资料运用肺纤方为主方进行辨证施治,同时结合西医抗炎、抑制免疫等方案,中西医结合治疗。疗效转归 经中西医结合治疗,患者病情逐渐好转,无明显气喘及咳嗽咳痰,可回归正常工作。2021年11月、2022年4月、8月复查胸部CT:病灶均逐渐吸收减少。目前甲泼尼龙减量至12 mg,并遵风湿科使用雷公藤多甙、环磷酰胺抑制免疫,中药以肺纤方加减制作成丸剂治疗至今,目前病情逐渐好转,未见复发。
Summary of case history, The patient, a 54-year-old female, was hospitalized in the Department of Shenzhen Hospital of Traditional Chinese Medicine on September 23, 2021 because of "Cough, asthma for more than 2 months, aggravated with fever for 4 days". On admission, the chest CT showed: diffuse interstitial inflammation in both lungs. After admission, the blood anti-SSA / Ro52 was positive while the antibody idiopathic inflammatory myopathy spectrum 1 (item 17) pointed out: EJ antibody +, Ro52 antibody +++. what's more, the electron bronchoscopy lung biopsy (TBLB) pathology showed: tissue changes consistent with connective tissue-associated interstitial pneumonia (non-specific interstitial pneumonia with organic pneumonitis). She received anti-infection, anti-inflammation, anti-asthma, immunosuppression treatments, immunoregulation and TCM syndrome differentiation and treatment for 18 days, and her symptoms were slightly improved, but her asthma was still obvious after exercise. Chest CT reviewed on October 5,2021: interstitial inflammation in both lungs was slightly absorbed than before. In order to seek further diagnosis and treatment of Chinese and western medicine, then asked for treatment in Xie Wei chief physician. The four methods of diagnosis for the first time: mental fatigue, obvious asthma after activity and bending, chest tightness, fatigue, cough, occasional cough of white sticky phlegm, dry and thirst, without fever with chilliness, easy sweating, poor appetite and sleep, loose stools, good urination.The tongue is dark red, the moss is yellow and greasy, and the pulse condition is string and slick.,TCM diagnosis, Atrophic lung disease (syndrome of asthenia of pulmonosplenic qi, phlegm and blood stasis obstructing lung).,Western medicine diagnosis, Interstitial lung disease related to antisynthetase syndrome(EJ antibody +, Ro52 antibody +).,Therapeutic methods, In terms of traditional Chinese medicine, combining with the basic pathogenesis about atrophic lung disease of "Deficiency of Qi, phlegm and blood stasis" that summarized by Xie Wei chief physician, the intervention of traditional Chinese medicine was given as the basic method of "tonify the spleen and lung, invigorating qi and removing phlegm, promoting lung and removing blood stasis, vein relaxing and relieving asthma". Combined with the clinical data from four methods of diagnosis, the Feixianfang was used as the main prescription and adjusted according to the syndrome differentiation. At the same time, the conventional western medicine was used, like anti-inflammatory, immune suppression programs and so on.,Clinical outcomes, After comprehensive diagnosis and treatment of Chinese and western medicine, the patient has no obvious asthma, cough and sputum, and can return to normal work. In November, 2021, April, 2022 and August, 2022, the chest CT showed that double pneumonia was significantly absorbed, and methylprednisolone was gradually reduced up to 12mg. Moreover, rheumatology department recommend triptoldoside, cyclophosphamide as immunodepressive treatment. At the same times, traditional Chinese medicine was changed to pills for long-term treatment, and the perceived quality of life was significantly improved, without recurrence.
间质性肺疾病肺痿肺脾气虚痰瘀互结中西医结合【适合阅读专业】 中医肺病中医内科呼吸科风湿免疫科
Interstitial lung diseaseAtrophic lung diseaseasthenia of pulmonosplenic qiPhlegm and blood stasis obstructing lungIntegrated traditional Chinese and western medicine【Suitable majors】 Traditional Chinese medicine of lung diseaseInternal medicine of traditional Chinese medicineRespiratory departmentRheumatology and immunology department
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