多器官功能障碍综合征患者中医虚实证与免疫变化的关系探讨  

Exploration of the Relationship of Traditional Chinese Medicine Deficiency and Excess Syndrome with the Immune Indexes in Patients with Multiple Organ Dysfunction Syndrome

作　　者：王怡欣 吴思慧[2] 翁书和[2] 植晓彤 WANG Yi-Xin;WU Si-Hui;WENG Shu-He;ZHI Xiao-Tong(The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of Critical Care Medicine,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院重症医学科,广东广州510405

出　　处：《广州中医药大学学报》2022年第6期1235-1240,共6页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】观察多器官功能障碍综合征(MODS)虚实证患者免疫指标的变化,旨在探讨MODS虚实证型与免疫指标变化的关系。【方法】随机选取39例符合MODS诊断标准的患者,按中医八纲辨证分为实证组25例和虚证组14例,并随机选取25例非MODS患者作为对照组,比较3组患者急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、T淋巴细胞计数、CD4^(+)T细胞计数、CD8^(+)T细胞计数、CD4^(+)/CD8^(+)比值及单核细胞人类白细胞抗原DR(m HLA-DR)水平情况,并分析虚实证与各免疫指标变化的关系。【结果】(1)与对照组比较,实证组和虚证组MODS患者的APACHEⅡ评分均明显升高(P<0.05);而实证组与虚证组MODS患者的APACHEⅡ评分比较,差异无统计学意义(P>0.05)。(2)与对照组比较,实证组和虚证组MODS患者的T淋巴细胞数、CD4^(+)T细胞计数、CD8^(+)T细胞计数及m HLA-DR水平均明显降低(P<0.05);其中,虚证组患者的mHLA-DR水平也明显低于实证组(P<0.05),mHLA-DR水平由高到低依次为对照组>实证组>虚证组;而实证组和虚证组患者的T淋巴细胞数、CD4^(+)T细胞计数、CD8^(+)T细胞计数比较,差异均无统计学意义(P>0.05);另外,3组患者的CD4^(+)/CD8^(+)比值比较,差异无统计学意义(P>0.05)。(3)虚证组MODS患者的mHLA-DR异常率明显高于实证组(P<0.05),其特点为虚证组以mHLA-DR降低为主;而虚证组和实证组MODS患者的T淋巴细胞数、CD4^(+)和CD8^(+)T细胞计数异常率比较,差异均无统计学意义(P>0.05)。【结论】MODS患者存在免疫功能低下变化,虚实证患者中的免疫指标存在差异,虚证患者的mHLA-DR降低更明显,提示m HLA-DR水平降低可作为区分虚实证的客观参考指标,可为存在免疫失衡的MODS患者中医遣方用药提供依据。Objective To explore the relationship of the traditional Chinese Medicine(TCM)deficiency and excess syndrome with the changes of immune indexes in the patients with multiple organ dysfunction syndrome(MODS).Methods Thirty-nine patients who met the diagnostic criteria of MODS were randomly selected,and then were divided into excess syndrome group(25 cases)and deficiency syndrome group(14 cases)according to the eightprinciple syndrome differentiation.Meanwhile,25 non-MODS patients were randomly selected as the control group.The acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)scores,T lymphocyte count,CD4^(+)T cell count,CD8^(+)T cell count,CD4^(+)/CD8^(+)ratio and the levels of monocyte human leukocyte antigen DR(m HLA-DR)in the 3 groups were compared.And then the relationship of the deficiency and excess syndrome with the changes of immune indexes was analyzed.Results(1)Compared with the control group,the APACHEⅡscores of MODS patients in the excess syndrome group and the deficiency syndrome group were significantly increased(P<0.05).But there was no statistical significance in APACHEⅡscores between the excess syndrome group and the deficiency syndrome group(P>0.05).(2)Compared with the control group,T lymphocyte count,CD4^(+)T cell count,CD8^(+)T cell count and m HLA-DR level of MODS patients in the excess syndrome group and the deficiency syndrome group were significantly decreased(P<0.05).The mHLA-DR level of MODS patients in the deficiency syndrome group was significantly lower than that in the excess syndrome group(P<0.05),and the mHLA-DR level in the control group,excess syndrome group,and deficiency syndrome group was in decreasing sequence.There was no statistical significance in the difference of T lymphocyte count,CD4^(+)T cell count and CD8^(+)T cell count between the excess syndrome group and the deficiency syndrome group(P>0.05).And the difference in the ratio of CD4^(+)/CD8^(+)among the three groups was not statistically significant either(P>0.05).(3)The m HLA-DR abnormalit

关 键 词：多器官功能障碍综合征 虚证 实证 免疫指标 T淋巴细胞 单核细胞人类白细胞抗原DR(mHLA-DR) 

分 类 号：R278[医药卫生—中医学]