脓毒症中医证型证素分布与炎症指标及预后的关系研究  

Study on the relationship between the distribution of TCM syndromes in types and factors and the inflammatory index and prognosis in sepsis

作　　者：赵昕[1] 蓝海涛[1] 王颖辉[1] 刘畅[1] 齐文升[1] 

机构地区：[1]中国中医科学院广安门医院急诊科,北京100053

出　　处：《北京中医药》2017年第1期12-16,共5页Beijing Journal of Traditional Chinese Medicine

摘　　要：目的探讨脓毒症中医证型证素分布与炎症指标及预后的关系。方法回顾性分析2014年1月—2015年6月中国中医科学院广安门医院重症监护室脓毒症患者的中医证型及证素分布,并分析其与年龄、性别、白细胞、C反应蛋白(CRP)、降钙素原(PCT)以及预后的关系。结果 124例患者中,证型分布:虚实夹杂76例(61.3%),单纯实证35例(28.2%),单纯虚证13例(10.5%);证素分布:从多至少依次为痰饮(61例)、热证(57例)、瘀证(49例)、阴血虚(49例)、气虚(39例)、阳虚(28例)、湿证(9例)、气滞证(7例)、腑实证(7例)、寒证(3例)。证型与炎性指标及预后的关系:虚证组与实证组相比,年龄(P=0.04)、28天死亡率(P=0.02)差异有统计学意义。经过年龄校正以后,虚证组死亡率仍高于实证组,相对风险为3.16。证素与炎性指标及预后的关系:热证与白细胞有关(P=0.03),阴血虚与白细胞(P=0.02)及CRP有关(P=0.001),阳虚与PCT(P=0.03)及28天死亡率(P=0.02)有关。证素、年龄与28天死亡率多元回归结果表明,阳虚与死亡率有关(P=0.01),年龄与死亡率有关(P=0.03)。结论脓毒症证型以虚实夹杂为主,虚证组死亡率高于实证组。PCT升高与阳虚证密切相关,且阳虚证死亡率明显升高,提示PCT或可作为脓毒症阳虚辨证要点,并用来判断脓毒症严重程度及预后。Objective To discuss the relationship between the distribution of TCM syndromes in types and factors and inflammatory index and prognosis. Methods A retrospective analysis was made on the distribution of TCM syndromes in types and factors among the ICU patients with sepsis in Guang’anmen Hospital,China Academy of Chinese Medical Sciences from January 2014 to June 2015. The relationship between the distribution of TCM syndromes in types and factors and their age, gender, leukocyte, CRP, PCT and prognosis were analyzed. Results Among 124 cases of patients,the distribution of syndrome types： combined deficiency and excess syndrome were seen in 76 cases（ 61. 3%）, excessive syndrome in 35 cases（ 28. 2%）, and deficiency syndrome in 13 cases（ 10. 5%）; the distribution of syndrome factors： phlegm fluid（ 61 cases）,heat syndrome（ 57 cases）,stagnation syndrome（ 49cases）,yin blood deficiency（ 49 cases）,qi deficiency（ 39 cases）,yang deficiency（ 28 cases）,damp syndrome（ 9 cases）,qi stagnation syndrome（ 7 cases）,fu excess syndrome syndrome（ 7 cases）,cold syndrome（ 3 cases）. The relationship between the syndrome types and inflammatory index and prognosis： to compare the excess syndrome group and deficiency syndrome group,the difference was statistically significant in age（ P = 0. 04） and 28-day death rate（ P = 0. 02）. Through age correction,the death rate in deficiency syndrome group was still higher than that of the excess syndrome group with relative risk 3. 16. The relationship between the syndrome factors and inflammatory index and prognosis： heat syndrome and leukocyte were related（ P = 0. 03）,yin blood deficiency and leukocyte were related（ P = 0. 02） and CRP related（ P = 0. 001）,yang deficiency and PCT were related（ P = 0. 03） and 28-day death rate relateol（ P = 0. 02）. The multiple regression results of syndrome factors,age and 28-day death rate showed that yang deficiency and the death rate were related（ P = 0. 01）,and the age

关 键 词：脓毒症 证型 证素 白细胞 降钙素原 C反应蛋白 

分 类 号：R278[医药卫生—中医学]